Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

Aims and objectives. Participant narratives from a feminist and queer phe- nomenological study aim to broaden current understandings of trauma. Examin- ing structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Background. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have (...) an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Design. Analysis of the qualitative data was guided by feminist and queer phe- nomenology. This was well suited to understanding queer women’s storied narra- tives of trauma, including disempowering processes of structural marginalisation. Methods. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Results. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that recon- structs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Conclusions. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. Relevance to clinical practice. New trauma-informed assessment strategies recon- struct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re- experiencing the process of coming out as queer in opposition to the expectation of heterosexuality. (shrink)

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer and trans patients (...) will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful. (shrink)

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

The following Acknowledgments were omitted in the original publication.

In this article, the theme of introductory engagement is developed through the conversational interviews and participatory observations I carried out with perinatal nurses and birthing women in the context of a feminist phenomenological methodology. Positioned against the landscape of hierarchical health care practices embedded with power dynamics and disembodied practices, this research explored the ways in which perinatal nurses related to birthing women in the context of relational care. The focus of attention in this article is to describe the theme (...) of introductory engagement by way of a storied phenomenological text. (shrink)

An understanding of autonomy has important significance in North American health care. Although a respect for autonomy is necessary to protect the self-determination and agency of birthing women in hospital settings, I suggest that enactments of autonomy that are independent of relationships offer only an incomplete interpretation of such a vital concept. In this article I explore an understanding of autonomy situated within the context of a relational birthing narrative. In so doing, autonomy becomes conceptualized as contextual and concrete, giving (...) rise to an embodied view of the birthing woman. (shrink)

In the first of a trilogy of articles published in the New England Journal of Medicine in May 2015, physician–journalist Lisa Rosenbaum observes that the crucial question regarding conflicts of interest between physicians and commercial industry is the extent to which interactions between the two are “beneficial or harmful to patients?”. She goes on to note that the answer to this question “depends on how you define harm,”1 and argues that many of the claims of harm flowing from COI (...) are incomplete, insufficient, or are based on “suggestive extrapolations from data”. If there are benefits to be gained from physician–industry relationships, and if the evidence... (shrink)

Sanford Goldberg investigates the role that others play in our attempts to acquire knowledge of the world.

A new theory of how the brain constructs emotions that could revolutionize psychology, health care, law enforcement, and our understanding of the human mind Emotions feel automatic, like uncontrollable reactions to things we think and experience. Scientists have long supported this assumption by claiming that emotions are hardwired in the body or the brain. Today, however, the science of emotion is in the midst of a revolution on par with the discovery of relativity in physics and natural selection in biology--and (...) this paradigm shift has far-reaching implications for us all. Leading the charge is psychologist and neuroscientist Lisa Feldman Barrett, whose theory of emotion is driving a deeper understanding of the mind and brain, and shedding new light on what it means to be human. Her research overturns the widely held belief that emotions are housed in different parts of the brain and are universally expressed and recognized. Instead, she has shown that emotion is constructed in the moment, by core systems that interact across the whole brain, aided by a lifetime of learning. This new theory means that you play a much greater role in your emotional life than you ever thought. Its repercussions are already shaking the foundations not only of psychology but also of medicine, the legal system, child-rearing, meditation, and even airport security. Why do emotions feel automatic? Does rational thought really control emotion? How does emotion affect disease? How can you make your children more emotionally intelligent? How Emotions Are Made answers these questions and many more, revealing the latest research and intriguing practical applications of the new science of emotion, mind, and brain. (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

One of the central points of contention in the epistemology of testimony concerns the uniqueness (or not) of the justification of beliefs formed through testimony--whether such justification can be accounted for in terms of, or 'reduced to,' other familiar sort of justification, e.g. without relying on any epistemic principles unique to testimony. One influential argument for the reductionist position, found in the work of Elizabeth Fricker, argues by appeal to the need for the hearer to monitor the testimony for credibility. (...) Fricker (1994) argues, first, that some monitoring for trustworthiness is required if the hearer is to avoid being gullible, and second, that reductionism but not anti-reductionism is compatible with ascribing an important role to the process of monitoring in the course of justifiably accepting observed testimony. In this paper we argue that such an argument fails. (shrink)

Internalism and Externalism in Semantics and Epistemology presents eleven specially written essays exploring these debates in metaphysics and epistemology and ...

