As we go to press, the threat of biological or chemical warfare in the Persian Gulf is no longer imminent. Yet the questions raised by the proposed use of “investigational drugs,” without informed consent, to protect U.S. troops remain. The article by Edmund G. Howe and Edward D. Martin presents the arguments that informed the Pentagon's thinking on the subject. It and the commentaries, by George J. Annas and Michael A. Grodin, and Robert J. Levine, explore, among others, issues (...) of informed consent, of distinguishing ‘research’ and ‘treatment,’ and of the nature and extent of the autonomy of military personnel.—B‐JC, HLN. (shrink)

In people with chronic low back pain, maladaptive structural and functional changes on a cortical level have been identified. On a functional level, somatosensory cortical excitability has been shown to be reduced in chronic pain conditions, resulting in cortical disinhibition. The occurrence of structural and/or functional maladaptive cortical changes in people with CLBP could play a role in maintaining the pain. There is currently no measurement protocol for cortical excitability that employs stimulation directly to the lower back. We developed a (...) protocol for the measurement of single pulse somatosensory evoked potential waveforms and paired-pulse behavior generated from sensory nerves of the lower back and quantified its test–retest reliability in a sample of 30 healthy individuals to gain insights into the normal variability of cortical responses, which could then be compared to results from people with CLBP. We investigated cortical excitability by measuring SEPs and PPB. PPB was defined as the ratio of the amplitude of the second cortical response divided by the first cortical response. A2s was determined by subtracting the response to single-pulse stimuli from the paired pulse stimuli response to account for linear superposition effects. The test–retest reliability of the protocol was very poor with no evidence of systematic bias but a high amount of random variability between sessions. There was no significant difference in the right side PPB for session 1 and session 2 ; mean session difference [ = −0.44 ; t = −1.17, p = 0.26]. The ICC3.1 for the outlier-removed right side PPB were 0.19 and 0.43 for left side PPB. This finding potentially has wider implications for PPB protocols. If these findings were replicated in other groups and other nerves, it would question the validity of this measure more generally. However, these findings are restricted to healthy people and sensory nerves of the lower back and may not be generalizable. (shrink)

In this work, on the one hand, we examined the relationship between emotional intelligence (EI) and empathy and, on the other, the relationship between emotional intelligence and nonverbal sensitivity, through two independent studies. The first study analyzed the relationship between dimensions of emotional intelligence and aspects of empathy, in a sample of 856 participants who completed two measures of EI, the Trait Meta-Mood Scale (TMMS) and the Trait Emotional Intelligence Questionnaire (TEIQue), and a measure of empathy, The Interpersonal Reactivity Index (...) (IRI). The results showed a similar pattern of significant positive relations in all the EI domains with empathic Perspective-taking, and significant negative relationships with empathic Personal Distress, except for the EI domain of Attention, which had a positive relationship. Stepwise multiple regression analyses showed that the dimension that best predicted empathic Perspective-taking and Empathic Concern was the Emotionality Factor; whereas Attention best predicted empathic Fantasy; and the Self-Control Factor best predicted Personal Distress, although negatively. Gender emerged as a predictor of three empathic aspects, Fantasy, Empathic Concern, and Personal Distress, with women obtaining higher scores than men in all of them. Age was the only predictor of Fantasy, with a negative relationship. The second study involved 646 people who completed the same measures of EI as the participants of the first study and the Mini-Profile of Nonverbal Sensitivity (Mini-PONS). The results showed some significant relationships between EI dimensions and the channels and quadrants of the MiniPONS. Stepwise multiple regression analyses showed that very few EI dimensions predicted nonverbal sensitivity, with Attention obtaining the best result. Both gender and age emerged as predictors, some in unique cases, of channels, quadrants and of the total score of nonverbal sensitivity; age had a negative relationship, and women obtained higher scores than men. (shrink)

