Medical classification systems aim to provide a manageable taxonomy for sorting diagnoses into their proper classes. The question, this paper wants to critically examine, is how to correctly systematise diseases within classification systems that are applied in a variety of different settings. ICD and DSM , the two major classification systems in medicine and psychiatry, will be the main subjects of this paper; however, the arguments are not restricted to these classification systems but point out general methodological and epistemological challenges (...) of classifying diseases for differing purposes. Deciding what qualifies as a disease to be included into a classification system as well as choosing a specific validator for correctly systematising diseases is complicated because the broad applicability of medical classification systems simultaneously appears as aim and challenge. Drawing upon the case study of classifying Alzheimer’s disease, this paper will address three dilemmas in designing ‘good’ medical classification systems. They are due to general epistemological problems of medicine, such as the relationship between individual manifestations of diseases and the necessity of building groups in order to scientifically elucidate causes of diseases. Moreover, they involve pragmatic issues of designing usable classifications that allow for easily discriminating between classes of diseases, restricting, however, the completeness of disease representations. This paper wants to trace how the choice of certain validators is unavoidably value-laden and deeply intertwined with epistemological assumptions of how different uses relate to each other, resulting either in a prioritisation of (constrained) coherence or of (vague) pluralistic connectibility. (shrink)

Next SectionThe current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value of (...) early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given “disease” in non-research-oriented medical settings? The very problem of framing this question in terms of diagnostic misconceptions connects conceptual with ethical issues of research into preclinical stages of neurodegenerative diseases. (shrink)

Medicine in a Neurocentric World: About the Explanatory Power of Neuroscientific Models in Medical Research and Practice Content Type Journal Article Category Editorial Notes Pages 307-313 DOI 10.1007/s12376-009-0036-2 Authors Lara Huber, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 Mainz Germany Lara K. Kutschenko, University Medical Center of the Johannes Gutenberg University Mainz Institute for History, Philosophy and Ethics of Medicine Am Pulverturm 13 55131 (...) Mainz Germany Journal Medicine Studies Online ISSN 1876-4541 Print ISSN 1876-4533 Journal Volume Volume 1 Journal Issue Volume 1, Number 4. (shrink)

Curricular design that addresses residency physician competencies in communication skills and professionalism remains a challenge. Graphic Medicine uses comics, a medium combining text and images, to communicate healthcare concepts. Narrative Medicine, in undergraduate medical education, has limited reported usage in Graduate Medical Education. Given the time constraints and intensity of GME, we hypothesized that comics as a form of narrative medicine would be an efficient medium to engage residents.The authors created a novel curriculum to promote effective communication and professionalism, focusing (...) on empathy, compassion and cultural competency. A four-week curriculum was delivered in a neurology residency program. Excerpts from non-fiction graphic memoirs about neurological conditions were read, discussed, and paired with prompt-driven drawing exercises. Qualitative surveys were used to assess acceptability of comics, usefulness of comics to convey patient illness experience, and perception of patient needs for physician-patient communication.Ninety-seven percent of residents reported the sessions were a good use of their time. Residents identified new symptoms of neurologic disorders, articulated patient communication needs, and expressed increased empathy after participation. Residents participated in drawing exercises, but these were not formally analyzed. Graphic medicine is a well received format that may build communication skills and increase empathy. (shrink)

Feminist relational theory can provide a theoretical framework for understanding and affirming the agency of women Cambodian religious leaders; an agency that can be overlooked if one assumes it co...

