Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

Background and methods: Psychiatric research can occasionally present particular ethical dilemmas, but it is not clear what kind of problems local research ethics committees actually experience in this field. We aimed to assess the type of problems that committees encounter with psychiatric research, using a postal survey of 211 LRECs.Results: One hundred and seven of those written to replied within the time limit. Twenty eight experienced few problems with psychiatric applications. Twenty six emphasised the value of a psychiatric expert on (...) the committee. The most common issues raised were informed consent and confidentiality . The use of placebos , the validity of psychiatric questionnaires and overuse of psychiatric “jargon” in psychiatric applications also raised concern.Conclusions: Our results suggest that LRECs have specific concerns regarding methodology, consent, and confidentiality in psychiatric research, and that they find psychiatric input invaluable. (shrink)

The clinical ethics propounded by Richard Zaner is unique. Partly because of his phenomenological orientation and partly because of his own daily practice as a clinical ethicist in a large university hospital, Zaner focuses on the particular concrete situations in which patients and their families confront illness and injury and struggle toward workable ways for dealing with them. He locates ethical reality in the clinical encounter. This encounter encompasses not only patient and physician but also the patients family and friends (...) and indeed the entire lifeworld in which the patient is still striving to live. In order to illuminate the central moral constituents of such human predicaments, Zaner discusses the often-overlooked features of disruption and crisis, the changed self, the patients dependence and the physicians power, the violation of personal boundaries and their necessary reconfiguring, and the art of listening. (shrink)

This essay introduces a thematic issue focused on the contributions to clinical ethics and the philosophy of medicine by Richard M. Zaner. We consider the apparent divorce of Zaners philosophical roots from his recent narrative immersions into the blooming, buzzing confusions of clinical-moral lifeworlds. Our considerations of the Zanerian context and origins of the clinical encounter introduce the fundamental questions faced by Zaner and his commentators in this issue, questions about the role of ethics consultants, moral authority, and clinical truths.

This article by Louis Sass, Josef Parnas, and Dan Zahavi takes us into the midst of a debate over recent developments in phenomenological psychiatry. In "Phenomenological Psychopathology and Schizophrenia: Contemporary Approaches and Misunderstandings" (Sass et al. 2011), Sass et al. are responding to criticisms of their position lodged by Aaron L. Mishara in "Missing Links in Phenomenological Clinical Neuroscience: Why We Are Still Not There Yet" (Mishara 2007). In their reply, Sass et al. offer several helpful clarifications and justifications of (...) their position, a position they have advanced in numerous important articles and books in the past. We are grateful for these clarifications and additional .. (shrink)

Basing ourselves on the writings of Hans Jonas, we offer to psychosomatic medicine a philosophy of life that surmounts the mind-body dualism which has plagued Western thought since the origins of modern science in seventeenth century Europe. Any present-day account of reality must draw upon everything we know about the living and the non-living. Since we are living beings ourselves, we know what it means to be alive from our own first-hand experience. Therefore, our philosophy of life, in addition to (...) starting with what empirical science tells us about inorganic and organic reality, must also begin from our own direct experience of life in ourselves and in others; it can then show how the two meet in the living being. Since life is ultimately one reality, our theory must reintegrate psyche with soma such that no component of the whole is short-changed, neither the objective nor the subjective. In this essay, we lay out the foundational components of such a theory by clarifying the defining features of living beings as polarities . We describe three such polarities: 1) Being vs. non-being: Always threatened by non-being, the organism must constantly re-assert its being through its own activity. 2) World-relatedness vs. self-enclosure: Living beings are both enclosed with themselves, defined by the boundaries that separate them from their environment, while they are also ceaselessly reaching out to their environment and engaging in transactions with it. 3) Dependence vs. independence: Living beings are both dependent on the material components that constitute them at any given moment and independent of any particular groupings of these components over time. We then discuss important features of the polarities of life: Metabolism; organic structure; enclosure by a semi-permeable membrane; distinction between "self" and "other"; autonomy; neediness; teleology; sensitivity; values. Moral needs and values already arise at the most basic levels of life, even if only human beings can recognize such values as moral requirements and develop responses to them. (shrink)

