The issue of advocacy has dominated discussion of the ethical dilemmas facing nurses. However, despite this, nurses seem to be no further towards a solution of how they can be effective advocates for patients without compromising their working identity or facing conflicts of loyalty. This article considers some of the problems around advocacy and, by the use of critical incidents written by nurses involved in a diploma module, attempts to highlight where the problem could lie. A communications model is outlined, (...) using a theoretical framework taken from the work of Jürgen Habermas, and applied to nursing practice. Finally, two examples are given from the research, which illustrate how the model could be used, highlighting the problems and pitfalls that still have to be overcome. The conclusion is a positive one, in that it suggests that advocacy is possible if nurses re-examine their practice in the light of the model proposed.Copyright of Nursing Ethics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (shrink)

In this essay, our goal is to discover science in Martin Heidegger's Introduction to Metaphysics, lecture notes for his 1935 summer semester course, because, after all, his subject is metaphysica generalis, or ontology, and this could be construed as a theory of the human brain. Here, by means of verbatim quotes from his text, we attempt to show that indeed these lectures can be viewed as suggestion for an objective scientific theory of human perception, the human capacity for deciphering (...) phenomena, ie. hermeneutics in its broadest sense. His added notes from the 1953 edition, all of which are comments, not corrections, imply that he never abandoned these thoughts on metaphysics, despite all of his utterances about a need to overcome it, and their popular interpretations to that effect. In his presentation, he further develops the colorful and intuitive style, an hermeneutic language, that he had created in his earlier work Being and Time. Of human existence he speaks in such expressions as being-there -- ``Dasein" -- and being-in-the-world, the latter term no longer explicit in the 1935 lectures. The lectures can be read as a pre-scientific analysis of how man, being-there, perceives his environment, artfully managing to deal with the manifold challenges posed by the phenomenal structures of the universe. Man attentively recognizes and deciphers their pre-linguistic contents and, while trying to make sense of it all, puts into words his awareness. There are numerous passages in Heidegger's work where he in fairly concrete terms provides us with hints for a perceptive science that, as it turns out and is demonstrated below in this essay, can be explained in terms of recent advances in neuroscience. It would be implausible, even unthinkable, unimaginable, for there not to be found essential agreement between on one hand his philosophical insights gained by hermeneutics of Dasein, into how our brain functions to let us know what's happening & on the other hand, scientific discoveries obtained through anatomy, EEG, fMRI, TMS, electrode implants, etc, of brain structures & functions employed in perception of the momentary scene. A nexus between science and philosophy is provided in Heidegger's definitive treatment of the Logos, here interpreted as a structural version of Platonic forms (Burchard, 2014). This allows for neurolinguistic brain functions to serve as meta-context for Heidegger's being-in-the-world. The logical functions of Dasein's anatomical brain are performed by the logos machine, formerly the human soul, using top-down processing based on a global context, the noumenal cosmos which humans maintain internally. Heidegger's 1942/43 winter semester lectures Parmenides extend in unbroken fashion his 1935 work, proving that he never abandoned, as is widely claimed, his metaphysical avenue of thought. (shrink)

Biotechnology is one of the fastest-growing areas of scientific, technical and industrial innovation and one of the most controversial. As developments have occurred such as genetic test therapies and the breeding of genetically modified food crops, so the public debates have become more heated and grave concerns have been expressed about access to genetic information, labelling of genetically modified foods and human and animal cloning. Across Europe, public opinion has become a crucial factor in the ability of governments and biotech (...) industries to exploit the new technology. This 2002 book presents the results of a unique cross-national and cross-disciplinary study of the relationship between the development of new biotechnology and public perception, media coverage and policy formulation. It outlines a conceptual framework for understanding these issues and contains a number of empirical studies including studies of the international controversies surrounding the cloning of Dolly the sheep and GM Soya. (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

Guided by key insights of the four great philosophers mentioned in the title, here, in review of and expanding on our earlier work (Burchard, 2005, 2011), we present an exposition of the role played by language, & in the broader sense, λογοζ, the Logos, in how the CNS, the brain, is running the human being. Evolution by neural Darwinism has been forcing the linguistic nature of mind, enabling it to overcome & exploit the cognitive gap between an animal and its (...) world by recognizing environmental structures. Our work was greatly influenced by Heidegger’s lecture notes on metaphysics (Heidegger, 1935). We found agreement with recent progress in neuroscience, but also mathematical foundations of language theory, equating Logos with the mathematical concept of structure. The mystery of perception across the gap is analyzed as radiation and molecules impinging on sensory neurons that carry linguistic information about gross environmental structures, and only remotely about the physical reality of elementary particles. The most important logical brain function is Ego or Self, guiding the workings of the brain as a logos machine. Ego or Self operates from neurons in frontopolar cortex with global receptive fields. The logos machine can function only by availing itself of global context, its internally stored noumenal cosmos NK, and the categorical-conceptual apparatus CCA, updated continually through the neural default mode network (Raichle, 2005). In the Transcendental Deduction, Immanuel Kant discovered that Ego or Self is responsible for conscious control in perception relying on concepts & categories for a fitting percept to be incorporated intoNK. The entire CNS runs as a “movie-in-the-brain” (Parvizi & Damasio, 2001), at peak speed processing simultaneously in a series of cortical centers a stack of up to twelve frames in gamma rhythm of 25 ms intervals. We equate global context, or NK, with our human world, Heidegger’s Dasein being-in-the-world, and are able to demonstrate that the great philosopher in EM parallels neuro-science concerning the human mind. (shrink)

