`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

The articles in this volume offer a fresh perspective on the important role of the concept of law (lex) in the moral and political philosophy of the 'School of Salamanca'.

A new theory of how the brain constructs emotions that could revolutionize psychology, health care, law enforcement, and our understanding of the human mind Emotions feel automatic, like uncontrollable reactions to things we think and experience. Scientists have long supported this assumption by claiming that emotions are hardwired in the body or the brain. Today, however, the science of emotion is in the midst of a revolution on par with the discovery of relativity in physics and natural selection in biology--and (...) this paradigm shift has far-reaching implications for us all. Leading the charge is psychologist and neuroscientist Lisa Feldman Barrett, whose theory of emotion is driving a deeper understanding of the mind and brain, and shedding new light on what it means to be human. Her research overturns the widely held belief that emotions are housed in different parts of the brain and are universally expressed and recognized. Instead, she has shown that emotion is constructed in the moment, by core systems that interact across the whole brain, aided by a lifetime of learning. This new theory means that you play a much greater role in your emotional life than you ever thought. Its repercussions are already shaking the foundations not only of psychology but also of medicine, the legal system, child-rearing, meditation, and even airport security. Why do emotions feel automatic? Does rational thought really control emotion? How does emotion affect disease? How can you make your children more emotionally intelligent? How Emotions Are Made answers these questions and many more, revealing the latest research and intriguing practical applications of the new science of emotion, mind, and brain. (shrink)

The concept of alienation: Hegelian themes in modern social thought -- Creative activity and alienation in Hegel and Marx -- The concept of labour -- The individual and society -- Freedom and the "realm of necessity" -- Alienation as a critical concept -- Private property and communism -- The division of labour and its overcoming -- Marx's concept of communism.

Psychological construction constitutes a different paradigm for the scientific study of emotion when compared to the current paradigm that is inspired by faculty psychology. This new paradigm is more consistent with the post-Darwinian conceptual framework in biology that includes a focus on (a) population thinking (vs. typologies), (b) domain-general core systems (vs. physical essences), and (c) constructive analysis (vs. reductionism). Three psychological construction approaches (the OCC model, the iterative reprocessing model, and the conceptual act theory) are discussed with respect to (...) these ideas. (shrink)

Some claim that moral factors affect the epistemic status of our beliefs. Call this _the moral encroachment thesis_. It’s been argued that the moral encroachment thesis can explain at least part of the wrongness of racial profiling. The thesis predicts that the high moral stakes in cases of racial profiling make it more difficult for these racist beliefs to be justified or to constitute knowledge. This paper considers a class of racial generalizations that seem to do just the opposite of (...) this. The high moral stakes of the beliefs we infer from these generalizations make it _easier_ rather than _harder_ for these beliefs to be justified or to constitute knowledge. I argue that the existence of this class of cases—cases of “positive profiling”—give us reason to expand our account of moral encroachment in a way that brings it closer to the ideal of pragmatic encroachment that motivates it in the first place. (shrink)

Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by (...) appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition. (shrink)

When cognitive scientists are looking for the neural basis of consciousness or the computational processes underlying vision, what are they looking to find? I argue for a new account of this explanatory project in cognitive science (and the special sciences more generally) on which it is best understood on close analogy with causal explanation in the special sciences. Causal explanations cite causal difference-makers: they explain how certain events causally depend on other events. Generative explanations cite generative difference-makers: they explain how (...) certain events obtain in virtue of (and so are generated by) other events. I show how that this generative difference-making account (GDM) extends well regarded developments in philosophical work on causal explanation, helps to usefully clarify and expands the hypothesis space of a key project in cognitive science – that of understanding how underlying nonmental processes give rise to the mental, including consciousness. In section 2, I develop GDM by close analogy with causal explanation, and locate both of them as species of a more general project in the special sciences: that of discovering what makes a difference to what. In section 3, I motivate GDM by contrasting it with other rival accounts, including correlationist, identity, and grounding accounts, as well as Carl Craver’s constitutive relevance account. In section 4, I tie all of the strands of the preceding discussion together to show how GDM provides a new and compelling response to the so-called hard problem of consciousness. (shrink)