Experimental studies have suggested that variables such as aptness or conventionality are predictors of people’s preference for expressing a particular topic–vehicle pair as either a metaphor or a simile. In the present study, we investigated if such variables would also be predictive within a more naturalistic context, where other variables, such as the intention to include an explanation, may also influence people’s decision. Specifically, we investigated the production of metaphor and simile expressions on the Internet via the Google search engine (...) and checked for accompanying explanations, as well as the properties they expressed, to examine whether ratings such as aptness, conventionality, as well as participants’ own stated preference or the intention to produce an explanation, would predict which topic–vehicle pairs appeared more often as metaphor. We found that participants’ stated preference predicted metaphor dominance on the Internet, and that apt topic–vehicles occurred more often as metaphors. The explanations collected, however, occurred 82% of the time after similes, and familiar expressions were the most explained. Finally, comparing the properties expressed in these explanations to normed property lists, we found that simile explanations typically expressed a novel conception of the topic–vehicle relationship. Therefore, we found that Internet posters use metaphors to convey an apt relationship, as found in previous laboratory studies, but prefer using a simile frame when they want to express a relationship that readers will find novel. (shrink)

To incorporate medical ethics into clinical practice, it must first be understood and valued by health care professionals. The recognition of this principle led to an expanding and continuing educational effort by the ethics committee of the Vancouver General Hospital. This paper reviews this venture, including some pitfalls and failures, as well as successes. Although we began with consultants, it quickly became apparent that education in medical ethics must reach all health care professionals—and medical students as well. Our greatest successes (...) came in the formative years of a medical career (ie, in medical school and residency training programmes), but other efforts were not wasted, particularly among nurses and other health care professionals.Although this is a personal review of the experience in one institution, the lessons learnt in Vancouver are applicable to the further development of medical ethics in the UK. (shrink)

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

Disjunctivism about perceptual appearances, as I conceive of it, is a theory which seeks to preserve a naïve realist conception of veridical perception in the light of the challenge from the argument from hallucination. The naïve realist claims that some sensory experiences are relations to mind-independent objects. That is to say, taking experiences to be episodes or events, the naïve realist supposes that some such episodes have as constituents mind-independent objects. In turn, the disjunctivist claims that in a case of (...) veridical perception like this very kind of experience that you now have, the experiential episode you enjoy is of a kind which could not be occurring were you having an hallucination. The common strategy of arguments from hallucination set out to show that certain things are true of hallucinations, and hence must be true of perceptions. For example, it is argued that hallucinations must have non-physical objects of awareness, or that such states are not relations to anything at all, but are at best seeming relations to objects. In insisting that veridical perceptual experience is of a distinct kind from hallucination, the disjunctivist denies that any of these conceptions of hallucination challenges our conception of veridical perceptions as relations to mind-independent objects. More specifically, I assume that the disjunctivist advocates naïve realism because they think that this position best articulates how sensory experience seems to us to be just through reflection. If the disjunctivist is correct in this contention, then anyone who accepts the conclusion of the argument from hallucination must also accept that the nature of sensory experience is other than it seems to us to be. In turn, one may complain that any such error theory is liable to lead to sceptical consequences. A Humean scepticism about the senses launches a challenge about our knowledge of the world through questioning the conception we have of what sense experience is, and how it can provide knowledge of the world. (shrink)

Book description: The capacity to represent and think about time is one of the most fundamental and least understood aspects of human cognition and consciousness. This book throws new light on central issues in the study of the mind by uniting, for the first time, psychological and philosophical approaches dealing with the connection between temporal representation and memory. Fifteen specially written essays by leading psychologists and philosophers investigate the way in which time is represented in memory, and the role memory (...) plays in our ability to reason about time. They offer insights into current theories of memory processes and of the mechanisms and cognitive abilities underlying temporal judgements, and draw out fundamental issues concerning the phenomenology and epistemology of memory and our understanding of time. The chapters are arranged into four sections, each focused on one area of current research: Keeping Track of Time, and Temporal Representation; Memory, Awareness and the Past; Memory and Experience; Knowledge and the Past: The Epistemology and Metaphysics of Time. A general introduction gives an overview of the topics discussed and makes explicit central themes which unify the different philosophical and psychological approaches. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