Karl Jaspers' phenomenology remains important today, not solely because of its continuing influence in some areas of psychiatry, but because, if fully understood, it can provide a method and set of concepts for making new progress in the science of psychopathology. In order to understand this method and set of concepts, it helps to recognize the significant influence that Edmund Husserl's early work, Logical investigations, exercised on Jaspers' formulation of them. We trace the Husserlian influence while clarifying the main components (...) of Jaspers' method. Jaspers adopted Husserl's notions of intuition, description, and presuppositionlessness, transforming them when necessary in order to serve the investigations of the psychopathologist. Jaspers also took over from Wilhelm Dilthey and others the tools of understanding (Verstehen) and self-transposal. The Diltheyian procedures were integrated into the Husserlian ones to produce a method that enables psychiatrists to define the basic kinds of psychopathological mental states. (shrink)

Understanding the mental life of persons with psychosis/schizophrenia has been the crucial challenge of psychiatry since its origins, both for scientific models as well as for every therapeutic encounter between persons with and without psychosis/schizophrenia. Nonetheless, a preliminary understanding is always the first step of phenomenological as well as other qualitative research methods addressing persons with psychotic experiences in their life-world. In contrast to Rashed's assertions, in order to achieve such understanding, phenomenological psychopathologists need not necessarily adopt the transcendental-phenomenological attitude, (...) which, however, is often required if performing phenomenological philosophy. Additionally, in the course of these scientific endeavors, differences between persons with psychosis/schizophrenia and so-called normal people seem to have a methodological function and value driving the scientist in her enterprise. Yet, these differences do not extend to ethical dimensions, and therefore, do not by any means touch ethical equality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 327-329 [Access article in PDF] Husserlian Comments on Blankenburg's "Psychopathology of Common Sense" Osborne P. Wiggins, Michael Alan Schwartz, and Jean Naudin In this essay, Wolfgang Blankenburg sketches his influential view that some of the disturbances of schizophrenia in particular can be interpreted as a pathology of common sense. We think it important at the outset, however, to avoid possible misunderstandings of (...) Blankenburg's point. It is perhaps unfortunate that this point is expressed by use of the phrase, "common sense." As Blankenburg's own essay shows, even among the learned, "common sense" has no definite or univocal meaning. Therefore, it is entirely possible to find many people who, under some conception of "common sense," appear to lack common sense and yet should not be deemed schizophrenic. Consequently, it is probably best to avoid the ambiguous phrase "common sense" altogether and seek to comprehend Blankenburg's point in other terms. That is precisely what we shall attempt here. We do endorse Blankenburg's view. Moreover, we shall pursue his suggestions that a Husserlian phenomenology of our experience of the life-world may provide the basis for developing the kind of psychopathology he seeks. Our ultimate aim, however, is for this phrase "common sense" to vanish into the Husserlian phenomenology we offer, so that all the other meanings of common sense will not threaten Blankenburg's position with misunderstandings.Our comments must remain a mere sketch. Since, however, Husserl's phenomenology is not well known, we shall have to devote some time to outlining those features of it that we deem relevant here.For Husserl, every mental process is an awareness of something. In his terminology, it is "intentional." No mental process occurs in isolation, however. It rather occurs within a concatenation of many other mental processes. Some of these co-occurring mental processes intend the same object; they intend other aspects of the object. For example, a woman may be aware of the color of a dress she is considering wearing. Hence, one process in her mental life is (visually) aware of the brown color. But another process in her mental life may be intending it as a "party dress." And yet another process in her mental life may be (tactually) intending the texture of the cloth. Because all of these mental processes (and many others) intend the same object, namely, the dress, Husserl says that they are synthesized with one another. "Synthesis," then, connotes a multiplicity of mental processes united with one another through intending the same object.Now Husserl believed that it is because the many processes occurring in our mental lives [End Page 327] synthetically intend the many objects we encounter that we experience ourselves as inhabiting a world of objects. If these syntheses failed to occur, we would not experience the world or ourselves as parts of this world. These syntheses make it possible for us to experience objects and events as related to one another in the manifold spatial, causal, temporal, social, political, religious, and other relationships that we do in fact experience. Husserl thus contends that our mental lives "constitute" the world for us. Mental life can accordingly be viewed as "world-constituting." Mental life is thus the condition for the possibility of there being a world of objects for us, to modify Kant's phrase. Husserl thought his notion of world-constituting consciousness sufficiently similar to Kant's for him to appropriate the latter philosopher's concept of "transcendental." Husserl also then spoke of "transcendental consciousness" and the study of this consciousness as "transcendental philosophy."Husserl made many distinctions among kinds of mental processes and their correlative objects. We shall here explicate only one such distinction. Mental processes must be distinguished as those that are actively generated by an ego and those that are not produced by an ego. The latter kind of mental process occurs automatically or, as Husserl writes, "passively." Husserl calls the first kind of mental process "active." Having mentioned him, however, we should also briefly characterize the "ego... (shrink)