Marina Sbisà has long advocated that we think of the illocutionary force of a speech act in terms of the act’s (predictable) systematic effects on the normative relationship between a speaker and her audience. Building on this idea, I argue that the hypothesis of distinctive speech act norms can be used to explain how participants in a conversation coordinate the normative expectations they have of one another in conversation. Such an explanation earns its keep by explaining how speakers render themselves (...) illocutionarily intelligible to their audiences—thereby enabling us to articulate the sense of mutuality that characterizes speech exchanges. One important upshot of my reflections is that we should reject both Austin’s thesis that the successful performance of an illocutionary act depends on audience uptake and Sbisà’s claim that Austin’s thesis is required if we are to make sense of the illocutionary dimension of speech in terms of an act’s systematic effects on participants’ normative expectations of one another. (shrink)

To what extent are meaning, on the one hand, and knowledge, on the other, determined by aspects of the 'outside world'? Internalism and Externalism in Semantics and Epistemology presents twelve specially written essays exploring these debates in metaphysics and epistemology and the connections between them. In so doing, it examines how issues connected with the nature of mind and language bear on issues about the nature of knowledge and justification. Topics discussed include the compatibility of semantic externalism and epistemic internalism, (...) the variety of internalist and externalist positions, semantic externalism's implications for the epistemology of reasoning and reflection, and the possibility of arguments from the theory of mental content to the theory of epistemic justification. (shrink)

Delusions are a common symptom of schizophrenia and dementia. Though most English dictionaries define a delusion as a false opinion or belief, there is currently a lively debate about whether delusions are really beliefs and indeed, whether they are even irrational. The book is an interdisciplinary exploration of the nature of delusions. It brings together the psychological literature on the aetiology and the behavioural manifestations of delusions, and the philosophical literature on belief ascription and rationality. The thesis of the book (...) is that delusions are continuous with ordinary beliefs, a thesis that could have important theoretical and practical implications for psychiatric classification and the clinical treatment of subjects with delusions. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and of attributions of self-knowledge in belief ascription. Presenting a highly original analysis of the debate on the nature of delusions, this book will interest philosophers of mind, epistemologists, philosophers of science, cognitive scientists, psychiatrists, and mental health professionals. (shrink)

Recently, we proposed a fundamental subdivision of the human cortex into two complementary networks—an “extrinsic” one which deals with the external environment, and an “intrinsic” one which largely overlaps with the “default mode” system, and deals with internally oriented and endogenous mental processes. Here we tested this hypothesis by contrasting decision making under external and internally-derived conditions. Subjects were presented with an external cue, and were required to either follow an external instruction or to ignore it and follow a voluntary (...) decision process . Our results show that a well defined component of the intrinsic system—the right inferior parietal cortex—was preferentially activated during the “free-will” condition. Importantly, this activity was significantly higher than the base-line resting state. The results support a self-related role for the intrinsic system and provide clear evidence for both hemispheric and regional specialization in the human intrinsic system. (shrink)

What is it to base a belief on reasons? Existing attempts to give an account of the basing relation encounter a dilemma: either one appeals to some kind of neutral process that does not adequately reflect the way basing is a content‐sensitive first‐personal activity, or one appeals to linking or bridge principles that over‐intellectualize and threaten regress. We explain why this dilemma arises, and diagnose the commitments that are key obstacles to providing a satisfactory account. We explain why they should (...) be rejected anyway, and then offer a new, knowledge‐first virtue epistemological theory of the basing relation that shows how we can substantially theorize about mental processes without these commitments. The resulting view plausibly captures the way in which basing is an inherently mental and content‐sensitive process. (shrink)

In recent years, there has been significant interest in injustices that do not consist in inflicting physical or material harm on others, but operate in more subtle ways, e.g. by targeting our status as epistemic agents. In a similar fashion, this paper aims to bring to the forefront a currently overlooked kind of injustice that occurs in relation to our concepts: conceptual injustice, which is characterised by wrongful in- or exclusion from the application of a concept. The first part of (...) the paper is concerned with spelling out the notion, discussing its characteristic wrongs, and with tracing it in a number of examples. In the second part, I discuss conceptual injustice in relation to connected but different forms of injustice, such as epistemic injustice. This highlights the advantages of having the notion on hand: it enhances our understanding of other forms of injustice like hermeneutical injustice, and allows us to capture a ‘remainder of injustice’ for which we could not account otherwise. (shrink)

Marks individually or in combination constitute images that represent objects. How do those images represent those objects? Marks vary in style, both between and within images. Images also vary in style. How do those styles relate to each other and to the objects that those images represent? Referencing a diverse range of images, we answer the first question with a response-dependence theory of image representation derived from Mark Johnston, differentiating Lockean primary qualities of marks from secondary qualities of images. We (...) answer the second question with a perceptual theory of style derived from Paul Grice, differentiating physical style from image style, and representing conventionally from representing conversationally. (shrink)

This article analyses the two main rhetorical techniques of “argumentation” and “persuasion” employed in politico-philosophical debates recorded in early Chinese argumentative texts of the Warring States period. Through the analysis of pertinent case studies drawn from the received literature, the contribution explores the formal, structural, and grammatical features of these techniques, with attention paid to the wide selection of rhetorical and literary devices they make use of. It also further provides an overview of the historical and socio-cultural background against which (...) such techniques developed among so called “wandering persuaders”, who were travelling from court to court to offer their services as political advisors and diplomats to the local rulers of the time. (shrink)