George Berkeley, Bishop of Cloyne, was one of the great philosophers of the early modern period. He was a brilliant critic of his predecessors, particularly Descartes, Malebranche, and Locke. He was a talented metaphysician famous for defending idealism, that is, the view that reality consists exclusively of minds and their ideas. Berkeley's system, while it strikes many as counter intuitive, is strong and flexible enough to counter most objections. His most studied works, the Treatise Concerning the Principles of Human Knowledge (...) Principles, for short) and Three Dialogues between Hylas and Philonous Dialogues), are beautifully written and dense with the sort of arguments that delight contemporary philosophers. He was also a wide ranging thinker with interests in religion (which were fundamental to his philosophical motivations), the psychology of vision, mathematics, physics, morals, economics, and medicine. Although many of Berkeley's first readers greeted him with incomprehension, he influenced both Hume and Kant, and is much read (if little followed) in our own day. (shrink)

This book offers a balanced and comprehensive account of philosophical thought from the middle of the fourteenth century to the emergence of modern philosophy at the turn of the seventeenth century.

Locke’s metaphysical commitments are a matter of some controversy. Further controversy attends the issue of whether and how Locke adapts his views in order to accommodate the success of Newton’s Principia. The chapter lays out an interpretation of Locke’s commitments according to which Locke’s response to Newton on gravity does not require the positing of brute powers and is consistent with his core essentialism. The chapter raises the question of how the hypothesis concerning the creation of matter, alluded to at (...) 4.10.18, fits with these commitments. The chapter concludes that the De grav hypothesis would represent a significant revision to the background metaphysical picture of the Essay, but that nevertheless its attractions to Locke are intelligible and illuminating. (shrink)

Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.

This paper argues that a priori justification is, in principle, compatible with naturalism—if the a priori is understood in a way that is free of the inessential properties that, historically, have been associated with the concept. I argue that empirical indefeasibility is essential to the primary notion of the a priori ; however, the indefeasibility requirement should be interpreted in such a way that we can be fallibilist about apriori-justified claims. This fallibilist notion of the a priori accords with the (...) naturalist’s commitment to scientific methodology in that it allows for apriori-justified claims to be sensitive to further conceptual developments and the expansion of evidence. The fallibilist apriorist allows that an a priori claim is revisable in only a purely epistemic sense. This modal claim is weaker than what is required for a revisability thesis to establish empiricism, so fallibilist apriorism represents a distinct position. (shrink)

Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research (...) by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence‐based practice, body care as a relational ethical practice, the body as a body‐object and a body‐subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities. (shrink)

Sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers causes severe physical and psychological consequences. Where SEA leads to pregnancy and childbirth, peacekeepers typically absolve themselves of their paternal responsibilities and paternity suits are largely unsuccessful. The lack of support for peacekeeper-fathered children (PKFC) tarnishes the image of the UN who fails to implement a victim-centred approach to SEA. Analysing shortcomings in the provision of support, this article presents an evaluation of the UN’s accountability system from the perspective of (...) PKFC families. In-depth interviews with thirty-five PKFC and sixty mothers demonstrate local barriers to child support and paternity claims in eastern Democratic Republic of Congo. We discuss PKFC’s need for assistance and their mothers’ attempts to navigate an opaque international legal system. The findings cast light on their limited access to UN subsidies and offer recommendations to better implement existing UN goals of justice and victim-oriented policies. (shrink)

In “Bourdieusian reflections on language: Unavoidable conditions of the real speech situation”, Simon Susen proposes that Bourdieu’s account of language is based on a number of ontological presuppositions. While the extensive commentary on Bourdieu’s analysis of language tends to bracket these assumptions—not least because of an enduring attachment to the “sociological Bourdieu”—Susen insists that a recognition of the ontological features of language is consistent with Bourdieu’s own writings. While Susen’s ontological retrieval may be controversial, especially to those attached to the (...) “sociological Bourdieu”, in this reply I suggest that in “Bourdieusian reflections on language” we find something more interesting than any such controversy. Specifically, Susen’s ontological retrieval opens out Bourdieu’s oeuvre to currents in the social sciences which question the limits of the sociology of the social in the context of an increasingly ontological life. In this reply, I ask how Susen’s “ontological Bourdieu” fares in a dialogue with this body of work. (shrink)

Everything possible to be believed is an image of truth (The Marriage of Heaven and Hell, Blake) Introduction In this book I deal with some of the central ...

