The sixteenth-century philosopher Jacopo Zabarella stands near the end of the long Aristotelian dominance of western academic philosophy. Yet, despite the fact that Aristotelianism was soon to be overwhelmed by other currents of thought, Zabarella’s influence on western thought would continue into at least the nineteenth century, and he still provides useful discussions relevant to today’s Aristotle scholars. In what follows, I discuss the existence and essence of matter, and show how Zabarella argues for his claims. What is especially notable (...) about the existence and essence of matter as a topic is that matter is clearly at the center of his well-known interest concerning the nature of scientific methodology. (shrink)

FRANCISCO SUÁREZ, THE GREAT JESUIT PHILOSOPHER AND THEOLOGIAN, has long been recognized as a pivotal figure in the development of Western philosophy. His thought is heavily indebted to the medieval philosophical tradition but also bears striking intimations of key themes in modern thought. In this paper I address one of the most controversial questions related to the thought of Suárez, namely, his relationship to the nominalist tradition. However, I shall do so rather indirectly by focusing not on explicit metaphysical questions (...) but rather on his account of our acquisition of universal concepts and its foundation in reality. By placing questions about the knowledge of singular and universal at the center of the discussion, I hope to shed new light on his account of the objectivity that we can have in our knowledge. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic (...) medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient’s report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians’ reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making. (shrink)

Science and technology studies scholars have turned their attention to the materiality of objects and buildings in order to examine what they make users do in practice. Taking a close look at a therapeutic community in a psychiatric day care center for teenagers, this paper joins these discussions by exploring the materiality of “spaces of care” as part of the center’s everyday practice. The analysis incorporates the concepts of scripts and dispositifs to describe the conditions of possibility (...) in which caregivers and youths may position themselves in relation to others and to the space itself. This paper describes how spaces of care offer open, enticing, and variable conditions for fostering a dynamic of personal and relational responses as part of the care work. In this sense, the material environment entails potentialities in ways that are unpredictable but nonetheless consequential. Rather than arguing that material arrangements and things act, this paper draws attention to their impact via their potential within dispositifs of care that request participants’ attentiveness and responsiveness. Describing these potentialities brings out the subtler requirements of material environments in care practices that aim at circumventing the coercion of disciplinary spaces and their impersonal classifications. (shrink)

AimThis study aimed to examine the dimensionality of the BCFQOL-AR using Rasch analysis.MethodThe sample consisted of 320 families having a member with intellectual or developmental disabilities. Rasch analysis was used to validate the dimensionality of the scale. The participants were from Riyadh, Saudi Arabia.ResultsThe BCFQOL-AR 25-item scale was multidimensional. Rasch analyses support the unidimensionality of the five subscales. There were no indicators of differential item function for any of the items, regardless of sex or age.ConclusionThe BCFQOL-AR is a multidimensional scale (...) that measures families with members who are satisfied with their quality of life. Therefore, obtaining a total score at the subscale level is supported and showed that each of the five subscales of the BCFQOL can be used alone. This study partially supports the practices used with other versions of the scale, by providing the statistical base, where means were used at the subscale level in different countries. (shrink)