This volume presents cutting-edge theory and research on emotions as constructed events rather than fixed, essential entities. It provides a thorough introduction to the assumptions, hypotheses, and scientific methods that embody psychological constructionist approaches. Leading scholars examine the neurobiological, cognitive/perceptual, and social processes that give rise to the experiences Western cultures call sadness, anger, fear, and so on. The book explores such compelling questions as how the brain creates emotional experiences, whether the "ingredients" of emotions also give rise to other (...) mental states, and how to define what is or is not an emotion. Introductory and concluding chapters by the editors identify key themes and controversies and compare psychological construction to other theories of emotion. (shrink)

No political, economic, or cultural segment of society has escaped the universal impact of recent cataclysmic change. Physicians were no exception. During the 20th century, all members of society, including physicians, have experienced change of enormous speed and magnitude. Futurist Alvin Toffler noted that global societal transformation has created a of personal malaise that poses difficulty for both individual and group adaptation. Toffler further described current change as a fundamental shift and conflict in all aspects of civilization (how we live, (...) work, and relate to each other). Toffler also noted major alterations in the basis for distribution of societal power (who controls what, why, and how). One manifestation of recent change directly affecting all members of society, includingphysicians, has been the social transformation of medicine that has been a power shift from the individual physicians to control by organizations and management. (shrink)

We are currently seeing dramatic changes in the ways we imagine and experience time. Permanent debt, unending violent conflict, climate change, economic instability, and widening social inequalities have led to suggestions that we are now living in the time of the 'end times'. In the shadow of a foreshortened future, the present is increasingly experienced as a form of 'non-stop inertia', resulting in experiences of time as both frenetic but also stuck - revving up, as Ivor Southwood puts it, to (...) go nowhere. So, where do we go and how when all options seem to have run their course and time is no longer moving forward? Enduring Time proposes some alternative relations of time which provide hopeful alternatives to the dominating models of oppression, limitation and exploitation. A strikingly original philosophy of time which also provides students and scholars with a rigorous and detailed survey of contemporary theories of time, Enduring Time is an indispensable read for those attempting to live meaningfully in the current age. (shrink)

Experiences of emotion are content-rich events that emerge at the level of psychological description, but must be causally constituted by neurobiological processes. This chapter outlines an emerging scientific agenda for understanding what these experiences feel like and how they arise. We review the available answers to what is felt (i.e., the content that makes up an experience of emotion) and how neurobiological processes instantiate these properties of experience. These answers are then integrated into a broad framework that describes, in psychological (...) terms, how the experience of emotion emerges from more basic processes. We then discuss the role of such experiences in the economy of the mind and behavior. (shrink)

In this paper I argue, first, that the most influential (and perhaps only acceptable) account of the epistemology of self-knowledge, developed and defended at great length in Wright (1989b) and (1989c) (among other places), leaves unanswered a question about the psychology of self-knowledge; second, that without an answer to this question about the psychology of self-knowledge, the epistemic account cannot be considered acceptable; and third, that neither Wright's own answer, nor an interpretation-based answer (based on a proposal from Jacobsen (1997)), (...) will suffice as an acceptable answer to the psychological question. My general ambition is thus to establish that more work is needed if we are to have a full account of self-knowledge in both its epistemological and psychological aspects. I conclude by suggesting how my thesis bears on those who aim to provide an empirical account of the cognition involved in self-knowledge. (shrink)

Lisa Bortolotti argues that some irrational beliefs are epistemically innocent and deliver significant epistemic benefits that could not be easily attained otherwise. While the benefits of the irrational belief may not outweigh the costs, epistemic innocence helps to clarify the epistemic and psychological effects of irrational beliefs on agency.

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a competence to know. (...) I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

Miranda Fricker's Epistemic Injustice is a wide-ranging and important book on a much-neglected topic: the injustice involved in cases in which distrust arises out of prejudice. Fricker has some important things to say about this sort of injustice: its nature, how it arises, what sustains it, and the unhappy outcomes associated with it for the victim and the society in which it takes place. In the course of developing this account, Fricker also develops an account of the epistemology of testimony. (...) Focusing my attention on that account, my central claims are two. First, at least some of Fricker's arguments against existing (inferentialist and non-inferentialist) views in the epistemology of testimony are less than fully persuasive, and the (non-inferentialist) view she ends up endorsing is not all that different from the views she criticizes. Second, her reasons for harboring doubts regarding the role of a principle of default entitlement within a non-inferentialist account are not persuasive. Neither of these claims affects the overall argument Fricker is trying to run. Rather, they suggest that Fricker may have picked more fights than she needed to in the epistemology of testimony. If so, we have reason to detach Fricker's important work on epistemic injustice from some of the details of the story she tells regarding the epistemology of testimony. (shrink)

