The Sarbanes–Oxley (SOX) Act was passed in 2002 in response to various instances of corporate malfeasance. The Act, designed to protect investors, led to wide-ranging regulation over various actions of managers, auditors and investment analysts. Part of SOX, and the focus of this study, targeted the disclosure by firms of “pro forma” earnings, an alternate (from GAAP earnings), flexible and unaudited measure of firm performance. Specifically, SOX directed the Securities and Exchange Commission (SEC) to craft regulation which would reduce – (...) and preferably eliminate – any pro forma earnings disclosure which might be “misleading”. Examining earnings press releases over a 3-year period, this study addresses three questions. Were firms disclosing pro forma in a potentially misleading manner, what was the nature of this potentially misleading disclosure, and did SOX affect the disclosure practices? We find the following. In 2001 (prior to SOX), 53 firms – over 10% of all U.S. S&P 500 firms – were disclosing pro forma earnings in a potentially misleading manner. This was being done most commonly by using traditional GAAP terminology (e.g., “net income”) in the press release headline to describe what was later in the press release revealed to be a pro forma amount (i.e., “net income excluding special items”). By 2003 (subsequent to the SEC regulation), potentially misleading disclosure practices were seen in less than 1% of the earnings press releases of S&P 500 firms. This significant reduction suggests that managers, prior to the regulation, were either careless in their pro forma reporting practice, or were intentionally – and unethically – attempting to mislead investors. Either way, we conclude that the SEC regulation was both necessary and effective. (shrink)

The late 20th century saw a remarkable flourishing of philosophy in France. The work of French philosophers is wide ranging, historically informed, often reaching out beyond the boundaries of philosophy; they are public intellectuals, taken seriously as contributors to debates outside the academy. Gary Gutting tells the story of the development of a distinctively French philosophy in the last four decades of the 20th century. His aim is to arrive at an account of what it was to 'do philosophy' (...) in France, what this sort of philosophizing was able to achieve, and how it differs from the analytic philosophy dominant in Anglophone countries. -/- His initial focus is on the three most important philosophers who came to prominence in the 1960s: Michel Foucault, Gilles Deleuze, and Jacques Derrida. He sets out the educational and cultural context of their work, as a basis for a detailed treatment of how they formulated and began to carry out their philosophical projects in the 1960s and 1970s. He gives a fresh assessment of their responses to the key influences of Hegel and Heidegger, and the fraught relationship of the new generation to their father-figure Sartre. He concludes that Foucault, Derrida, and Deleuze can all be seen as developing their fundamental philosophical stances out of distinctive readings of Nietzsche. The second part of the book considers topics and philosophers that became prominent in the 1980s and 1990s, such as the revival of ethics in Levinas, Derrida, and Foucault, the return to phenomenology and its use to revive religious experience as a philosophical topic, and Alain Badiou's new ontology of the event. Finally Gutting brings to the fore the meta-philosophical theme of the book, that French philosophy since the 1960s has been primarily concerned with thinking the impossible. (shrink)

"An essential overview of an important intellectual movement, Logical Empiricism in North America offers the first significant, sustained, and multidisciplinary attempt to understand the intellectual, cultural, and political dimensions of ...

Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

The first part of the essay explores the relations between the will and practical reason or judgement. The second part takes up decision in the realm of belief, i.e. deciding that such and such is so. This phenomenon raises two questions. Since we decide that as well as to, should we speak of a doxastic will? Secondly, should we regard ourselves as active in the formation of our judgements as in the formation of our intentions? The author's answer to these (...) two further questions is ‘no’ and ‘yes’, respectively: the boundaries between the active and the passive are not marked by the will. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

This book offers a detailed look at Guattari's working methods in transdisciplinary experimentation from the time of his youth to his final years.His youthful adventures in the post-war Youth Hostels movement, decisive contact with institutional pedgagogy and the mentor figures of Fernand Oury and his brother Jean, give rise to an extraordinary penchant for organizational innovation in his life at Clinique de La Borde in Cour-Cheverny, France, and collective forms of expression manifested in publishing ventures and diverse collaborative research formations.Guattari's (...) highly original and hitherto neglected theories of a-signifyng semiotics and minor cinema are explored in depth with reference to the political goals of the critique of infoculture and the molecular revolutionary tendencies that are released in the search for a people to come.Guttari's engagement with eco-politics and art practices displays his originality as a political thinker and is firmly grounded on his exporation of how subjectivity is produced inlate capitalism.Guattari's ground-breaking conception of transversal politics is fully explored in relation to Michel Foucault's sense of the concept and its role in global political theory. (shrink)

John Locke's Essay Concerning Human Understanding is among the most important books in philosophy ever written. It is a difficult work dealing with many themes, including the origin of ideas; the extent and limits of human knowledge; the philosophy of perception; and religion and morality. This volume focuses on the last two topics and provides a clear and insightful survey of these overlooked aspects of Locke's best-known work. Four eminent Locke scholars present authoritative discussions of Locke's view on the ethics (...) of belief, personal identity, free will and moral theory. (shrink)

This volume presents readings in philosophy from around the world and across history, from the Buddha to bell hooks, organized around traditional Anglo-European philosophical themes such as freedom and the existence of God. An introductory section discusses the nature of philosophy and gives advice on reading philosophical texts, and introductions to selections provide background and questions for thought.