Along with political, economic, ethical, rehabilitative and military dimensions, psychopathological sequelae of war and terrorism also deserve our attention. The terrorist attack on the World Trade Centre ( W.T.C.) in 2001 and the Gulf War of 1990-91 gave rise to a number of psychiatric disturbances in the population, both adult and children, mainly in the form of Post-traumatic Stress disorder (PTSD). Nearly 75,000 people suffered psychological problems in South Manhattan alone due to that one terrorist attack on the (...) WTC in New York and the Pentagon in Washington. In Gulf War I, more that 1,00,000 US veterans reported a number of health problems on returning from war, whose claims the concerned government has denied in more than 90% cases. Extensive and comprehensive neurological damage to the brain of Gulf War I veterans has been reported by one study, as has damage to the basal ganglia in another, and Amyotrophic Lateral Sclerosis (ALS) in a third, possibly due to genetic mutations induced by exposure to biological and chemical agents, fumes from burning oil wells, landfills, mustard or other nerve gases. The recent Gulf War will no doubt give rise its own crop of PTSD and related disorders. In a cost-benefit analysis of the post Gulf War II scenario, the psychopathological effects of war and terrorism should become part of the social audit any civilized society engages in. Enlightened public opinion must become aware of the wider ramifications of war and terrorism so that appropriate action plans can be worked out. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Hospitalization—Bridging the Gap Between Respect and ControlPaul P. ChristopherIntroductionThis issue of Narrative Inquiry in Bioethics offers varied and somewhat unique perspectives on the experience of psychiatric hospitalization. This commentary highlights a number of salient themes that emerge from reading these essays and attempts to explore how they relate to the broader academic literature on psychiatric hospitalization, particularly with regard to ethical considerations. In reading these (...) narratives, each several times, I was repeatedly struck by the courage required of the authors, both to share their stories publicly and to endure the challenges that the writing process no doubt demanded of them—revisiting and suspending themselves in deeply emotional and, at times, traumatic experiences in order to share the most compelling narrative. Their hard work clearly paid off—the stories are at once intimate and indelible. Still, in many instances, I found myself wanting to know more; to enter the story and sit with the individual through these events; to ask what they were thinking or feeling in a particular situation; to see and hear the world in which they found themselves. Such is the nature of good story telling—the reader, left with the lingering vision created in his mind, turns over the last page, eagerly hoping for more.Narrative ThemesI. Loss of Autonomy or ControlPerhaps the most notable theme had to do with the loss of control or freedom that followed from hospitalization. On first consideration, it may seem odd that this issue appears so often since patient autonomy constitutes one of the fundamental principles of medical ethics. Only under specific circumstances—e.g., when there is a risk of imminent harm—may autonomy be curtailed, and even then only to the extent that is minimally necessary. Yet, as these narratives highlight, there are a multitude of ways in which psychiatric hospitalization engenders actual or perceived restrictions in freedom (Newton-Howes & Mullen, 2011).Consistent with prior research (Goodwin et al., 1999), many of the authors describe a fear or the actual experience of not being able to leave the hospital freely, even when the admission seems to have been voluntary. For example, one writer worries, “I was so afraid that if I ever went ‘in,’ I would never get ‘out’... I thought I would never taste freedom again... alive.” Another describes:When it came time for my possible discharge they told me that I might not get discharged because I was ‘acting up the previous evenings.’ My anxiety level at this point went through the roof. The only reason I was discharged was because my father knew some politicians. If not [End Page 29] for him I would have been a patient there for perhaps years and my life would have been ruined.A third gives this example: “When I asked to sign the form to leave after three days, [the psychiatrist] told me if I did that she would have me committed.” Another writer fears not having any control of how the psychiatrist might approach the treatment: “... I was totally vulnerable... would the doctors blame me, drug me, shock me, kill me?”Somewhat surprising, however, was the fact that so few of the narratives take issue with the decision to hospitalize. This omission is especially striking in light of the fact that prior reports consistently note that a substantial minority (up to nearly half) of voluntarily admitted patients nevertheless experience their admission as coerced (Bonsack & Borgeat, 2005; Hiday et al., 1997; Katsakou et al., 2010; Rogers et al., 1993; Sheehan & Burns, 2011). Because many of these narrators had been hospitalized more than once, the relative absence of expressed resistance to being hospitalized seems strange, particularly when earlier hospital experiences or their aftermath are often described as negative. For example, one individual characterized the time after being released from the hospital as, “My sense of self was questioned. I felt as if I lost my soul.” Another put it this way:When I got out of the private hospital, I felt like my soul had been ripped out of me. I felt like I had a gaping hole in the center of my body... I felt psychically raped, dazed, and confused.Given these... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deflating Psychiatric ClassificationClaudio E. M. Banzato (bio)Keywordsnosography, comorbidity, utility, pragmatismSystems of classification bring order into the world. They are a key part of the informational working infrastructure of the world we inhabit (Bowker and Star 1999). Thus, much of the human interaction hinges on these ordering—pattern identifying and creating—systems. Formal or informal, standardized or ad hoc, visible or invisible, enforced or optional, there are a myriad of classifications (...) we necessarily live by.Typically, classifications convey representations of states of affairs to make interventions on them feasible and, to some extent, predictable. In other words, classificatory systems and schemes try to confer intelligibility to the world. By succeeding in such task, they may provide rational grounds to human operation on reality (toward the most diverse ends). This account fully applies to medical classifications, which struggle to sort out all kinds of diseases, ailments, complaints, and sufferings that can possibly be targeted by medical interventions. This means classifications are instrumental to the ends pursued by medicine, quintessential modificatory activity. In sum, classifications are cognitive tools devised to build up knowledge by making relevant distinctions, which may prove helpful to guide human action.By working well, classifications eventually tend to become invisible. They end up looking just natural, as if they were carved by nature itself. But indeed purpose is the touchstone here. Even if a given class of objects fully qualifies as a 'natural kind' and necessary and sufficient criteria for class membership can be definitely established, it does not entail that it constitutes the best way to classify these objects irrespective of the context. Peter Zachar (2002) offers a compelling example from natural sciences, the utmost practical importance of distinguishing between hydrogen and its isotopes (hydrogen, deuterium, and tritium). In this case, the classificatory thrust stretches beyond the shared atomic number. In his words, "A crucial factor in recognizing them as distinct is that they are used in distinct activities and practices. We get a better neutron bounce with heavy water or D2O. Deciding what aspects of internal structure are important therefore cannot be isolated from external factors." (p. 220)In contemporary psychiatry, diagnostic classification has been center stage for several reasons. But before addressing them, however, a brief historical detour is necessary. Back in the nineteenth century, putting forward a new classification of mental diseases was taken somewhat as a token of psychiatric proficiency according to the witty remark by the French physician and publicist Philippe Buchez: "Upon believing that they have [End Page 23] completed their studies, rhetoricians will compose a tragedy and alienists a classification" (Berrios 1999, 152). By the middle of the twentieth century, many psychiatric classifications (based on diverse principles and underlying theoretical orientations) were still used across the world. The British psychiatrist Erwin Stengel (1959), in his influential report on classification of mental disorders, pointed out that the issue of difficulty of communication was then the order of the day for psychiatry, because it was widely perceived as one of the most serious obstacles to the progress in the field.The broad, worldwide survey carried out by Stengel made it clear that classifications of all shapes were used in different contexts, but they were seldom appealing outside the boundaries of the respective centers that generated them. Such diversity of classifications reflected not only different functions or purposes they were meant to serve, but also the role played by the history of a given problem within a particular medical tradition and cultural background. Thus, Stengel's aims for an acceptable statistical international classification were relatively modest: it should simply ground epidemiological work.Stengel's stance on classification was frankly pragmatic and utilitarian. He understood well the difficulties posed by the 'disease entity' assumption in psychiatry and asked the straight question: "Firstly, what do we classify in this field? Are we classifying diseases or people?", to which he offered a compromised answer: "It may be said that the material the psychiatrist has to classify consists neither of diseases nor of people but of a variety of disorders or reactions, a material which does not readily lend itself to classification" (Stengel 1959, 612). For him, the pursued agreement on the... (shrink)