Eyewitnesses to crimes sometimes search for a culprit on social media before viewing a police lineup, but it is not known whether this affects subsequent lineup identification accuracy. The present online study was conducted to address this. Two hundred and eighty-five participants viewed a mock crime video, and after a 15–20 min delay either viewed a mock social media site including the culprit, viewed a mock social media site including a lookalike, or completed a filler task. A week later, participants (...) made an identification from a photo lineup. It was predicted that searching for a culprit on social media containing the lookalike would reduce lineup identification accuracy. There was a significant association between social media exposure and lineup accuracy for the Target Present lineup, but for the Target Absent lineup there was no significant association with lineup identification accuracy. The results suggest that if an eyewitness sees a lookalike when conducting a self-directed search on social media, they are less likely to subsequently identify the culprit in the formal ID procedure. (shrink)

Background: The brief generic Multicultural Quality of Life Index is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life. QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder in children might negatively influence the parents’ QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of children (...) with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD.Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index, and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5.Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach’s alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high, reflecting convergent validity since the association between the two measures was strong.Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS. (shrink)

O presente artigo analisa a leitura de Hannah Arendt sobre os textos de Franz Kafka, o que será feito a partir do prefácio de Entre o passado e o futuro, dos ensaios Franz Kafka: uma reavaliação e O judeu como pária: uma tradição oculta, além das narrativas kafkianas Descrição de uma luta, O Processo, O Castelo e da parábola Ele, identificando tanto o que as vincula como o definhamento do humano retratado pelo escritor. Porquanto o absurdo que reveste o cenário (...) descrito por Kafka é percebido por Arendt como um presságio dos horrores praticados pelos regimes totalitários, nossa hipótese é que discutir a leitura da autora sobre os textos kafkianos auxilia a compreensão sobre as consequências desastrosas que as relações sociais podem acarretar e a desfiguração fomentada pela burocracia como aparelho organizacional e forma de governo que normaliza os procedimentos de rotina, os massacres administrativos, a obediência cadavérica e os processos infindáveis baseados em legislações superiores, utilizados como meios de gerir indivíduos desarraigados, indistinguíveis e massificados. (shrink)

Kant’s _Groundwork for the Metaphysics of Morals_, first published in 1785, is still one of the most widely read and influential works of moral philosophy. This Broadview edition combines a newly revised version of T.K. Abbott’s respected translation with material crucial for placing the _Groundwork_ in the context of Kant’s broader moral thought. A varied selection of other ethical writings by Kant on subjects including our moral duties, fundamental principles of justice, the concept of happiness, and the relation of morality (...) to religion are included, along with important criticisms of Kant’s ethics by Fichte, Schiller, Hegel, and Sidgwick. (shrink)

Tarihte herhalde çok az soru Tanrı’nın varlığı sorusu kadar sık sorulmuş, çok yanıtlanmış ve verilen birbirinden farklı onca yanıta rağmen kesin bir sonuca ulaştırılamayıp tartışılmaya devam etmiştir. Yine de geçmişe dönüp baktığımızda bu soruya verilen farklı yanıtların farklı uygarlıkların inşa edilmesine, bazılarının yıkılmasına, acımasız çatışmalara ve her şeye rağmen kucaklaşmalara da vesile olduğunu görüyoruz. Tanrı var mı? Varsa onu nasıl bilebiliriz? Tanrı yoksa her şey mubah mı? İnsan aklı ilahi olanı kavrayabilir mi? Tanrı’nın varlığı ahlaklı olmanın şartı mı? Evren akıllı (...) bir tasarımcının imzasını taşıyor mu? Bu kitapta felsefeci William David Beck, bu sorulara tarihte verilen yanıtları ve bu konudaki tartışmaları ele alarak meselenin genel ve tarihsel bir tablosunu bize sunuyor. Platon, Aristoteles, Marcus Aurelius gibi Eski Yunan ve Roma düşünürlerinden Anselmus, Thomas Aquinas, Augustinus ve Yahudi-Hıristiyan geleneğine, Doğu’nun bilgelerine, İbni Rüşd, Fârâbî ve Gazzâlî gibi İslam düşünürlerinden Alvin Plantinga, Graham Oppy, Sam Harris, Richard Dawkins, Max Tegmark gibi Batılı modern ilahiyatçılara, bilim insanlarına ve Yeni Ateizm hareketine kadar uzanan bir çizgide “Tanrı var mı?” sorusuna verilen çeşitli yanıtları ve bu yanıtlara sunulan akılcı gerekçeleri ortaya koyarak soruya felsefece bir yanıt vermenin nasıl bir iş olduğunu da gösteriyor. (shrink)

Lara Buchak sets out a new account of rational decision-making in the face of risk. She argues that the orthodox view is too narrow, and suggests an alternative, more permissive theory: one that allows individuals to pay attention to the worst-case or best-case scenario, and vindicates the ordinary decision-maker.