Scrap yard challenge : junkyard wars -- Freedom, origination, and irony -- Mimesis and cruelty -- Improvisation, origination, re-novation -- Conclusion : improvisation, thinking, writing.

With its unique combination of depth, clarity, and humor that has enchanted millions, this beloved classic by bestselling author Gary Zukav opens the fascinating world of quantum physics to readers with no mathematical or technical background. "Wu Li" is the Chinese phrase for physics. It means "patterns of organic energy," but it also means "nonsense," "my way," "I clutch my ideas," and "enlightenment." These captivating ideas frame Zukav's evocative exploration of quantum mechanics and relativity theory. Delightfully easy to read, (...) The Dancing Wu Li Masters illuminates the compelling powers at the core of all we know. (shrink)

Since the 1970s Gary Watson has published a series of brilliant and highly influential essays on human action, examining such questions as: in what ways are we free and not free, rational and irrational, responsible or not for what we do? Moral philosophers and philosophers of action will welcome this collection, representing one of the most important bodies of work in the field.

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Traces the life of Confucius and discusses the history and culture of ancient China.

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Therapeutic privilege is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be (...) inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing (...) on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

Introduction Gramsci's relevance The name of the late Italian Marxist, Antonio Gramsci, appears increasingly in the cultural media of the English- speaking ...

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ’normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ’explanatory complexity’. In brief, normative complexity relates to (...) the inherent difficulty of deciding what kinds of changes are ’improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (’orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, (...) be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

Previous research has described some of the main characteristics of university teachers who teach in different ways, using a variety of methods and conceptions. What is generally missing from previous research is the impact of contrasting teaching approaches on students with different learning characteristics. The present investigation builds on a previous case study that identified the potential influence of a ‘meeting of minds’ between tutors and students in developing personal understanding, and also suggested contrasting perceptions of differing forms of teaching. (...) Twenty-one in-depth interviews were used to identify distinctive perceived ways of teaching and groups of students with contrasting learning intentions, looking in particular at the perceptions of tutors who were seen to encourage a ‘meeting of minds’. The main characteristics of these tutors were found be tolerating ambiguity, showing authenticity and empathy, which led to providing opportunities for discussion in breaks, and offering thinking spaces within class. The analyses identified contrasting perceptions of teaching among students who differed in their learning characteristics, and suggested how cognitive and affective elements in students’ experiences of teaching might be intertwined in influencing the development of personal understanding. (shrink)

Can what we know change what we see? Does language affect cognition and perception? The last few years have seen increased attention to these seemingly disparate questions, but with little theoretical advance. We argue that substantial clarity can be gained by considering these questions through the lens of predictive processing, a framework in which mental representations—from the perceptual to the cognitive—reflect an interplay between downward-flowing predictions and upward-flowing sensory signals. This framework provides a parsimonious account of how what we know (...) ought to change what we see and helps us understand how a putatively high-level trait such as language can impact putatively low-level processes such as perception. Within this framework, language begins to take on a surprisingly central role in cognition by providing a uniquely focused and flexible means of constructing predictions against which sensory signals can be evaluated. Predictive processing thus provides a plausible mechanism for many of the reported effects of language on perception, thought, and action, and new insights on how and when speakers of different languages construct the same “reality” in alternate ways. (shrink)

Jean-François Lyotard is generally acknowledged as the theoretical spokesperson for postmodernism. In 1979, his seminal work _The Postmodern Condition_ challenged the presumption and orientation of modern political philosophy. In particular, Lyotard repudiated the notion of grand narratives and promoted a postmodern acceptance of difference and variety and a skepticism towards unifying metatheories. Yet _The Postmodern Condition_ is just one work by a prolific author whose life and work involved close theoretical engagement with Kant, Hegel and Marx and who played a (...) prominent role in the events in Paris of May 1968. This study combines a careful reading of Lyotard's texts with a critical review of his theoretical ploys to demonstrate the incapacity of theory. Lyotard's variety of styles, ranging from the incandescent _Libidinal Economy_ to the economical lucidity of _The Differend_, are recognized as posing questions for those who defend the rationality of the _status quo_ and for those who undertake general critiques of society. In this book, Gary Browning takes issue with Lyotard's approach to Hegel and Marx and his generalized notion of social development as proceeding according to a one-dimensional, instrumentalist logic. Nevertheless, Lyotard is shown to be a disturbing theorist who challenged the assumptions of classic theorists of modernity as well as opposing mainstream attitudes prevalent in contemporary political theory. (shrink)