In Science as Social Knowledge in 1990 and The Fate of Knowledge in 2002, Helen Longino develops an epistemological theory known as Critical Contextual Empiricism (CCE). Knowledge production, she argues, is an active, value-laden practice, evidence is context dependent and relies on background assumptions, and science is a social inquiry that, under certain conditions, produces social knowledge with contextual objectivity. While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature (...) in recent years. In this paper I outline the key elements of Longino’s theory and propose modifications to the four norms offered by the account. The version of CCE I defend, which draws on lessons learned by medical researchers in recent years, gives principles of epistemic diversity a central role and also provides greater specification of three of the four norms. Further, it offers additional resources for defending CCE against Alvin Goldman’s suggestion that there is a need for a “healthy dogmatism” in science, as well as a concern about “manufactured uncertainty” arising out of recent work by David Michaels. Finally, the modified version proposed here is also well positioned to respond (negatively) to a suggestion from Kristen Intemann that CCE needs to be adapted to incorporate a central insight from feminist standpoint theory. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

In their paper, “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Stephanie Morain and Emily Largent (2023) argue that investigators, and poss...

What is it to base a belief on reasons? Existing attempts to give an account of the basing relation encounter a dilemma: either one appeals to some kind of neutral process that does not adequately reflect the way basing is a content‐sensitive first‐personal activity, or one appeals to linking or bridge principles that over‐intellectualize and threaten regress. We explain why this dilemma arises, and diagnose the commitments that are key obstacles to providing a satisfactory account. We explain why they should (...) be rejected anyway, and then offer a new, knowledge‐first virtue epistemological theory of the basing relation that shows how we can substantially theorize about mental processes without these commitments. The resulting view plausibly captures the way in which basing is an inherently mental and content‐sensitive process. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

Most phase III clinical trials today are explanatory. Because explanatory, or efficacy, trials test hypotheses under “ideal” conditions, they are not well suited to providing guidance on decisions made in most clinical care contexts. Pragmatic trials, which test hypotheses under “usual” conditions, are often better suited to this task. Yet, pragmatic, or effectiveness, trials are infrequently carried out. This mismatch between the design of clinical trials and the needs of health care professionals is frustrating for everyone involved, and explains some (...) of the challenges inherent in attempts to enhance knowledge translation and encourage evidence-based practice. The situation is more than simply frustrating, however; it is potentially unethical. Clinical trials must be socially valuable in order to (1) warrant the risks they impose on human research subjects and (2) fairly and efficiently assess new clinical interventions. Most bioethicists would agree that trials that have no social value, for instance, because their results do not have the potential to advance clinical care, should not be performed. What is less widely appreciated is that given limited research resources, trials that are more socially valuable should be preferred to trials that are less socially valuable when all else is equal. With respect to clinical trial design, I argue that while explanatory trials often have some social value, many have less social value than their pragmatic counterparts. On the basis of this general ethical assessment, I provide a preliminary defense of the position that clinical researchers should aim to conduct pragmatic trials, that is, that researchers face a burden of justification related to any idealizing elements added to trial designs. (shrink)

Clinical research has at least three problematic features: it tends to be redundant, secretive, and isolated.1 Research with these features not only wastes resources and causes harm, it also fails to meet a basic ethical requirement of research: scientific validity. As bioethicists, we should be asking why, if research with these three features is ethically unjustified, it has been so routinely approved by research ethics committees over the past half century. In what follows, I provide one answer to this question. (...) The first section of this paper outlines empirical evidence for the redundant, secretive, and isolated nature of much contemporary clinical research. Next, I argue that a lack of clarity .. (shrink)