Book reviewed in this article: Philosophy in Medicine: Conceptual and Ethical Problems in Medicine and Psychiatry. By Charles M. Culver and Bernard Gert. Psychiatric Ethics. Edited by Sidney Block and Paul Chodoff. Man, Mind, and Morality: The Ethics of Behavior Control. By Ruth Macklin.

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws (...) and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by (...) participants during this consent process? 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape, and older participants, were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness nor education were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies. (shrink)

Ce texte s’intéresse aux conditions de réussite des mécanismes de type commission de vérité et de réconciliation. Il présente deux grilles à partir desquelles il analyse et compare trois cas : la Truth and Reconciliation Commission d’Afrique du Sud, les tribunaux gacaca au Rwanda et la Commission de vérité et réconciliation du Canada sur les pensionnats indiens. La première grille évalue la capacité d’une CVR à promouvoir la justice et la responsabilité. La seconde, leur capacité à favoriser la réconciliation nationale. (...) La thèse défendue est que les CVR relèvent davantage de l’éthique que du droit et du politique. La première grille applique des critères qui relèvent de ces deux derniers registres. Ce faisant, elle ne prend pas en compte la finalité de réconciliation des CVR et faillit à les évaluer correctement. La seconde grille, qui emprunte aux modalités de la justice réparatrice et à l’éthique, corrige ces lacunes. (shrink)

Ask any clinical ethics consultant, and they can tell you about their transformative cases. Some stick with us because all roads led nowhere. Cassandra Lee had a history of pulling out lines and tubes and a distaste of warming blankets. Her admission marked her thirtieth over the past year. Many of the challenges facing the hospital caring for her were not unique: significant psychiatric issues, prolonged nonadherence to medical advice, and end‐of‐life decision‐making combined to create an ethically dense and (...) vexing situation. Ms. Lee, like so many patients, was suffering because of system failures. (shrink)

This paper traces the diverse contexts of radiation protection from liberation in post-1945 South Korea to its professionalization by the early 1970s, using the emerging field of health physics as the focus. The Korean nuclear center, AERI, started two affiliates, RRIA and RRIM in the early 1960s. In particular, RRIM emphasized the use of radiation within cancer research, especially the use of cobalt in treating patients. In this context, health physics initially took the form of “radiation medicine.”With the (...) two institutes returning to AERI’s fold in 1973, health physics took another turn: the second major subfield, following “radiation medicine,” invoked a broader conception of “radiation protection,” which now referred to a cluster of related interests, including the environment and the effects of industrialization.Rather than a simple transfer of American and international models after 1953, Korean health physics reflects its origins in a post-colonial research setting, one more diverse than its “official” institutional context at AERI. (shrink)

Patients with psychiatric illness feel the brunt of the intersection of many of our society's and our health care system's disparities, and the vulnerability of this population during the Covid‐19 pandemic cannot be overstated. Patients with psychiatric illness often suffer from the stigma of mental illness and receive poor medical care. Many patients with severe and persistent mental illness face additional barriers, including poverty, marginal housing, and food insecurity. Patients who require psychiatric hospitalization now face the risk (...) of transmission of Covid‐19 due to the inherent difficulties of social distancing within a psychiatric hospital. Patients whose freedom and self‐determination have been temporarily overruled as they receive involuntary psychiatric treatment deserve a setting that maintains their health and safety. While tele‐mental health has been rapidly expanded to provide new ways to access psychiatric treatment, some patients may have limitations in technological literacy or access to devices. The social isolation, economic fallout, and potential traumatization related to the current pandemic will disproportionately affect this vulnerable population, and society's duties to them must be considered. (shrink)