Parmi les multiples énigmes de la généalogie de Jésus en Mt 1,1-17, la présence de quatre, voire de cinq femmes dans un texte où prédominent les hommes a suscité de nombreuses tentatives d’explication. Cet article part de l’observation que les quatre premières femmes sont en amont ou complices du roi David, tandis que la cinquième femme est la mère de celui qui est présenté comme Messie. Il constate par ailleurs que si l’on avait appliqué strictement les dispositions de la Torah (...) à leur égard, ni le grand roi, ni a fortiori la dynastie davidique n’auraient vu le jour. Le récit du dilemme de Joseph en 1,18-25 témoigne de son effort pour se frayer un chemin entre une certaine conformité avec la Loi et les exigences de la miséricorde en rapport avec le cas de sa femme enceinte. Ainsi, dès le début de l’évangile de Matthieu est posée la question de l’observance de la Torah face aux exigences des Prophètes et ultérieurement face à l’enseignement de Jésus. (shrink)

Schizophrenia, like other pathological conditions of mental life, has not been systematically included in the general study of consciousness. By focusing on aspects of chronic schizophrenia, we attempt to remedy this omission. Basic components of Husserl’s phenomenology (intentionality, synthesis, constitution, epoche, and unbuilding) are explicated and then employed in an account of chronic schizophrenia. In schizophrenic experience, basic constituents of reality are lost and the subject must try to explicitly re-constitute them. “Automatic mental life” is weakened such that much of (...) the world that is normally taken-for-granted cannot continue to be so. The subject must actively re-lay the ontological foundations of reality. (shrink)

Merleau-ponty's phenomenology of the intentional arc uniting body and world is viewed as grounded in the meaningfulness and materiality of both. the genetic constitution of the interrelated meaning and physicality of body and world is sketched in a phenomenological interpretation of jean piaget's ``the origin of intelligence in children''. from this sketch emerges an assertion of the priority of action over perception in prepredicative experience.

