Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...) practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

BackgroundPublic health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising (...) ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability, opportunity, and motivation to work in an ethically prepared way.MethodsWe use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.ResultsOur analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge, a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.ConclusionsTo understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared. (shrink)

INDICE -/- Note biografiche Introduzione, di Riccardo Faucci -/- Parte I - Da Verri a Toniolo 1. Jeremy Bentham: Contemporary Interpretations, di M.D.A. Freeman 2. Su Helvétius, Beccaria e Bentham, di Letizia Gianformaggio 3. L'etica utilitaristica di Pietro Veti, di Vincenzo Polignano 4. ll liberismo interventista di Vincenzo Emanuele Sergio, di Anna Li Donni 5. Il concetto di " felicità pubblica, nella << Genesi del diritto penale » di Romagnosi, e il rapporto Romagnosi-Bentham, di Robertino Ghiringhelli 6. « La più (...) grande felicità per il maggior numero » all'Accademia dei Georgofili ( 18)0-1850), di Gabriella Gioli 7. Una nota su Manzoni critico dell'utilitarismo, di Maurizio Mori 8. Sul concetto di utile in Francesco Ferrara e in Maffeo Pantaleoni, di Daniela Parisi Acquaviva 9. Sul pensiero sociale cristiano di fronte all'edonismo, di Luciano Avagliano 10. Giuseppe Toniolo e il recupero cattolico dell'utile e del valore, di Anna Camaiti -/- Parte II Aspetti di storia del pensiero economico nell’età classica -/- 1. La filosofia economica di Thomas Hobbes, di Marco Bertozzi 2. Ordinamento del sapere, modelli metodologici ed economia politica in Adam Smith, di Sergio Cremaschi 3. Elementi classici nel pensiero di Adam Smith: giurisprudenza romana e morale stoica, di Gloria Vivenza 4. Il “lusso” negli economisti italiani del Settecento, di Cosimo Perrotta 5. Prezzi naturali, prezzi di mercato e legge degli sbocchi nel dibattito fra Malthus e Ricardo, di Lilia Costabile 6. Marx e la moneta, di Roberto Petrini -/- . (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is (...) unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

The paper is devoted to the subject status of the discipline “Philosophy of Sociology”. Philosophy of sociology is an interdisciplinary direction focusing on the main preconditions of sociological knowledge development as well as cognitive value of sociological facts, theories and conceptions. Its subject can be divided into “philosophical foundations of sociology” and “philosophical problems of sociology”. “Sociologism” as the concept of substitution of social philosophy by sociology as a science which is better empirically oriented and is able to give more (...) exact and proved picture of social reality also poses danger to social philosophy. “Sociologism” presents a positivist attack on social philosophy. Indeed, sociology is no less speculative science than social philosophy is, which is well illustrated by a lot of divergences among its theoretical constructions and empirical data. The main functions of philosophy of sociology in the world of contemporary social-humanitarian knowledge are critical function, integrative function and axiological function. (shrink)

A multidisciplinary faculty committee designed a curriculum to shape biomedical graduate students into researchers with a high commitment to professionalism and social responsibility and to provide students with tools to navigate complex, rapidly evolving academic and societal environments with a strong ethical commitment. The curriculum used problem-based learning (PBL), because it is active and learner-centred and focuses on skill and process development. Two courses were developed: Scientific Professionalism: Scientific Integrity addressed discipline-specific and broad professional norms and obligations for the ethical (...) practice of science and responsible conduct of research (RCR). Scientific Professionalism: Bioethics and Social Responsibility focused on current ethical and bioethical issues within the scientific profession, and implications of research for society. Each small-group session examined case scenarios that included: (1) learning objectives for professional norms and obligations; (2) key ethical issues and philosophies within each topic area; (3) one or more of the RCR instructional areas; and (4) at least one type of moral reflection. Cases emphasised professional standards, obligations and underlying philosophies for the ethical practice of science, competing interests of stakeholders and oversight of science (internal and external). To our knowledge, this is the first use of a longitudinal, multi-semester PBL course to teach scientific integrity and professionalism. Both faculty and students endorsed the active learning approach for these topics, in contrast to a compliance-based approach that emphasises learning rules and regulations. (shrink)

The blackbody radiation field is studied from different points of view. The existence of zero-point fluctuations is shown to be crucial in determining the form of the thermal part of the spectrum. The notion of a continuous field is seen to be compatible with a discrete structure for its interaction: The description normally used in the quantum context does not refer to the field but to its interaction with atomic systems, which involves statistically independent elementary acts of absorption and emission. (...) The same classical field has different effects on absorption and on emission, and these are conveniently, but not necessarily, described in terms of non-commuting operators. (shrink)