This section concerns the question of how best to understand the scientific status of mental health care in general and psychiatry in particular. On the assumption that psychiatry is based, in part at least, on natural science, what is the nature or the general shape of that science? Some of the chapters aim at shedding light on component parts of a scientific world view: causation, explanation, natural kinds, models of medicine, etc. Others concern potentially fruitful scientific approaches to mental health (...) care, drawing on brain imaging results, phenomenology, enactivism and what can be learnt from debate of the status of psychoanalysis. One overall lesson is that twenty-first-century psychiatry needs twenty-first-century philosophy of science. (shrink)

This Section examines several moral dilemmas and epistemological aporias in clinical practice and shows how clinicians can benefit from the introduction of philosophical methods and discourse. The authors develop these issues having in mind emblematic mental disorders and typical clinical situations. One important claim shared by the Authors is that a great effort has been made to ground psychiatry on evidence-based science, and to tie it to our growing understanding of the human brain. This is obviously an exceedingly important project, (...) but it would be a mistake to assume that the central questions of psychiatry can be completely resolved through scientific inquiry. Science offers guidance for clinical practice only in light of our concepts and normative judgments. (shrink)

In the editorial introduction the stage is set for the chapters in the section by a brief discussion of the relationship between the disciplines of philosophy and psychiatry. Then each chapter briefly is summarized or highlighted.

In this introduction to the Section II, the thrust of the component chapters is described. An important strand in the philosophy of psychiatry since its beginnings has been sociopolitical critiques: criticism which aims to improve and humanize psychiatric practice and mental health systems. From this standpoint, the introduction provides an overview of this tradition, including considerations of "postpsychiatry," value commitments in psychiatry, the recovery movement, racism and sexism in the field, and technology.

A cross-disciplinary discussion of the basis of interpersonal relating is of interest to philosophers and psychiatrists for several reasons. The development of successful clinical practice may depend, at least partly, on having an accurate understanding of the basic character of unimpaired interpersonal relating because such understanding can shed light on the nature and source of its disturbed forms. How we think about the basis of "mind-minding" competencies influences how we think about the prognosis and possible treatment of dysfunctional interpersonal relating. (...) Another reason is that philosophical frameworks influence the way we think about and evaluate possible psychiatric disorders and philosophical discussions may be of direct practical importance to psychiatry given that different theories suggest different potential ways of devising therapies. (shrink)

The editorial introduction sets the stage for the chapter by identifying the roles that concepts and categories play not just in the field of mental health medicine but in the human mind itself. Then, each chapter is summarized or highlighted.

Following on from Section IV on summoning concepts, this section of the Handbook presents theoretically informed descriptions of psychopathologies. The topics of the chapters range from anxiety, depression, and body image disorders, through emotion and affective disorders, to delusion, thought insertion, and the fragmentation of consciousness. These phenomena call, not only for assessment and diagnosis, but also for understanding on the part of both the engaged clinician and the philosophical commentator. They also provide case studies for general philosophical questions about (...) different levels of description and conceptualisation and the relationships between them, and about the contributions to psychological understanding that are made by phenomenology, clinical expert knowledge, and the sciences of the mind. (shrink)

In this introduction to Section VI, the thrust of the component chapters is described. The classification and diagnosis of mental disorders collects a number of philosophical challenges to the field that call for responses from a variety of philosophical resources: hermeneutics, phenomenology, philosophy of mind, narrative theory, philosophy of science, epistemology-to name a few. The authors in this section address the general challenges in the classification of psychopathology, as well as address particular kinds of mental disorders, including autism, dementia, mania, (...) psychotic disorders, and personality disorders. (shrink)

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

This book offers the first comparative account of the changes and stabilities of public perceptions of science within the US, France, China, Japan, and across Europe over the past few decades. The contributors address the influence of cultural factors; the question of science and religion and its influence on particular developments (e.g. stem cell research); and the demarcation of science from non-science as well as issues including the incommensurability versus cognitive polyphasia and the cognitive (in)tolerance of different systems of knowledge.

Throughout the biological and biomedical sciences there is a growing need for, prescriptive ‘minimum information’ (MI) checklists specifying the key information to include when reporting experimental results are beginning to find favor with experimentalists, analysts, publishers and funders alike. Such checklists aim to ensure that methods, data, analyses and results are described to a level sufficient to support the unambiguous interpretation, sophisticated search, reanalysis and experimental corroboration and reuse of data sets, facilitating the extraction of maximum value from data sets (...) them. However, such ‘minimum information’ MI checklists are usually developed independently by groups working within representatives of particular biologically- or technologically-delineated domains. Consequently, an overview of the full range of checklists can be difficult to establish without intensive searching, and even tracking thetheir individual evolution of single checklists may be a non-trivial exercise. Checklists are also inevitably partially redundant when measured one against another, and where they overlap is far from straightforward. Furthermore, conflicts in scope and arbitrary decisions on wording and sub-structuring make integration difficult. This presents inhibit their use in combination. Overall, these issues present significant difficulties for the users of checklists, especially those in areas such as systems biology, who routinely combine information from multiple biological domains and technology platforms. To address all of the above, we present MIBBI (Minimum Information for Biological and Biomedical Investigations); a web-based communal resource for such checklists, designed to act as a ‘one-stop shop’ for those exploring the range of extant checklist projects, and to foster collaborative, integrative development and ultimately promote gradual integration of checklists. (shrink)

For decades, the discussion on children’s competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children’s interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children’s competence to consent, however, is currently not assessed in a standardized way. (...) Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children’s competence. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)