The disjunctive theory of perception claims that we should understand statements about how things appear to a perceiver to be equivalent to statements of a disjunction that either one is perceiving such and such or one is suffering an illusion (or hallucination); and that such statements are not to be viewed as introducing a report of a distinctive mental event or state common to these various disjoint situations. When Michael Hinton first introduced the idea, he suggested that the burden of (...) proof or disproof lay with his opponent, that what was needed was to show that our talk of how things look or appear to one.. (shrink)

Disjunctivism about perceptual appearances, as I conceive of it, is a theory which seeks to preserve a na.

Listening to someone from some distance in a crowded room you may experience the following phenomenon: when looking at them speak, you may both hear and see where the source of the sounds is; but when your eyes are turned elsewhere, you may no longer be able to detect exactly where the voice must be coming from. With your eyes again fixed on the speaker, and the movement of her lips a clear sense of the source of the sound will (...) return. This ‘ventriloquist’ effect reflects the ways in which visual cognition can dominate auditory perception. And this phenomenological observation is one what you can verify or disconfirm in your own case just by the slightest reflection on what it is like for you to listen to someone with or without visual contact with them. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

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

A long-standing theme in discussion of perception and thought has been that our primary cognitive contact with individual objects and events in the world derives from our perceptual contact with them. When I look at a duck in front of me, I am not merely presented with the fact that there is at least one duck in the area, rather I seem to be presented withthisthing (as one might put it from my perspective) in front of me, which looks to (...) me to be a duck. Furthermore, such a perception would seem to put me in a position not merely to make the existential judgment that there is some duck or other present, but rather to make a singular, demonstrative judgment, that that is a duck. My grounds for an existential judgment in this case derives from my apprehension of the demonstrative thought and not vice versa. (shrink)

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

Listening to someone from some distance in a crowded room you may experience the following phenomenon: when looking at them speak, you may both hear and see where the source of the sounds is; but when your eyes are turned elsewhere, you may no longer be able to detect exactly where the voice must be coming from. With your eyes again fixed on the speaker, and the movement of her lips a clear sense of the source of the sound will (...) return. This ‘ventriloquist’ effect reflects the ways in which visual cognition can dominate auditory perception. And this phenomenological observation is one that you can verify or disconfirm in your own case just by the slightest reflection on what it is like for you to listen to someone with or without visual contact with them. (shrink)

A common objection to sense-datum theories of perception is that they cannot give an adequate account of the fact that introspection indicates that our sensory experiences are directed on, or are about, the mind-independent entities in the world around us, that our sense experience is transparent to the world. In this paper I point out that the main force of this claim is to point out an explanatory challenge to sense-datum theories.

This interview deals with the major themes in the work of Ruth Millikan. Her most fundamental idea is that the intentionality of inner and outer representations can be understood in analogy to biological functions. Another innovative feature is the view that thought and language stand parallel to each other. Thirdly, the basic ideas concerning the ontology and the epistemology of concepts are explained. Millikan aims at clarifying her position by contrasting it with Dretske, Fodor, Sellars, and Brandom. Finally, the interview (...) addresses topics that pose problems for her account as well as questions she does not treat in her work. (shrink)

One of the areas of concern raised by cross-border reproductive travel regards the treatment of women who are solicited to provide their ova or surrogacy services to foreign consumers. This is particularly troublesome in the context of developing countries where endemic poverty and low standards for both medical care and informed consent may place these women at risk of exploitation and harm. We explore two contrasting proposals for policy development regarding the industry, both of which seek to promote ethical outcomes (...) and social justice: While one proposal advocates efforts to minimize cross-border demand for female reproductive resources through the pursuit of national self-sufficiency, the other defends cross-border trade as a means for meeting the needs of vulnerable groups. Despite the conflicting objectives of the proposed strategies, the paper identifies common values and points of agreement between the two, including the importance of regulations to safeguard those providing ova or surrogacy services. (shrink)