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; (...) Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Threat to Selfhood: Moral Distress and the Psychiatric Training CultureEsther NathansonWhile many medical specialties offer to heal, or even cure, psychiatry—uniquely—places the doctor–patient relationship at the center of the therapeutic effort. Psychiatrists must possess a complex and challenging combination of broad medical knowledge, finely honed interpersonal and analytic skills and confidence in their abilities, despite limited understanding of the workings of the brain. Inpatient psychiatry in (...) particular demands a degree of strength to withstand emotional, and sometimes physical, assault from patients who may be suicidal, desperate, paranoid, aggressive or delusional. Beyond these abilities, a good psychiatrist must have robust but ‘therapeutically porous’ emotional boundaries that allow genuine empathy for the patient but, at the same time, limit internalization of the patient’s anguish as the practitioner’s own: the exquisite balance of ‘self–versus–other’ in the therapeutic encounter.Unfortunately, during my psychiatry residency in the UK, development of these intangible but essential boundaries was entirely absent from the curriculum. Early in training I struggled with my tendency to become an emotional chameleon with feelings and energies buffeted around by the prevailing emotions of each patient that walked through the door. I felt that patients expected me to offer tidy explanations for their suffering and provide answers to profound questions of meaning; to make the world a safe and understandable place. Given the complexity of mental illness and its interplay with social circumstances this was naïve and, I now realize, often unnecessary, but the weight of responsibility was unbearable. I was also completely unprepared for the intensity of human suffering I saw, and wholly unready to provide the level of interpersonal engagement required for genuine healing. My own emotional integrity felt threatened by the depth of patients’ needs, and my response—both physical and emotional—was intense and frightening.Much of my distress resulted from the profound and inevitable tension between the empathy necessary to comprehend patients’ experiences, which were often extreme and bewildering, and the need for resilience and self–protection at a time when my grasp of psychological theories and treatment practices was still rudimentary. I felt guilty that patients bore the brunt of my inexperience, and duplicitous purporting to help while burdening them with intolerable drug side–effects and stigmatizing, albeit effective, treatments such as electroconvulsive therapy (ECT). Time constraints and guidance from senior faculty encouraged expediency over treatment efficacy or durability; psychopharmacology was prioritized over the psychotherapeutic techniques and psychosocial interventions I found more effective for many patients. During the phase of our training that took place in a rambling, now defunct, asylum in the U.K, visits to the locked ward, which was reserved for patients considered a danger to others, were usually prompted by nurses’ requests for chemical restraint, the ‘pharmaceutical strait–jacket’. I was deeply uncomfortable with the role of ‘restrainer’ but had insufficient experience or seniority to propose other methods. It was only when, years later, I investigated re–training in the U.S that the senior psychiatry resident at a well–known program told me gently, ‘Oh, we assume that students will have a breakdown in their first year, so we have systems in place to help’. I’ll never forget those words; they are, to this day, the only validation of the emotional toll of my early training years.Adding to my discomfort were various ethically dubious administrative practices, the most troubling being the clinic’s unwillingness to disclose to patients that we were trainees, with little clinical experience. Senior faculty were dismissive when I asked whether my first psychotherapy patient had been told I was a trainee, indeed that I had never conducted psychotherapy before. My question was greeted with amusement and an assurance that, although she had not been told, I (not the patient, interestingly) would do fine.Due to the large number of no–shows in psychiatric outpatient clinics it was also standard practice to triple–book appointment times on the [End Page 115] assumption that one or more patients would fail to attend. Not uncommonly, more than one patient would arrive for the same appointment, leaving others to suffer agonizing waits that were often intensified by the deep discomfort... (shrink)

Summary Leading scholars offer perspectives from the philosophy of science on the crisis in psychiatric research that exploded after the publication of DSM-5. -/- Psychiatry and mental health research is in crisis, with tensions between psychiatry's clinical and research aims and controversies over diagnosis, treatment, and scientific constructs for studying mental disorders. At the center of these controversies is the Diagnostic and Statistical Manual of Mental Disorders (DSM), which—especially after the publication of DSM-5—many have found seriously flawed as (...) a guide for research. This book addresses the crisis and the associated “extraordinary science” (Thomas Kuhn's term for scientific research during a state of crisis) from the perspective of philosophy of science. The goal is to help reconcile the competing claims of science and phenomenology within psychiatry and to offer new insights for the philosophy of science. -/- The contributors discuss the epistemological origins of the current crisis, the nature of evidence in psychiatric research, and the National Institute for Mental Health's Research Domain Criteria project. They consider particular research practices in psychiatry—computational, personalized, mechanistic, and user-led—and the specific categories of schizophrenia, depressive disorder, and bipolar disorder. Finally, they examine the DSM's dubious practice of pathologizing normality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White River Junction, (...) Vermont to establish the V.A. National Center for Clinical Ethics. In this article I describe the organizational context, mission, operation, and future direction of the Center, which William A. Nelson, Ph.D., and I co-direct.The Veterans Health AdministrationThe Department of Veterans Affairs operates 171 hospitals providing services ranging from primary, secondary, and tertiary medical care to psychiatric hospitals, rehabilitation centers, and nursing homes. The V.A. also provides outpatient services at all hospitals and at dozens of free-standing outpatent clinics. V.A. medical centers employ over 14,000 physicians and serve approximately 4.5 million veteran patients (Hollingsworth and Bondy 1990; Mirvis 1990).The V.A. serves an important educational function, providing training sites for medical students, postgraduate physicians, and trainees in other health-related fields. Approximately 78 percent of V.A. medical centers are affiliated with medical schools. Over one-third of all American medical students and over 40 percent of interns and residents spend a portion of their training in V.A. medical centers. More than 100,000 students in all health-related fields train in V.A. facilities annually (Hollingsworth and Bondy 1990).Research is another mission of the V.A. Many academic physicians and scientists derive their research and salary funding from V.A contracts and awards. The V.A. Research Career Development Program provides the means for many medical school faculty members to achieve successful careers as scientists and clinical investigators. Although research accounts for only slightly more than 1 percent of the V.A. medical budget, two V.A. researchers have been awarded the Nobel Prize (Hollingsworth and Bondy 1990). [End Page 385]In comparison to other medical care settings, the average V.A. patient is likely to be older, poorer, male, less well-educated, more chronically ill, and more expensive to care for. Many patients first patronize the V.A. system after they have been bankrupted by the costs of a major illness. Unlike young, healthy patients ideally favored by health maintenance organizations, these patients immediately require large expenditures for hospitalizations, medications, and other treatments. Additional burdens have been placed on V.A. facilities by a record of chronic federal underfunding over the past decade, despite expanded patient censuses at every facility.Bioethical issues arise in V.A. facilities with great frequency for several reasons. Older and poorer patients are often sicker, have fewer home-support resources, and have completed fewer advance directives for health care. Chronic operational underfunding requires explicit health care rationing systemwide. Academic physicians within the V.A. system have multiple professional duties that have the potential for conflict. Although their primary duty is to their patients, they also must serve the federal government and their medical school academic supervisors. The practice of medical care rationing pits the physician's professional duty to his patient against his duty to the system (Mirvis 1990).The V.A. has responded to these bioethical demands with several initiatives. Hospital ethics advisory committees have been developed in nearly every V.A. medical center. The V.A. National Bioethics Committee has been empaneled to encourage uniform policies across the V.A. system concerning bioethical issues. Most recently, funds were provided for the V.A. National Center for Clinical Ethics.Functions of the National Center for Clinical Ethics (NCCE)The NCCE has a fourfold mission: 1) to enhance the quality of clinical ethics programs at all 171 V.A. medical centers nationwide; 2) to staff the V.A. National Bioethics Committee; 3) to assist administrators and planners in the V.A. Central Office on policy development concerning bioethical issues; and 4) to study, organize, and coordinate clinical, educational, and research bioethics programs throughout the system.Enhancing the quality of clinical ethics programs at V.A. medical centers is largely an... (shrink)