Conceptions of evil have changed dramatically over time, and though humans continue to commit acts of cruelty against one another, today we possess a clearer, more moral way of analyzing them. In _Narrating Evil_, María Pía Lara explores what has changed in our understanding of evil, why the transformation matters, and how we can learn from this specific historical development. Drawing on Immanuel Kant's and Hannah Arendt's ideas about reflective judgment, Lara argues that narrative plays a key role (...) in helping societies acknowledge their pasts. Particular stories haunt our consciousness and lead to a kind of examination and dialogue that shape notions of morality. A powerful description of a crime can act as a filter, helping us to draw conclusions about what constitutes a moral wrong, and public debates over these narratives allow us to construct a more accurate picture of historical truth, leading to a better understanding of why such actions are possible. In building her argument, Lara considers Greek tragedies, Shakespeare's depictions of evil, Joseph Conrad's literary metaphors, and movies that portray human cruelty. Turning to such philosophers and writers as Jürgen Habermas, Walter Benjamin, Primo Levi, Giorgio Agamben, and Ariel Dorfman, Lara defines a reflexive relationship between an event, the narrative of the event, and the public reception of the narrative, and she proves that the stories of perpetrators and sufferers are always intertwined. The process of disclosure, debate, and the public fashioning of collective judgment are vital methods through which we make sense not only of new forms of cruelty but of past crimes as well. _Narrating Evil_ describes the steps of this process and why they are a crucial part of our attempt to build a different, more just world. (shrink)

There are currently two robust traditions in philosophy dealing with doxastic attitudes: the tradition that is concerned primarily with all-or-nothing belief, and the tradition that is concerned primarily with degree of belief or credence. This paper concerns the relationship between belief and credence for a rational agent, and is directed at those who may have hoped that the notion of belief can either be reduced to credence or eliminated altogether when characterizing the norms governing ideally rational agents. It presents a (...) puzzle which lends support to two theses. First, that there is no formal reduction of a rational agent’s beliefs to her credences, because belief and credence are each responsive to different features of a body of evidence. Second, that if our traditional understanding of our practices of holding each other responsible is correct, then belief has a distinctive role to play, even for ideally rational agents, that cannot be played by credence. The question of which avenues remain for the credence-only theorist is considered. (shrink)

This paper provides an account of what it is to have faith in a proposition p, in both religious and mundane contexts. It is argued that faith in p doesn’t require adopting a degree of belief that isn’t supported by one’s evidence but rather it requires terminating one’s search for further evidence and acting on the supposition that p. It is then shown, by responding to a formal result due to I.J. Good, that doing so can be rational in a (...) number of circumstances. If expected utility theory is the correct account of practical rationality, then having faith can be both epistemically and practically rational if the costs associated with gathering further evidence or postponing the decision are high. If a more permissive framework is adopted, then having faith can be rational even when there are no costs associated with gathering further evidence. (shrink)

Postmodern political critiques speak of the death of ideology, the end of history, and the postsecular return of religious attitudes, yet radical conservative theorists such as Mark Lilla argue religion and politics are inextricably intertwined. Returning much-needed uncertainty to debates over the political while revitalizing the very terms in which they are defined, María Pía Lara explores the ambiguity of secularization and the theoretical potential of a structural break between politics and religion. For Lara, secularization means three things: (...) the translation of religious semantics into politics; a transformation of religious notions into political ideas; and the reoccupation of a space left void by changing political actors that gives rise to new conceptions of political interaction. Conceptual innovation redefines politics as a horizontal relationship between governments and the governed and better enables societies (and individual political actors) to articulate meaning through action--that is, through the emergence of new concepts. These actions, Lara proves, radically transform our understanding of politics and the role of political agents and are further enhanced by challenging the structural dependence of politics on religious phenomena. (shrink)