Amending and Defending Critical Contextual Empiricism: Lessons from Medical Research In Science as Social Knowledge (1990) and The Fate of Knowledge (2002), Helen Longino develops a social epistemological theory known as Critical Contextual Empiricism (CCE). While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature in recent years. In this paper I outline the key elements of Longino’s theory and propose several modifications to the four norms offered by the (...) account. The revisions I propose are shaped by a number of developments in the medical context in recent years. The modified norms, which determined whether a particular community produces objective knowledge, are thus: 1. Avenues for Criticism – there must be recognized avenues for criticism, and these avenues must be publicly accessible and require transparent disclosure of all relevant information (including competing interests) from those who present their ideas. It must also be a community requirement that all members present their ideas for critical scrutiny if they wish them to be recognized as knowledge. 2. Responsiveness to Criticism – the community must be responsive to criticism. 3. Shared Public Standards – there must be some shared standards that determine community membership. Outsiders to a particular community are welcome to engage in critical debates as long as they share at least one of the community standards with the target community. 4. Cultivation of Diverse Perspectives – communities must cultivate diverse perspectives, that is, the perspectives of those who express strong dissent. The version of CCE I defend gives the principle of diversity a more central role than the original and provides greater specification of two of the other norms in light of challenges faced by medical researchers in recent years. The medical context provides us with a number of cautionary tales in which knowledge production that appears to meet the original four norms has been seriously compromised by particular social interests. The proposed modifications attempt to address these ‘loopholes’ in a way that is not ad hoc. I argue that the modifications I suggest are in line with the underlying assumptions and goals of CCE. The modified version of CCE also offers resources for defending CCE against the criticisms leveled against it by Miriam Solomon & Alan Richardson, Alvin Goldman and Philip Kitcher as well as one general concern arising out of a recent work by David Michaels. I provide responses to these criticisms in the final section of the paper. Throughout the paper I connect the theoretical work done in social epistemology to the real practice of knowledge-production as is occurs in the medical context. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

This classic, with a new introduction by Madeleine L'Engle, is by turns an entrancing mediation on language a piercing commentary on the nature of art and why so much of what we read, hear, and see falls short and a brilliant examination of the fundamental tenets of Christianity. The Mind of the Maker will be relished by those already in love with Dorothy L. Sayers and those who have not yet met her. A mystery writer, a witty and perceptive (...) theologian, culture critic, and playwright, Dorothy Sayers sheds new,unexpected light on a specific set of statements made in the Christian creeds. She examines anew such ideas as the image of God, the Trinity, free will, and evil, and in these pages a wholly revitalized understanding of them emerges. The author finds the key in the parallels between the creation of God and the human creative process. She continually refers to each in a way that illuminates both. (shrink)

I argue that epistemic failings are a significant and underappreciated moral hazard in the financial services industry. I argue further that an analysis of these epistemic failings and their means of redress is best developed by identifying policies and procedures that are likely to facilitate good judgment. These policies and procedures are “best epistemic practices.” I explain how best epistemic practices support good reasoning, thereby facilitating accurate judgments about risk and reward. Failures to promote and adhere to best epistemic practices (...) contributed to the 2008 financial crisis. I identify and discuss some of the ways in which best epistemic practices were violated in the events that led to the crisis, with a focus on the role of the credit rating agencies. I go on to discuss some of the ways in which these failings have been redressed. I conclude by observing how proactive regulation for best epistemic practices might help us to anticipate and avoid future crises. (shrink)

Advance refusals of life-sustaining treatment involve three potentially conflicting interests: those of the patient; those of the doctor; and those of the law. The state's interest in protecting life can clash with the patient's right to self determination which, in turn, can conflict with the doctor's desire to act in the patient's best interests. Against this background, we present the case of a patient who was treated (arguably) contrary to his advance refusal but in accordance with English law.

This edited volume evaluates how sport organizations in the public, private, and non-profit sectors define responsible management and sustainability and what these mean in their daily operations. Using country-specific cases, the chapters provide an empirical investigation of sport organizations in each sector, analyzing managerial decisions and policies through a sustainability lens. All chapters are structured in the same way, providing a truly comparative approach. Offering insights for scholars interested in responsibility and sustainability in different context, this volume will be important (...) to undergraduate and postgraduate sport management, event management, sport science, and sport study programs around the globe. (shrink)

Proponents of evidence-based medicine have recently suggested a “4S” approach to clinical decision making in which physicians are advised to rely on increasingly abstract summaries of the available research evidence. This retreat from the original data of medical research is ill-advised: it extends an unjustified evidence hierarchy, overestimates the role of computer systems, divides communities, discards evidence, ignores contexts, and devalues broad critical evaluation. I draw upon feminist social epistemology to evaluate the 4S approach to EBM and to suggest means (...) for improving the evidence base of medical research and practice. (shrink)

This article analyses the two main rhetorical techniques of “argumentation” and “persuasion” employed in politico-philosophical debates recorded in early Chinese argumentative texts of the Warring States period. Through the analysis of pertinent case studies drawn from the received literature, the contribution explores the formal, structural, and grammatical features of these techniques, with attention paid to the wide selection of rhetorical and literary devices they make use of. It also further provides an overview of the historical and socio-cultural background against which (...) such techniques developed among so called “wandering persuaders”, who were travelling from court to court to offer their services as political advisors and diplomats to the local rulers of the time. (shrink)