From the author: This dissertation undertakes a critical examination of one central problem in Hegelian philosophy: viz., whether the final realization of “absolute knowledge” is logically consistent with significant epistemic progress in the system’s continuing development. Serious consideration of the concept of systematic completeness, as interpreted on Hegel’s terms, uncovers the existence of a profound paradox. On the one hand, if the Truth is the Whole, then the truth of any finite part or aspect of that Whole depends upon its (...) place within the system as a totality. In order to grasp the part and comprehend it correctly, one must already have a systematically ordered knowledge of the universe in its entirety. Yet the methodological open-endedness of dialectical thinking precludes the acceptance of any particular theoretical formulation as final or complete in itself. Hegel interprets the history of philosophy as a progression of successive formulations of the Truth, each of which improves on its predecessors by reconciling their internal contradictions, but no one of which is adequate in itself. Hence, no theoretical world view, including Hegel’s own, can rest content within its limits, for the inevitable advance of thought must in the end throw it down. (shrink)

The IAB’s selection of the Qatar-based Research Center for Islamic Legislation & Ethics (CILE) for hosting the 2024 World Congress of Bioethics does not leave the international bioethics community...

Background Physical morbidity is rife among patients with serious mental illness. When they are involuntarily hospitalized and even treated, they may still refuse treatment for physical illness leading clinicians to wonder about the ethics of coercing such treatments. Research aim This survey study explored psychiatric caregivers’ perceptions on whether compulsory treatment of physical illness is legal and whether it is justifiable in patients with serious mental illness and under what circumstances. Research design A questionnaire that included two case vignettes (...) of an involuntarily hospitalized psychiatric patient with diabetes refusing treatment with insulin for various reasons. The cases differed in terms of diabetes severity. Participants answered questions regarding the appropriateness of involuntary treatment. Participants and research context Psychiatric medical doctors and nurses working in a mental health center. ( N = 89, 50 female, ages 26–66). Ethical considerations The study was approved by the Medical Centre Institutional Review Board (IRB) and the University Ethics Committee. The respondents’ anonymity was kept. Participation was voluntary and consent was obtained. Results The severity of the patient’s medical condition and their reason for refusing treatment were associated with participants’ willingness to give insulin despite patient objection [( F(1, 87) = 49.41, p <.01; ( F(1, 87) = 33.44, p <.01), respectively]. Participants were more inclined to support compulsory treatment if the patient’s refusal was “illness-oriented” (i.e. directly related to psychiatric illness). Participants presented diverse views regarding the perceived legality of compulsory treatment of physical illness in such situations (illegal 63.09%; legal 23.8%; 13% unsure). The majority (53.5%–55.3%) of those who thought it was illegal supported compulsory treatment in high-severity, illness-oriented refusal situations. Conclusions The severity of the medical condition and the reason for treatment refusal influence psychiatric caregivers’ willingness to provide compulsory treatment for physical illness in involuntary hospitalized psychiatric patients. Beyond the legal framework, ethical guidelines for these situations are warranted, while decisions should be made on a case-by-case basis. (shrink)