One phenomenon arising in epistemic life is allegiance to, and break from, a tradition. This phenomenon has three central features. First, individuals who adhere to a tradition seem to respond dogmatically to evidence against their tradition. Second, individuals from different traditions appear to see the same evidence differently. And third, conversion from one tradition to another appears to be different in kind from ordinary belief shift. This paper uses recent work on the nature and rationality of faith to show that (...) these features can all emerge from individuals acting rationally—in particular, from individuals rationally having faith in the core assumptions of their traditions. One upshot is that we don't need to employ the idea of incommensurability to explain these features. (shrink)

The ‘rollback argument,’ pioneered by Peter van Inwagen, purports to show that indeterminism in any form is incompatible with free will. The argument has two major premises: the first claims that certain facts about chances obtain in a certain kind of hypothetical situation, and the second that these facts entail that some actual act is not free. Since the publication of the rollback argument, the second claim has been vehemently debated, but everyone seems to have taken the first claim for (...) granted. Nevertheless, the first claim is totally unjustified. Even if we accept the second claim, therefore, the argument gives us no reason to think that free will and indeterminism are incompatible. Furthermore, seeing where the rollback argument goes wrong illuminates how a certain kind of incompatibilist, the ‘chance-incompatibilist,’ ought to think about free will and chance, and points to a possibility for free will that has remained largely unexplored. (shrink)

Faith is a central attitude in Christian religious practice. The problem of faith and reason is the problem of reconciling religious faith with the standards for our belief-forming practices in general (‘ordinary epistemic standards’). In order to see whether and when faith can be reconciled with ordinary epistemic standards, we first need to know what faith is. This chapter examines and catalogues views of propositional faith: faith that p. It is concerned with the epistemology of such faith: what cognitive attitudes (...) does such faith require, what epistemic norms govern these attitudes, and whether Christian faith can ever adhere to them. (shrink)

It is sometimes said that faith is recalcitrant in the face of new evidence, but it is puzzling how such recalcitrance could be rational or laudable. I explain this aspect of faith and why faith is not only rational, but in addition serves an important purpose in human life. Because faith requires maintaining a commitment to act on the claim one has faith in, even in the face of counter-evidence, faith allows us to carry out long-term, risky projects that we (...) might otherwise abandon. Thus, faith allows us to maintain integrity over time. (shrink)

In secondary literature, Schelling’s Naturphilosophie is most commonly discussed within the context of Kant’s epistemology and the transcendental deduction, which was swiftly identified by the generation of young Kantians as a skeptical problem, i.e., the need to demonstrate that our a priori conditions of knowledge indeed determine their object. In this paper I argue that the central concern that motivates Schelling’s Naturphilosophie is better understood within the context of the question of unity of theoretical and practical reason with which Schelling (...) was familiar from his study of Kant’s third Critique. But unlike Kant, for whom the occurrences of beauty and organisms in the world exhibit a contingent harmony of nature with the demands of our rationality, Schelling demands a necessary correspondence between reason and nature. Schelling anchors the necessary correspondence between the self and nature in the claim that nature is not a dead object of self-consciousness, but that which is at the same time a subject and its own object. He takes the latter to be the essential characteristic of 'life'. Nature must not be conceived as a dead mechanism, but as a living organization and as an “analogue of reason” because to be one’s own subject and object defines both the spontaneity of self-consciousness and the spontaneity of self-determination. Thus, nature that is no longer represented mechanically, but as an “analogue of reason,” is nature that is necessarily amenable with both the minimal (i.e., cognitive) and final ends of our rationality (i.e., freedom). (shrink)

