This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders has elicited numerous criticisms throughout its history. Its particularly controversial status has not been resolved by the recent release of the DSM-5 ; rather, the new edition has amplified debates in psychiatry as well as philosophy and the wider public. To a certain extent, such controversies are to be expected because of the influential role the DSM plays in science and health care. Researchers have often been required to use the DSM classification (...) to get funded and published, clinicians need to use it for diagnosis, and patients need a DSM code to get reimbursed for treatment.1 Classification in psychiatry shapes the course of research... (shrink)

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad luck, (...) where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (shrink)

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and (...) an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)

The distinction between ‘disease’ and ‘illness’ has played an important role in the debate between naturalism and normativism. Both employ these notions, yet disagree on whether to assign priority to ‘disease’ or ‘illness’. I argue that this discussion suffers from implicit differences in the underlying interpretations: While for naturalists the distinction between ‘disease’ and ‘illness’ is one between a descriptive and a prescriptive notion, for normativists it is one between cause and effect. This discrepancy is connected to different interpretations of (...) priority, which also tend to be conflated in the debate. I disambiguate these different usages and develop a distinction between ‘disease’ and ‘illness’ that is theoretically neutral with regard to naturalism or normativism. Moreover, I propose a concept of heuristic priority that could serve as a common focus. This framework can avoid common confusions by providing a shared terminology and thereby help to make debates on disease-concepts more fruitful. (shrink)

This article is an introduction to the special issue on philosophy of medicine. Philosophy of medicine is a field that has flourished in the last couple of decades and has become increasingly institutionalized. The introduction begins with a brief overview of some of the most central recent developments in the field. It then describes the six articles that comprise this issue.

»Artistic Research« ist in aller Munde - ein Modewort der Gegenwartsdebatte, das Vereinnahmungen ebenso provoziert wie Zurückweisungen. Doch was meinen wir, wenn wir von der Kunst als Forscherin sprechen? Kann Kunst als eine Einsichten generierende, reflexive Praxis angesehen werden, die sich in ästhetischen Artikulationen formuliert? Welche Einsicht über welche Welt könnte sie bereitstellen? Eine umfassende epistemologische Ästhetik, die sich dem künstlerischen Forschen als Methode und Praxis annimmt, gibt es bisher nicht. In diesem Grundlagenwerk stellt sich Anke Haarmann den Fragen (...) nach den originären Methoden, historischen Vorläufern, spezifischen Artikulationsformen und konkreten Handlungsweisen künstlerischen Forschens. (shrink)

Die Wertfreiheit der Wissenschaft gilt als Bedingung ihrer Objektivitat. Eine Analyse des entsprechenden Wertfreiheitsideals zeigt jedoch, dass dieses auf einer Reihe von Voraussetzungen beruht wie der Trennbarkeit kognitiver von anderen Werten und der epistemischen Unabhangigkeit der Rechtfertigung die sich als problematisch erweisen. Eine Fallstudie zur Frauengesundheitsforschung untermauert zudem, dass die Moglichkeiten fur Werteinflusse in der Wissenschaft weit komplexer sind, als dieses Ideal zu erfassen vermag. Daher bietet ein sozialepistemologischer Ansatz, der auf Wertvielfalt statt Wertfreiheit setzt, die bessere Grundlage fur Objektivitat: (...) Epistemische Vertrauenswurdigkeit erfordert nicht Neutralitat, sondern einen pluralistischen und konsensorientierten kritischen Prozess.". (shrink)

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There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences (...) of the proposed moral obligation to actively reinterpret variant classifications that carry a higher risk of being false positives. Such reclassification is likely to result in ‘downgrades’: previously pathogenic variants (pathogenic/likely pathogenic, P/LP) reclassified to benign (likely benign/benign, LB/B) or uncertain variants (variant of uncertain significance, VUS). Any laboratory policy to actively reinterpret (specific sets of) classifications will confront the clinician with the question whether the person tested should be recontacted on a reinterpretation of previously reported results. As others have pointed out, recontacting in general comes with challenges, since patients may not want to be recontacted or have forgotten about their genetic test.2 3 Recontacting in case of a downgrade, however, is particularly impactful. Previous studies on the psychosocial impact of reclassification on patients …. (shrink)

This article examines the relation between the critical theory of Moishe Postone and the philosophy of Theodor Adorno. While the former is clearly influenced by the latter, these influences mostly stay implicit. When explicit, he does not so easily put his own thought in line with Adorno’s and is highly critical of him. I will investigate the ways in which ideas from Adorno made their way into Postone’s work, but also where the latter diverts from them. As will be shown, (...) Postone’s critical theory runs into a problem when one examines the immanent ground of his critical norm, freedom. Adorno, on the contrary, does succeed in employing the same norm in his own immanent critique. I will conclude that the problem Postone encounters can be avoided by being more of an ‘Adornian’, and that his theory allows this. (shrink)

Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care. Method Ten health-care workers participating in a Forum Play course took part in (...) this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison. Results The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency. Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

This paper gives insight into the Islamic bioethical discussion on harvesting and using human embryonic and adult stem cells. It describes some of the Islamic legal mechanisms involved in the bioethical discourse among Muslims. As the contemporary Islamic bioethical discourse is very diverse, the paper focuses on the critical discussion of related resolutions of the Saudi-based Islamic Fiqh Academy due to the esteem in which the IFA is held in the Islamic world and the pertinence of their rulings on this (...) issue. This study discusses the different sources of human adult and embryonic stem cells and their use from an Islamic perspective, while questioning some directions the Islamic bioethical discourse has taken. The paper invites interested parties to deliberate the use of some of the legal means resorted to in the ongoing Islamic bioethical discourse. (shrink)

Excerpt: How does subjective well-being change over the life course and what concepts do people draw upon when they answer questions about their well-being? Does well-being indeed change or are people endowed with a set level of happiness around which their well-being fluctuates? These are some of the questions this paper will address with a focus on three domains of life: family, work, and health.

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

Die Arbeit entwickelt erstmals eine von hermeneutischen Grundannahmen geleitete systematische Theorie des Films und reflektiert deren methodische Konsequenzen für die Analyse und Interpretation von Filmen. Auf der Grundlage einer zeichen- und sprechakttheoretischen Bestimmung filmischer Kommunikation werden die wichtigsten Strukturen filmischen Erzählens (Kameraführung, Montage, Erzählsituationen, verbale und nonverbale Figurenrede, Perspektivenstrukturen, uneigentliche Bilderrede) einer theoretischen und methodenpraktischen Reflexion unterzogen.

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage (...) and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction, because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis’s work (...) offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people’s agency can also result in people losing belief in their self-efficacy. Lewis’s strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent’s values and to available techniques of self-control. However, the agent can overcome this stage by developing new techniques of self-control, by building on their self-concept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent. (shrink)

TheoryDigital technologies have become an integral part of everyday life that children are exposed to. Therefore, it is important for children to acquire an understanding of these technologies early on by teaching them computational thinking as a part of STEM. However, primary school teachers are often reluctant to teach CT. Expectancy-value theory suggests that motivational components play an important role in teaching and learning. Thus, one hindrance to teachers’ willingness to teach CT might be their low expectancies of success and (...) high emotional costs, e.g., anxiety towards CT. Thus, introducing preservice teachers to CT during their university years might be a promising way to support their expectancies and values, while simultaneously alleviating their emotional costs. Prior CT competences might contribute to these outcomes.AimsWe investigated whether a specifically designed seminar on CT affected preservice teachers’ expectancies and values towards programming.Method: A total of 311 German primary school and special education preservice teachers took part in the study. The primary school preservice teachers received a seminar on CT and programming with low-threshold programming tasks, while the special education teachers served as a baseline group. The seminar was specifically designed to enhance expectancies and values and decrease emotional costs, following implications of research on expectancy-value theory.ResultsThe preservice teachers who visited the seminar gained higher expectancies and values towards CT and programming compared to the baseline group. Moreover, their emotional costs decreased. CT was positively related to change in expectancies and values and negatively related to emotional costs.DiscussionInterventions with low-threshold programming tasks can support primary school preservice teachers in finding trust in their abilities and values towards CT. Moreover, their anxiety towards CT and programming can be alleviated. Thus, first steps in preparing preservice teachers to teach CT in their future classrooms can be taken in university. (shrink)

ABSTRACTThis is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task, an Emotional Visual Search Task, and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: (...) evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying... (shrink)

Andalus and Sefarad: On Philosophy and Its History in Islamic Spain. By Sarah Stroumsa. Princeton: Princeton University Press, 2019. Pp. xxi + 220. $35, £28.

IntroductionBurnout is a growing problem among young researchers, affecting individuals, organizations and society. Our study aims to identify burnout profiles and highlight the corresponding job demands and resources, resulting in recommendations to reduce burnout risk in the academic context.MethodsThis cross-sectional study collected data from young researchers at five Flemish universities through an online survey measuring burnout risk, work engagement, sleeping behavior, and the most prominent job demands and resources. We conducted Latent Profile Analysis to identify burnout profiles in young researchers (...) and subsequently compared these groups on job demands and resources patterns.ResultsFive burnout profiles were identified: High Burnout Risk, Cynical, Overextended, Low Burnout Risk, and No Burnout Risk. Each burnout profile was associated with a different pattern of job demands and resources. For instance, high levels of meaningfulness decreased the odds to being classified in the Cynical profile.ConclusionOur findings show that the Cynical profile corresponds to a relatively high number of young researchers, which may imply that they are particularly vulnerable to the cynicism dimension of burnout. Additionally, work-life interference and perceived publication pressure seemed the most significant predictors of burnout risk, while meaningfulness, social support from supervisor and learning opportunities played an important protective role. (shrink)