God is playful. Like a child building sand castles on the beach, God creates the world and destroys it again. God plays with his (or her) devotees, sometimes like a lover, sometimes like a mother with her children, sometimes like an actor in a play. The idea of God's playfulness has been elaborated in Hinduism more, perhaps, than any other religion, providing one of the most distinctive and charming aspects of Indian religious life. Lila or "divine play" can refer (...) to many things: to God's playful creation of the world and to religious dramas or "plays," as well as to various motifs in Hindu art. But despite the importance of lila in the cultural history of South Asia, few comprehensive studies of it are available, partly because scholars have tended to emphasize only one dimension of lila--either the theological or the performative--at the expense of the other. The Gods at Play fills this gap by bringing together scholarly essays on all aspects of this important Hindu idea, providing students with a broader understanding of popular Hindu culture and religion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 32.3-4 (2002) 33-59 [Access article in PDF] Amnesty or Impunity? A Preliminary Critique of the Report of the Truth and Reconciliation Commission of South Africa (TRC) Mahmood Mamdani The Truth and Reconciliation Commission of South Africa was the fruit of a political compromise whose terms both made possible the Commission and set the limits within which it would work. These limits, in turn, defined the space (...) available to the Commission to interpret its terms of reference and define its agenda. This paper takes the compromise legislation that set up the TRC as a historical given and focuses attention on the TRC's interpretation of its terms of reference.The TRC claimed to be different from its predecessors, whether in Latin America or Eastern Europe. It would practice neither impunity nor vengeance. It was therefore determined to avoid two pitfalls: on the one hand, reconciliation becoming an unprincipled embrace of political evil and, on the other hand, a pursuit of justice so relentless as to turn into revenge. To do so, the Commission was determined to address both "victims" and "perpetrators," not just one or the other.This double determination was first written into the interim constitution that paved the way for the legislation that set up the TRC. First, there would be no blanket amnesty. Amnesty would be conditional. It would not be a group amnesty. Every perpetrator would have to be identified individually, and would have to own up to his or her guilt—the truth—before receiving amnesty from legal prosecution. Second, any victim who is so acknowledged would give up the right to prosecute perpetrators in courts of law. Justice for the victim would thus not be criminal but restorative: acknowledgment would be followed by reparations. In sum, individual amnesty for the perpetrator, truth for the society, and acknowledgement and reparations for the victim—this was the pact built into the legislation that set up the TRC.Since the Act did not clearly define "victim," however, the definition of "perpetrator" was unclear as well. The task of defining "victim" and "perpetrator" was left to the Commission and was the single most important decision that determined the scope and depth of the Commission's work. Without a comprehensive acknowledgment of victims of apartheid, there would be only a limited identification of perpetrators and only a partial understanding of the legal regime that made possible the "crime against humanity." From this perspective, the paper identifies three key limitations in the Commission's Report.First, the TRC individualized the victims of apartheid. Though it acknowledged apartheid as a "crime against humanity" which targeted entire communities for ethnic and racial policing and cleansing, the Commission majority was reluctant to go beyond the formal acknowledgment. The Commission's analysis reduced apartheid from a relationship between the state and entire communities to one between the state and [End Page 33] individuals. Where entire communities were victims of gross violations of rights, the Commission acknowledged only individual victims. If the "crime against humanity" involved a targeting of entire communities for racial and ethnic cleansing and policing, individualizing the victim obliterated this particular—many would argue central—characteristic of apartheid. Limiting the definition of harm and remedy to individuals center-staged political activists as victims of apartheid, as indeed happened with the victim hearings. The consequence was to narrow the TRC perspective to a political reconciliation between state agents and political activists, individual members of a fractured political elite, rather than the "national unity and reconciliation" mandated by the legislation that set it up. To pursue its actual mandate, the TRC needed to broaden its perspective: to work for a social reconciliation between perpetrators and victims required that the relationship between the state and the entire South African people be addressed.Second, by focusing on individuals and obscuring the victimization of communities, the TRC was unable to highlight the bifurcated nature of apartheid as a form of power that governed natives differently from non-natives. If the apartheid state spoke the language of rights to... (shrink)

Following the recent call for advancement in knowledge about business ethics in East Asia, this study proposes a complementary perspective on business ethics in South Korea. We challenge the conventional view that South Korea is a strictly collectivist country, where group norms and low trust determine the norms and values of behavior. Using the concept of civil religion, we suggest that the center of the South Korean civil religion can be seen in the affective ties and (...) networks pervading the economic, political, and social institutions, embedded in and guided by Confucian ideals. We argue that South Korea should be seen not as a collectivist low-trust society, but rather as an affective-relational society, in which the relational context determines whether collectivism or individualism prevails. Further, we assert that trust, the cohesive factor of affective ties and networks, has until now been inadequately captured by conventional surveys. Our proposed perspective contributes to a more holistic picture and a more firmly grounded understanding of business ethics in South Korea. (shrink)