Disrespect in health care often persists despite firm commitments to respectful service provision. This conceptual paper highlights how the ways in which respect and disrespect are characterised can have practical implications for how well disrespect can be tackled. We stress the need to focus explicitly on disrespect (not only respect) and propose that disrespect can usefully be understood as a failure to relate to people as equals. This characterisation is consonant with some accounts of respect but sometimes obscured by a (...) focus on respecting people’s autonomy and dignity. Emphasising equality is consistent with connections patients draw between being (dis)respected and (in)equality. It readily accommodates microaggressions as forms of disrespect, helping to understand how and why experiences of disrespect may be unintentional and to explain why even small instances of disrespect are wrong. Our view of disrespect with an emphasis on equality strengthens the demand that health systems take disrespect seriously as a problem of social injustice and tackle it at institutional, not just individual levels. It suggests several strategies for practical action. Emphasising relational equality is not an easy or short-term fix for disrespect, but it signals a direction of travel towards an important improvement ambition. (shrink)

This book argues that sometimes we have reasons to overcome repression and that these reasons are unlike any other reasons for action typically recognized by philosophers.

Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone...

Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...) using the discourse and methodology of healthcare quality improvement. -/- Discussion: Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. -/- Conclusions: We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods. (shrink)

Combining all four distinct volumes in the series, this compilation explores the philosophical reasons behind the existence of humanity. The first volume investigates the concept of relations, revealing that unique, complex relationships come into being simultaneously and exponentially through the combination of multiple elements. The second volume focuses on intellect, probing the most obscure corners of comprehension and conducting a fascinating tour of the human psyche. The third volume addresses volition, analyzing the extent to which human judgment, decisions, and actions (...) impact future prospects for mankind and deflect the course of nature. The fourth and final volume delves into affections, dispassionately highlighting the merits and shortcomings of man’s most ethereal faculties. (shrink)

Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety (...) as a field of practice. We argue that dignitary harms in health care are—at least sometimes—preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality. (shrink)

The distinction between occurrent and non-occurrent mental states is frequently appealed to by contemporary philosophers, but it has never been explicated in any significant detail. In the literature, two accounts of the distinction are commonly presupposed. One is that occurrent states are conscious states. The other is that non-occurrent states are dispositional states, and thus that occurrent states are manifestations of dispositions. I argue that neither of these accounts is adequate, and therefore that another account is needed. I propose that (...) occurrent states are active states. (shrink)

Theories of language production propose that utterances are constructed by a mechanism that separates linguistic content from linguistic structure, Linguistic content is retrieved from the mental lexicon, and is then inserted into slots in linguistic structures or frames. Support for this kind of model at the phonological level comes from patterns of phonological speech errors. W present an alternative account of these patterns using a connectionist or parallel distributed proceesing (PDP) model that learns to produce sequences of phonological features. The (...) model's errors exhibit some of the properties of human speech errors, specifically, properties that have been attributed to the action of phonological rules, frames, or other structural generalizations. (shrink)

Inquiries into organisational scandals repeatedly attribute wrongdoing to the normalisation of deviance. From this perspective, the cause of harm lies not in the actions of any individual but rather in the institutionalised practices of organisations or sectors. Although an important corrective to dramatic tales of bad apples, the normalisation thesis underplays the role of management in the emergence of deviance. Drawing on literatures exploring ideas of amoral (Carroll in Bus Horiz 30(2):7–15, 1987) or ethically neutral leadership (Treviño et al. in (...) Calif Manag Rev 42(4):128–142, 2000) we seek to bring management back into the explanation of organisational wrongdoing. Amoral theorists point to management’s ethical silence, but they also describe the way in which that silence is sustained by a series of organisational characteristics. We build on this work in arguing that it is management’s deliberate focus on bottom line performance, the diffusion of responsibility and high levels of organisational identification that explain the emergence of wrongdoing. We apply these ideas to the case of the UK’s Stafford hospital which hit the headlines in 2009 when it was reported that poor standards of care had led to a mortality rate markedly above that expected for a hospital of its type. We conclude with a discussion of the circumstances which translate amoral management into unethical outcomes. (shrink)