Delusions are a common symptom of schizophrenia and dementia. Though most English dictionaries define a delusion as a false opinion or belief, there is currently a lively debate about whether delusions are really beliefs and indeed, whether they are even irrational. The book is an interdisciplinary exploration of the nature of delusions. It brings together the psychological literature on the aetiology and the behavioural manifestations of delusions, and the philosophical literature on belief ascription and rationality. The thesis of the book (...) is that delusions are continuous with ordinary beliefs, a thesis that could have important theoretical and practical implications for psychiatric classification and the clinical treatment of subjects with delusions. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and of attributions of self-knowledge in belief ascription. Presenting a highly original analysis of the debate on the nature of delusions, this book will interest philosophers of mind, epistemologists, philosophers of science, cognitive scientists, psychiatrists, and mental health professionals. (shrink)

Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.Setting—A large district general hospital in the United Kingdom.Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision (...) making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.Results—Twenty-four were inadequately informed of their illness.Forty-six said they would want to know were something serious to be found. Twenty-eight wanted to make their own decision if requiring risky treatment and 11 wanted family members involved. Thirty-one wanted to make a cardiopulmonary resuscitation decision and five of these decisions differed from those made by the doctors. Twenty-five preferred the doctors to decide. Eleven of the patients had heard of living wills but only one had executed such a will. Seven of the patients wished to provide advance directives. Three did not find the history taking helpful but none were discomforted.Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences. (shrink)

Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors’ decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed (...) ought to make such decisions, and whether the relatives’ preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors’ decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious , because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death. (shrink)

The paper by Szasz is about mental illness and its meaning, and like Procrustes, who altered hapless travellers to fit his bed, Szasz changes the meanings of words and concepts to suit his themes.1 Refuting the existence of “mental illness”, he suggests that the term functions in an apotropaic sense. He submits that in this sense it is used to avert danger, protect society, and hence justify preventive detention of “dangerous” people.But his arguments misrepresent the precise meaning of the term (...) “apotropaic”, which is an adjective, defined in Webster’s, Chambers and the New Shorter Oxford dictionaries as averting or turning aside evil. It is possible that amulets and incantations ward off evil, in the same way as garlic repels vampires, but evil and danger are different concepts. Yet Szasz talks of using phrases like ‘“dangerousness to self and others’ as apotropaics to ward off dangers we fear”, and the word “evil” does not appear in his paper.I will argue that “dangerousness to self and others” and “psychiatric treatment” have a prosaic rather than an apotropaic function.The word “danger” is familiar rather than arcane, and includes many risks. A predatory paedophile is usually both dangerous and evil, but many dangerous people are not evil. For example, a child who plays with a box of matches is dangerous, as is a demented person who drives a car, or a schizophrenic who, acting on delusional beliefs, arms herself with a knife and roams the streets believing she is an avenging angel.Suppose …. (shrink)

Proponents of evidence-based medicine have recently suggested a “4S” approach to clinical decision making in which physicians are advised to rely on increasingly abstract summaries of the available research evidence. This retreat from the original data of medical research is ill-advised: it extends an unjustified evidence hierarchy, overestimates the role of computer systems, divides communities, discards evidence, ignores contexts, and devalues broad critical evaluation. I draw upon feminist social epistemology to evaluate the 4S approach to EBM and to suggest means (...) for improving the evidence base of medical research and practice. (shrink)

Volume 20, Issue 2, February 2020, Page 25-27.

This volume presents cutting-edge theory and research on emotions as constructed events rather than fixed, essential entities. It provides a thorough introduction to the assumptions, hypotheses, and scientific methods that embody psychological constructionist approaches. Leading scholars examine the neurobiological, cognitive/perceptual, and social processes that give rise to the experiences Western cultures call sadness, anger, fear, and so on. The book explores such compelling questions as how the brain creates emotional experiences, whether the "ingredients" of emotions also give rise to other (...) mental states, and how to define what is or is not an emotion. Introductory and concluding chapters by the editors identify key themes and controversies and compare psychological construction to other theories of emotion. (shrink)