Shortly before and during World War II many European psychoanalysts found refuge in South America, concentrated in Buenos Aires. Here, together with local professionals, they created a strong, creative and productive psychoanalytic movement that in turn gave birth to theoretical and clinical contributions that transformed psychoanalysis, psychology, medicine and culture in South America. _The Pioneers of Psychoanalysis in South America_ is a collection of those pioneers’ papers, and introduces the reader to a body of ideas and advancements, (...) many of which have had limited and piecemeal exposure within the psychoanalytic community in the rest of the world until now. The editors Nydia Lisman-Pieczanski and Alberto Pieczanski present original papers and essays, many of which have never before been published in English; those that have been translated were rarely presented in context. Each one of the chapters is accompanied by a scholarly introduction written by psychoanalysts, many of whom personally knew the pioneers and their oeuvres in depth, tracing the roots of their ideas in the European analytic schools. _The Pioneers of Psychoanalysis in South America _is divided into six main sections: Psychoanalytic process Psychoanalytic technique Metapsychology Psychoanalysis of children Culture and society Psychosomatic medicine. Nydia Lisman-Pieczanski and Alberto Pieczanski provide a coherent guide to the seminal ideas and practices of the South American psychoanalysts who have made major theoretical and clinical contributions to the advancement of the psychoanalytic discipline. The chapters present the material in a way that is accessible to psychoanalysts from across the globe and will enable them to incorporate the ideas and practices outlined here into their everyday psychoanalytic work. It will also be of interest to psychoanalytic psychotherapists, academics interested in the history and development of psychoanalytic ideas and psychoanalysis, and advanced students. The following link leads to an video interview featuring Nydia Lisman-Pieczanski and Alberto Pieczanski by the Washington Center for Psychoanalysis for the History Project, where they open up about their stories, their marriage, and their new book: https://www.routledge.com/posts/8996. (shrink)

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa. A systematic search of good clinical practice guidelines was conducted employing search strategies modeled in line with the recommendations of ADPTE Collaboration. The search focused (...) on three main areas namely bibliographic data bases, clinical practice guidelines data bases and a restricted internet search. A manual search of references cited in relevant guideline documents was also conducted. The search terms, Medical Subject Headings and key words were developed for a PubMed platform and then adapted for all other data bases. The search terms were kept constant for each country with the only difference being the country name. The documents so obtained were subjected to systematic content analysis. The study revealed that there is vast panoply of regulations which exist on a continuum. On one extreme is India with comprehensive regulations that are codified into law, and on the other end there is China which does not have specific laws regulating research related injuries. There are a number of differences and similarities such as mandatory insurance requirements, existence of no fault compensation, compensable injuries and the role of research ethics committees. It is imperative to enact legislations that protect participants without stifling the research enterprise. There is need for consistency and ideally harmonization of such regulations at a global level. A model policy on compensation for research related injuries should borrow from the best aspects of the different country policies and should be informed by the cardinal ethics principles of autonomy, justice and beneficence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 32.3-4 (2002) 33-59 [Access article in PDF] Amnesty or Impunity? A Preliminary Critique of the Report of the Truth and Reconciliation Commission of South Africa (TRC) Mahmood Mamdani The Truth and Reconciliation Commission of South Africa was the fruit of a political compromise whose terms both made possible the Commission and set the limits within which it would work. These limits, in turn, defined the space (...) available to the Commission to interpret its terms of reference and define its agenda. This paper takes the compromise legislation that set up the TRC as a historical given and focuses attention on the TRC's interpretation of its terms of reference.The TRC claimed to be different from its predecessors, whether in Latin America or Eastern Europe. It would practice neither impunity nor vengeance. It was therefore determined to avoid two pitfalls: on the one hand, reconciliation becoming an unprincipled embrace of political evil and, on the other hand, a pursuit of justice so relentless as to turn into revenge. To do so, the Commission was determined to address both "victims" and "perpetrators," not just one or the other.This double determination was first written into the interim constitution that paved the way for the legislation that set up the TRC. First, there would be no blanket amnesty. Amnesty would be conditional. It would not be a group amnesty. Every perpetrator would have to be identified individually, and would have to own up to his or her guilt—the truth—before receiving amnesty from legal prosecution. Second, any victim who is so acknowledged would give up the right to prosecute perpetrators in courts of law. Justice for the victim would thus not be criminal but restorative: acknowledgment would be followed by reparations. In sum, individual amnesty for the perpetrator, truth for the society, and acknowledgement and reparations for the victim—this was the pact built into the legislation that set up the TRC.Since the Act did not clearly define "victim," however, the definition of "perpetrator" was unclear as well. The task of defining "victim" and "perpetrator" was left to the Commission and was the single most important decision that determined the scope and depth of the Commission's work. Without a comprehensive acknowledgment of victims of apartheid, there would be only a limited identification of perpetrators and only a partial understanding of the legal regime that made possible the "crime against humanity." From this perspective, the paper identifies three key limitations in the Commission's Report.First, the TRC individualized the victims of apartheid. Though it acknowledged apartheid as a "crime against humanity" which targeted entire communities for ethnic and racial policing and cleansing, the Commission majority was reluctant to go beyond the formal acknowledgment. The Commission's analysis reduced apartheid from a relationship between the state and entire communities to one between the state and [End Page 33] individuals. Where entire communities were victims of gross violations of rights, the Commission acknowledged only individual victims. If the "crime against humanity" involved a targeting of entire communities for racial and ethnic cleansing and policing, individualizing the victim obliterated this particular—many would argue central—characteristic of apartheid. Limiting the definition of harm and remedy to individuals center-staged political activists as victims of apartheid, as indeed happened with the victim hearings. The consequence was to narrow the TRC perspective to a political reconciliation between state agents and political activists, individual members of a fractured political elite, rather than the "national unity and reconciliation" mandated by the legislation that set it up. To pursue its actual mandate, the TRC needed to broaden its perspective: to work for a social reconciliation between perpetrators and victims required that the relationship between the state and the entire South African people be addressed.Second, by focusing on individuals and obscuring the victimization of communities, the TRC was unable to highlight the bifurcated nature of apartheid as a form of power that governed natives differently from non-natives. If the apartheid state spoke the language of rights to... (shrink)