In “Can it be rational to have faith?”, it was argued that to have faith in some proposition consists, roughly speaking, in stopping one’s search for evidence and committing to act on that proposition without further evidence. That paper also outlined when and why stopping the search for evidence and acting is rationally required. Because the framework of that paper was that of formal decision theory, it primarily considered the relationship between faith and degrees of belief, rather than between faith (...) and belief full stop. This paper explores the relationship between rational faith and justified belief, by considering four prominent proposals about the relationship between belief and degrees of belief, and by examining what follows about faith and belief according to each of these proposals. It is argued that we cannot reach consensus concerning the relationship between faith and belief at present because of the more general epistemological lack of consensus over how belief relates to rationality: in particular, over how belief relates to the degrees of belief it is rational to have given one’s evidence. (shrink)

Decision theory has at its core a set of mathematical theorems that connect rational preferences to functions with certain structural properties. The components of these theorems, as well as their bearing on questions surrounding rationality, can be interpreted in a variety of ways. Philosophy’s current interest in decision theory represents a convergence of two very different lines of thought, one concerned with the question of how one ought to act, and the other concerned with the question of what action consists (...) in and what it reveals about the actor’s mental states. As a result, the theory has come to have two different uses in philosophy, which we might call the normative use and the interpretive use. It also has a related use that is largely within the domain of psychology, the descriptive use. This essay examines the historical development of decision theory and its uses; the relationship between the norm of decision theory and the notion of rationality; and the interdependence of the uses of decision theory. (shrink)

This book is the first collection of essays on Schelling in English that systematically explores the historical development of his philosophy. It addresses all four periods of Schelling's thought: his Transcendental Philosophy and Philosophy of Nature, his System of Identity [Identitätsphilosophie], his System of Freedom, and his Positive Philosophy. The essays examine the constellation of philosophical ideas that motivated the formation of Schelling's thought, as well as those later ones for which his philosophy laid the foundation. They therefore relate Schelling's (...) philosophy to a broad range of systematic issues that are of importance to us today: metaphysics, epistemology, aesthetics, ethics, our modern conceptions of individual autonomy, philosophy of history, philosophy of religion, political philosophy, and theology. The result is a new interpretation of Schelling's place in the history of German Idealism as an inventive and productive thinker. (shrink)

In the peer disagreement debate, three intuitively attractive claims seem to conflict: there is disagreement among peers on many important matters; peer disagreement is a serious challenge to one’s own opinion; and yet one should be able to maintain one’s opinion on important matters. I show that contrary to initial appearances, we can accept all three of these claims. Disagreement significantly shifts the balance of the evidence; but with respect to certain kinds of claims, one should nonetheless retain one’s beliefs. (...) And one should retain them even though these beliefs would not be supported by the new total evidence if one didn’t already hold them. (shrink)

In the shift from the balance of nature to the flux of nature paradigm, the concept of resilience has gained great traction in ecology. While it has been suggested that the concept of resilience does not imply a genuine departure from the balance of nature paradigm, I shall argue against this stance. To do so, I first show that the balance of nature paradigm and the related conception of a single-state equilibrium relies on what Eliot Sober has named the “Natural (...) State Model (NSM)”, suggesting that the NSM has instead been dismissed in the flux of nature paradigm. I then focus on resilience as the main explanatory concept of the flux paradigm. After distinguishing between two main different understandings of “resilience”, namely engineering resilience and ecological resilience, I argue that the former is close to the concept of balance or stability and still part of the NSM, while the latter is not. Finally, I claim that ecological resilience is inconsistent with the NSM, concluding that this concept–being incompatible with the NSM–is not part of the balance of nature paradigm but rather a genuinely new explanatory tool. (shrink)

The good of those who are worse off matters more to the overall good than the good of those who are better off does. But being worse off than one’s fellows is not itself bad; nor is inequality itself bad; nor do differences in well-being matter more when well-being is lower in an absolute sense. Instead, the good of the relatively worse-off weighs more heavily in the overall good than the good of the relatively better-off does, in virtue of the (...) fact that the former are relatively worse off. This paper articulates and defends the view just described. (shrink)

