Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (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 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)

The aim of this study was to get a deeper understanding of student nurses’ experiences of personal caring ethics by reflection on caring encounters with patients in clinical practice, ethical caring ideals, ethical problems, and sources for inner strength that give courage to practice good caring. In all, 24 Scandinavian student nurses participated voluntarily in an interview study. The interviews were analyzed within a phenomenological–hermeneutical approach and revealed three themes. The students found themselves in two different states of vulnerability: one (...) in which they were overwhelmed by their vulnerability and began to suffer themselves and the other where their vulnerability became a source of development with focus on the patient. The students’ ethical caring ideals served as fixed reference points in their ethical development, but their ideals were at risk of decline. The students reflected on the barriers for performing ethical care and nurtured their ethical ideals by providing ethical care in secret. Caring in secret occurred also when student nurses did not experience a shared ethos. (shrink)

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Caribbean sociology accords with the Du Boisan paradigm of sociology as a science. Caribbean sociology originated as an undifferentiated discipline. It is a panoply of social thought integrated with history, political science, anthropology, psychology, and philosophy. Sociology has never been a discipline sufficient unto itself. To speak of Caribbean sociology is to introduce space and place, territory, and identity as parameters of a social scientific discipline that is yet to adhere to its own boundaries or adequately define itself. Caribbean countries (...) constitute the poor West, and it is a challenge of the discipline to study a region where half of its peoples have migrated and are migrating to the global north. Caribbean sociology contributed diverse if not also original perspectives on significant humanity and is rich in the quality and sophistication of its thought. The sociology of the Caribbean is a sociology of possibilities—a sociology of solutions to the problems of underdevelopment and unfreedom. In the tradition of the scientific sociology of W. E. B. Du Bois it is a quest for social justice. (shrink)

Useful as a starting point and as a resource to revisit as our perspectives shift, this empowering book encourages individuals to "seek answers that will mark ...

This paper examines people's reasoning about identity continuity and its relation to previous research on how people value one-of-a-kind artifacts, such as artwork. We propose that judgments about the continuity of artworks are related to judgments about the continuity of individual persons because art objects are seen as physical extensions of their creators. We report a reanalysis of previous data and the results of two new empirical studies that test this hypothesis. The first study demonstrates that the mere categorization of (...) an object as “art” versus “a tool” changes people's intuitions about the persistence of those objects over time. In a second study, we examine some conditions that may lead artworks to be thought of as different from other artifacts. These observations inform both current understanding of what makes some objects one-of-a-kind as well as broader questions regarding how people intuitively think about the persistence of human agents. (shrink)

The concept of authenticity plays an important role in how people reason about objects, other people, and themselves. However, despite a great deal of academic interest in this concept, to date, the precise meaning of the term, authenticity, has remained somewhat elusive. This paper reviews the various definitions of authenticity that have been proposed in the literature and identifies areas of convergence. We then outline a novel framework that organizes the existing definitions of authenticity along two key dimensions: describing the (...) type of entity that is evaluated and describing the source of information that is consulted. We argue that this convergence across a number of papers, and more importantly, across a number of domains, reflects significant progress in articulating the meaning of authenticity. We conclude by suggesting new avenues for research in this area, with particular attention toward psychological process. (shrink)

The obstacle to more objective knowledge of early Pythagoreanism is the ideological conflict over the proper mission of historiography. Not only the confusing evidence, but also the different investigative procedures and theories of history employed, make solving the Pythagorean problem difficult. I analyze the historiographic methodologies of some modern historians of Pythagoreanism in respect to the kinds of historical explanation they provide. Immediately ideological controversy arises between idealist and materialist historians. ;My critical evaluation proceeds from two theses. The content of (...) ideas reflects their social referents. Consequently, one must identify the class interests of early Pythagoreans. Writing history is a contemporary undertaking by which historians reflect their own social interests. Therefore, historiographic methodology continually must be objectified to overcome the subjectivism of historical relativism. ;I review the reconstructions of six historians. John Burnet, an empiricist, held that the Greeks entirely broke from their religious past to develop philosophy. F. M. Cornford, a Durkheimian, used anthropology to reveal philosophy's totemic content. J. E. Raven is a philologist; he maintaned that ancient philosophy was the Eleatic-Pythagorean debate. W. K. C. Guthrie, an eclectic, held that science served Pythagorean religious interests. These idealist historians attributed the Greek achievement to absolutized temperaments or racial factors; the development of ideas is not mediated by practical necessity. George Thomson and Alban Winspear are historical materialists. They explained ancient philosophy by showing the class interests of philosophers in a mercantile economy based on slave labor. ;After introducing the Pythagorean problem, I present, by chapter, first an exposition of each historian's account of the causes of Greek philosophy and then his exposition of early Pythagoreanism. My analyses follow each section. In the first part of the final chapter I discuss each historian in the context of the ideological controversy. In the second part I present a general outline of procedure for scientific historiography. (shrink)

Religious Representation in Place brings together an interdisciplinary group of scholars from the Humanities and Sciences to broaden the understanding of how religious symbols and spatial studies interact. The essays consider the relevance of religion in the experience of space, a fundamental dimension of culture and human life.

This book constitutes the outcome of an international conference held at the Otto-Mobes-Volkswirtschaftsschule, Graz-Stifting( Austria), from June 16 to 22, 1974. The conference was initiated by a project group working on determinants and controls of social science development at the In stitute for Advanced Studies and Scientific Research in Vienna and or ganized by the editors of this volume. It was held under the auspices of the Austrian Ministry of Science and Research. The main topics of the conference were those (...) at the forefront of the 'state of argumentation' (to borrow from one of our contributors) in philosophy and sociology of science ever since the controversy between Thomas S. Kuhn and Sir Karl R. Popper has sharpened our awareness for the methodological and substantial presuppositions involved with questions of growth and development in science. Let us give two examples of those topics. The borderline between sociology of science and philo sophy of science has become more and more unclear; while the work of at least some philosophers of science comes to have an empirical flavour, sociologists of science are increasingly apt to include logical and methodo logical components of the research process as their objects of examina tion. Papers included in this volume testify to both tendencies. (shrink)

Epicurus, born at Samos, Greece, in 341 BC, and died at Athens in 270 BC, founded a school of philosophy in the ancient world which has little to do with the meanings that surround the word "Epicureanism" today and more to do with living a mindful, simple life, maximizing simple pleasures and minimizing pain, such as the irrational fear of death--"Death is nothing to us, since when we are, death has not come, and when death has come, we are not." (...) Epicurus did not believe that humans would be punished for their sins after death, and stressed the search for lasting pleasures during the life we have, such as tranquility, friendship, and philosophical inquiry. What is good is what is pleasurable and what is bad is what is painful. Epicurus was a prolific author, but very few of his writings have come down to us. Included in this collection, edited and translated by George K. Strodach, are a collection of observations that were preserved by the biographer of ancient philosophers, Diogenes Laertius, and three important letters. (shrink)