Western representation of countries from the Global South implies a dichotomist view of business ethics: on the one hand, universal ethics largely reproduces commonsensical views of the South as ‘less ethical’, and on the other hand, voices from the South are often conditioned to present themselves as substantially indigenous and unambiguous to be accepted as legitimate ethical subjects. We join the growing interest in bridging this gap by drawing on studies from human geography, and ask to what (...) extent the materiality of moral dilemmas bespeaks the disputed underpinning ethical values of a given space. Drawing on Henri Lefebvre’s perspective of the production of social space, we outline and apply the idea of ‘spatial ethics’ to organizations, in order to approach the entanglement between center and periphery. We analyze organizations in favelas, which are, for many authors, territories where experiences are extreme, and poverty and violence mix with vibrant culture and ingenuity. We critically approach the field of business ethics and suggest that one way of moving beyond the North–South debate is to consider that ethics cannot be transmitted or represented in empty milieus. (shrink)

This article examines the neurobiological basis of the healing power attributed to shamanic practices in the Andes and Brazil in light of the pharmacology of neurotransmitters and the new technological explorations of brain functioning. The psychotropic plants used in shamanic psychiatric cures interfere selectively with the intrinsic neuromediators of the brain. Mainly they may alter: (1) the neuroendocrine functioning through the adrenergic system by controlling stressful conditions, (2) the dopaminergic system in incentive learning and emotions incorporation, (3) the serotoninergic (...) system in modulating behaviors, and mood, and (4) basic functions implied in anxiety or depression. PET scans and functional magnetic resonance imaging studies of hypnotic trance and altered states of consciousness may provide a useful model for the neurophysiological phenomena of shamanic drum-and-dance trance. The reorganization of cortical areas and the direct interconnections between the prefrontal cortex and the dopaminergic reward centers in the limbic system are of particular significance for human social judgment and symbolic processing. Those centers—including the hypothalamus and the amygdala (associated with psychosomatic equilibrium, memory, and emotion) are enhanced. This arousal may be amplified in order to induce a cathartic crisis—the shamanic trance. It is suggested that through this holistic approach the shaman empirically interferes in neurobiological dysfunctions. (shrink)

Explores the metaphysical, epistemological, and hermeneutical theories of Schelling’s final system concerning the nature and meaning of religious mythology.

Resumen: Las cambiantes relaciones entre seres humanos y árboles en los relatos de los habitantes cordilleranos del sur de Chile invitan a revisar los límites de la comunidad moral para incluir en ella a los seres con que se convive y de los que se depende. La presencia de prácticas mapuches cordilleranas de largo aliento junto con las transformaciones experimentadas por las poblaciones madereras y los relatos de las personas que explotaron los árboles nativos se encarnan en conversaciones que invitan (...) a reformular el vínculo con la naturaleza, tomando como referencia la pluralidad de experiencias locales. Estas voces cordilleranas convergen con aquellas orientaciones filosóficas que reconocen al ser humano como parte y no como centro de un entramado vital de mayores y más complejas dimensiones, a la vez que, en un sentido práctico, con la urgencia de generar respuestas que resguarden la naturaleza y que garanticen la inclusión social y la convivencia intercultural.: The changing relations between human and trees open opportunities in the narratives of the south Andean residents to expand the moral duties towards those beings upon whom humans depend and with whom they live. The existence of long lasting Mapuche cultural practices in the mountainous areas along with the transformations of timber towns and the narratives of people who exploited the native trees in those territories prompt a reshaping of the link with nature by means of the creation of moral duties based upon the diversity of local experiences. Such an alternative coincides with those philosophical orientations that recognize humans as part and not as the center of a vital patchwork. At the same time, it relates to the need of alternatives to preserve nature while guaranteeing social inclusion and intercultural coexistence. (shrink)

The literature on gender and health typically addresses behavioral patterns when discussing men’s attitudes to health. Few of these studies explore men’s anxieties or presentations of self in relation to health problems, particularly for stigmatizing conditions such as sexually transmitted infections. Through direct observation and focus group interviews of health workers, clients, and students, this study explores African American men’s attitudes toward attending STI clinics in the Deep South. The men’s concerns about STI clinics center on realistic health (...) or stigma-related concerns. Using a gender-relational analysis, three main sources of fear are identified in relation to attending the clinics: Gender anxiety, social anxiety, and racial anxiety. These fears present a barrier to STI care for African American men. (shrink)