Suppose we want to do the most good we can with a particular sum of money, but we cannot be certain of the consequences of different ways of making use of it. This article explores how our attitudes towards risk and ambiguity bear on what we should do. It shows that risk-avoidance and ambiguity-aversion can each provide good reason to divide our money between various charitable organizations rather than to give it all to the most promising one. It also shows (...) how different attitudes towards risk and ambiguity affect whether we should give to an organization which does a small amount of good for certain or to one which does a large amount of good with some small or unknown probability. (shrink)

Medical stem cell research is currently the cause of much moral controversy. Those who would confer the same moral status to embryos as we do to humans consider that harvesting such embryonic cells entails sacrificing embryos. In this paper, the author analyses critically the arguments given for such a perspective. Finally, a theory of moral status is outlined that coherently and plausibly supports the use of embryonic stem cells in therapeutic research.

Some early phase clinical studies of candidate HIV cure and remission interventions appear to have adverse medical risk–benefit ratios for participants. Why, then, do people participate? And is it ethically permissible to allow them to participate? Recent work in decision theory sheds light on both of these questions, by casting doubt on the idea that rational individuals prefer choices that maximise expected utility, and therefore by casting doubt on the idea that researchers have an ethical obligation not to enrol participants (...) in studies with high risk–benefit ratios. This work supports the view that researchers should instead defer to the considered preferences of the participants themselves. This essay briefly explains this recent work, and then explores its application to these two questions in more detail. (shrink)

I have claimed that risk-weighted expected utility maximizers are rational, and that their preferences cannot be captured by expected utility theory. Richard Pettigrew and Rachael Briggs have recently challenged these claims. Both authors argue that only EU-maximizers are rational. In addition, Pettigrew argues that the preferences of REU-maximizers can indeed be captured by EU theory, and Briggs argues that REU-maximizers lose a valuable tool for simplifying their decision problems. I hold that their arguments do not succeed and that my original (...) claims still stand. However, their arguments do highlight some costs of REU theory. (shrink)

Individual differences in convergent and divergent thinking may uniquely explain variation in analogical reasoning ability. Across two studies we investigated the relative influences of divergent and convergent thinking as predictors of verbal analogy performance. Performance on both convergent thinking and divergent thinking uniquely predicted performance on both analogy selection and analogical generation tasks. Moreover, convergent and divergent thinking were predictive above and beyond creative behaviours in Study 1 and a composite measure of crystallised intelligence in Study 2. Verbal analogies in (...) Study 2 also varied in semantic distance, with results demonstrating divergent thinking as a stronger predictor of analogy generation for semantically far than for semantically near analogies. Results thus further illuminate the link between analogical reasoning and creative cognition by demonstrating convergent and di.. (shrink)

This essay argues that when setting climate policy, we should place more weight on worse possible consequences of a policy, while still placing some weight on better possible consequences. The argument proceeds by elucidating the range of attitudes people can take towards risk, how we must make choices for people when we don’t know their risk-attitudes, and the situation we are in with respect to climate policy and the consequences for future people. The result is an alternative to the Precautionary (...) Principle, an alternative that gives similar policy recommendations in many cases but is also sensitive to the costs of precautions. (shrink)

This paper addresses the question of whether gathering additional evidence is always rationally required, both from the point of view of instrumental rationality and of epistemic rationality. It is shown that in certain situations, it is not instrumentally rational to look for more evidence before making a decision. These are situations in which the risk of “misleading” evidence – a concept that has both instrumental and epistemic senses – is not offset by the gains from the possibility of non-misleading evidence. (...) These situations also undermine a particular argument for the claim that it is epistemically rational to look for more evidence, though it is argued that the relationship between instrumental and epistemic rationality makes such arguments flawed to begin with. Furthermore, these situations show us that our epistemic and our practical goals sometimes point us in different directions, not merely because of our limited resources or because our desires are sometimes best served by being in particular epistemic states, but because of the nature of rational action. (shrink)