Lisa Tessman's Burdened Virtues is a deeply original and provocative work that engages questions central to feminist theory and practice, from the perspective of Aristotelian ethics. Focused primarily on selves who endure and resist oppression, she addresses the ways in which devastating conditions confronted by these selves both limit and burden their moral goodness, and affect their possibilities of flourishing. She describes two different forms of "moral trouble" prevalent under oppression. The first is that the oppressed self may be (...) morally damaged, prevented from developing or exercising some of the virtues; the second is that the very conditions of oppression require the oppressed to develop a set of virtues that carry a moral cost to those who practice them--traits that Tessman refers to as "burdened virtues." These virtues have the unusual feature of being disjoined from their bearer's own well being. Tessman's work focuses on issues that have been missed by many feminist moral theories, and her use of the virtue ethics framework brings feminist concerns more closely into contact with mainstream ethical theory. This book will appeal to feminist theorists in philosophy and women's studies, but also more broadly, ethicists and social theorists. (shrink)

This paper proposes the ‘AGENCY model’ of conscious state attribution, according to which an entity's displaying certain relatively simple features (e.g. eyes, distinctive motions, interactive behavior) automatically triggers a disposition to attribute conscious states to that entity. To test the model's predictions, participants completed a speeded object/attribution task, in which they responded positively or negatively to attributions of mental properties (including conscious and non-conscious states) to different sorts of entities (insects, plants, artifacts, etc.). As predicted, participants responded positively to conscious (...) state attributions only for those entities that typically display the simple features identified in the AGENCY model (eyes, distinctive motion, interaction) and took longer to deny conscious states to those entities. (shrink)

This essay is part of a dossier on Cristina Lafont's book Democracy without Shortcuts.

Substance addiction affects millions of individuals worldwide and yet there is no consensus regarding its conceptualisation. Recent neuroscientific developments fuel the view that addiction can be classified as a brain disease, whereas a different body of scholars disagrees by claiming that addictive behaviour is a choice. These two models, the Brain Disease Model and the Choice Model, seem to oppose each other directly. This article contends the belief that the two models in the addiction debate are polar opposites. It shows (...) that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions. Moreover, some of the most fiercely debated aspects - for instance, whether or not addiction should be classified as a disease or disorder - are irrelevant for the conceptualisation of addiction. Instead, the real disagreement is shown to revolve around capacities. Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility. (shrink)

Substance addiction affects millions of individuals worldwide and yet there is no consensus regarding its conceptualisation. Recent neuroscientific developments fuel the view that addiction can be classified as a brain disease, whereas a different body of scholars disagrees by claiming that addictive behaviour is a choice. These two models, the Brain Disease Model and the Choice Model, seem to oppose each other directly. This article contends the belief that the two models in the addiction debate are polar opposites. It shows (...) that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions. Moreover, some of the most fiercely debated aspects - for instance, whether or not addiction should be classified as a disease or disorder - are irrelevant for the conceptualisation of addiction. Instead, the real disagreement is shown to revolve around capacities. Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility. (shrink)

Substance addiction affects millions of individuals worldwide and yet there is no consensus regarding its conceptualisation. Recent neuroscientific developments fuel the view that addiction can be classified as a brain disease, whereas a different body of scholars disagrees by claiming that addictive behaviour is a choice. These two models, the Brain Disease Model and the Choice Model, seem to oppose each other directly. This article contends the belief that the two models in the addiction debate are polar opposites. It shows (...) that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions. Moreover, some of the most fiercely debated aspects - for instance, whether or not addiction should be classified as a disease or disorder - are irrelevant for the conceptualisation of addiction. Instead, the real disagreement is shown to revolve around capacities. Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility. (shrink)

For the inaugural Workshop on Philosophy & Engineering (WPE-2007), this abstract asks why engineers are turning now to philosophy. Upon reflection, philosophy and engineering are very different occupations, and engineering has rarely turned to philosophy in the long history of the systematic design and production of complex artifacts. After briefly examining events since World War 2, the extended abstract carries over Kuhn's explanation of the rise of philosophy of science during the intellectual tumult of relativity and quantum physics in the (...) opening moments of the 20th century to the case of engineering in the early moments of the 21st century. Specifically, the paper argues that the crisis of the rapid pace of technological change, reflected in the centripetal forces of the O's (bio, nano, and info) may help explain increased interest in a philosophy of engineering at this time. The abstract concludes by citing a number of ways that philosophy may help clarify what otherwise might be confusing times. (shrink)