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

Husserlian reduction is a rigorous method for describing the foundations of psychiatric experience. With Jaspers we consider three main principles inspired by phenomenological reduction: direct givenness, absence of presuppositions, re-presentation. But with Binswanger alone we refer to eidetic and transcendental reduction: to establish a critical epistemology; to directly investigate the constitutive processes of mental phenomena and their disturbances, freed from their nosological background; to question the constitution of our own experience when facing a person with mental illness. Regarding the last (...) item, we suggest a specific kind of reduction, typically intersubjective from the start, which we call the ‘looking-glass reduction'. The schizophrenic experience -- understood as a ‘loss of taken-for-grantedness’ implying the constitutions of the body, of the other, and of internal time -- is a real ‘epochal provocation’ for the psychiatrist. As the horizon it opens seems to be both corporeal and narrative, this ‘provoking’ of an epoche in the attitude of the psychiatrist himself and the resistances it implies raise important issues regarding the general constitution of human experience. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Debunking arguments typically attempt to show that a set of beliefs or other intensional mental states bear no appropriate explanatory connection to the facts they purport to be about. That is, a debunking argument will attempt to show that beliefs about p are not held because of the facts about p. Such beliefs, if true, would then only be accidentally so. Thus, their causal origins constitute an undermining defeater. Debunking arguments arise in various philosophical domains, targeting beliefs about morality, the (...) existence of God, logic, and others. They have also arisen in material-object metaphysics, often aimed at debunking common-sense ontology. And while most of these arguments feature appeals to ‘biological and cultural contingencies’ that are ostensibly responsible for our beliefs about which kinds of objects exist, few of them take a serious look at what those contingencies might actually be. The purpose of this paper is twofold. First, to remedy this by providing empirical substantiation for a key premise in these debunking arguments by examining data from cognitive science, evolutionary biology, and developmental psychology that support a ‘debunking explanation’ of our common-sense beliefs and intuitions about which objects exist. Second, to argue that such data also undermines a particular kind of rationalist defense of common-sense ontology, sometimes employed as a response to the debunking threat. (shrink)

Valéry, P. The idea of art.--Sartre, J.-P. The work of art.--Ingarden, R. Artistic and aesthetic values.--Merleau-Ponty, M. Eye and mind.--Moore, G. E. Wittgenstein's lectures in 1930-33.--Findlay, J. N. The perspicuous and the poignant.--Hungerland, I. C. Once again, aesthetic and non-aesthetic.--Wollheim, R. On drawing an object.--Elliott, R. K. Aesthetic theory and the experience of art.--Savile, A. The place of invention in the concept of art.--Bibliography (p. [178]-184).

AS THE twentieth century comes to a close and the twenty-first dawns, the British Journal of Aesthetics begins its fortieth volume and enters its fortieth year. This seems an apt moment, or a good excuse, for a special issue, prefaced by a few general reflections, through the lens of the journal, on nearly half a century of aesthetics and on the prospects ahead. Strictly speaking, the fortieth anniversary of the journal does not fall until the autumn of 2000 as it (...) was in the autumn of 1960 that the first issue appeared. But there is a seductiveness in round numbers and the coincidence of the start of volume 40 with the start of the new millen- nium is justification enough for special attention.1 In fact self-reflection has been a rare event in the BJA. There have been few editorials and only two previous Special Issues, one commemorating the eightieth birthday of the founding editor, Harold Osborne, in 1985 (vol. 25, no. 2), the other in 1994 (vol. 34, no. 1), a collection of papers on the theme of repres- entation. The editorial voice is seldom heard in the journal, at least in the form of observations about the journal’s contents. Both Harold Osborne and Terry Diffey, the two previous editors, were modestly reticent about the development of the journal that they did so much to create and consolidate. On occasion they did publish their own essays and reviews so their ideas on specific topics in aesthetics were on display. Indeed the 1977 volume contained no fewer than four essays and five reviews by Osborne while he was editor. But editorial commentary as such has been light. That said, it has been a feature of the BJA from its inception that the editor’s own stamp has been imprinted on the contents, as a consequence of the large degree of autonomy each editor has possessed in selecting material to publish. (shrink)

Friends, family, and the Association of the Advancement of Philosophy and Psychiatry community mourn the death of Osborne "Ozzie" Wiggins this past May 18. In many ways, his story contributes a large portion to the founding of the AAPP, this journal, and the philosophy/psychiatry community worldwide.I met Professor Wiggins as a sophomore at Southern Methodist University in Dallas in 1974. I was a student in his twentieth-century humanities class. I didn't know at the time that he was in his (...) early years as an academic, having recently obtained his PhD in philosophy from the New School for Social Research in New York. Moreover, I hadn't yet encountered a teacher who was so audacious as to tell his students on... (shrink)