Modern microscopic theory is employed to construct a powerful analytical algorithm that permits a clear description of characteristic features of strongly correlated quantum fluids in thermodynamic equilibrium. Using recently developed formal results we uncover an intricate relationship between strongly correlated systems and free quantum gases of appropriately defined constituents. The latter entities are precisely defined renormalized bosons or fermions. They carry all the information contained in the statistical correlations of the strongly interacting many-particle system by virtue of their effective masses. (...) The mass of such a renormalized boson or fermion depends in a specific form on temperature, bulk particle number density of the many-body system, and eventually on momentum. Due to these properties the renormalized bosons and fermions determine in particular the location and nature of the transition to non-normal phases. (shrink)

When do organizations decide to ‘adopt’ a given social issue such that they come to acknowledge it in their patterns of action and communication? Traditional answers to this question have focused either on the characteristics of the issue itself, or on the traits of the focal organization. In many cases, however, a firm’s decision to adopt or ignore an issue is not a straightforward function of firm or issue characteristics. Instead, we view issue adoption as a socially constructed process of (...) information exchange between parties that are involved in the emergence and evolution of the issue, mediated by third-party organizations. We refer to this process as the infomediary process and these latter organizations as ‘infomediaries,’ after the information mediation and brokerage roles they play in the social processes linking social issues to organizational impact. We present a concise theoretical model of how infomediaries establish credible linkages between focal organizations and social issues. The thrust of the model is that the infomediation process, rather than the issue or firm characteristics, is what really drives firm-level issue adoption decisions. (shrink)

Karl Popper’s falsificationist epistemology that all knowledge advances through a process of conjectures and refutations carries profound implications for politics and education. In this article, I first argue that, on a political level, it is necessary to establish and maintain an open society by fostering not only five core values, viz. freedom, tolerance, respect, rationalism, and equalitarianism, but also three crucial practices, viz. democracy, state interventionism, and piecemeal social engineering. Then, considering that an open society places great political, and thus (...) educational, demands upon its members, I examine the role played by education in its establishment and maintenance, focusing on its educational aims, curriculum, and pedagogy. (shrink)

Intended as an introduction of the phenomenological writings of Pfänder to English-speaking readers, this work contains two major essays and two minor selections by Pfänder, plus an introduction and two appendixes by Spiegelberg. Because of its composition, this book should be classified as a Pfänder's anthology centered around a main essay titled "Motives and Motivation." As reasons for the translation and publishing of this main essay, Spiegelberg mentions first its influence on Ricoeur's phenomenology of the will, and secondly its topical (...) affinity with R. S. Peter's The Concept of Motivation, a work considered by Spiegelberg as capable of restoring the importance of the will in Anglo-American philosophy. The other major essay is, curiously enough, the introduction to a text-book in logic written by Pfänder in response to Husserl's own request. The two essays, though different, are not unrelated; they represent the theoretical and practical sides of the unique phenomenological method of constitution. The presence of these two essays, side by side, in this volume raises in fact the question of Pfänder's own understanding of the theoretical unity of thought and action that is the key to phenomenological subjectivity. A clarification of Pfänder's thought on this unity would certainly help us evaluate his contribution to phenomenology. Spiegelberg himself depicts Pfänder as a reasonable phenomenologist, accurate in analysis and moderate in speculative claims, a sober figure indeed in an environment sometimes seen as prone to intellectual excesses.--A. de L. M. (shrink)

Marion Lee Sanders,1 Anthony James Langone2 1Department of Medicine, Division of Nephrology and Hypertension, University of Iowa, Iowa City, IA, 2Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA: Transplantation is the preferred treatment option for individuals with end-stage renal disease. Individuals who undergo transplantation must chronically be maintained on an immunosuppression regimen for rejection prophylaxis to help ensure graft survival. Current rejection prophylaxis consists of using a combination of calcineurin inhibitors, mTOR inhibitors, antimetabolite (...) agents, and/or corticosteroids. These agents have collectively improved the short-term outcomes of renal transplantation, but improvements in late/chronic graft loss and recipient survival have lagged significantly behind challenging the field of transplantation to develop novel prophylactic agents. There have been several clinical trials conducted within the last 5 years in an attempt to bring such novel agents to the commercial market. These trials have resulted in the US Food and Drug Administration approval of extended-release tacrolimus, as well as belatacept, which has the potential to replace calcineurin inhibitors for rejection prophylaxis. Other trials have focused on the development of novel calcineurin inhibitors, costimulation blockade, kinase inhibitors, and inhibitors of leukocyte migration. While these later agents have not been FDA-approved for use in transplantation, they remain noteworthy, as these agents explore pathways not previously targeted for allograft-rejection prophylaxis. The purpose of this review was to consolidate available clinical trial data with regard to the recent developments in rejection prophylaxis in kidney transplantation. Keywords: rejection, prophylaxis, immunosuppression, transplantation. (shrink)

G. Deledalle is the author of a Histoire de la philosophie américaine, and of some excellent studies on Dewey, such as La pédagogie de Dewey, philosophie de la continuité, and "Durkheim et Dewey". These are all works that deserve full attention by students of the Golden Age of American philosophy. For a European, Deledalle has an unusual capacity to detect the vitality and freshness, but also the depth, of the growth of higher education in the U.S. in the first half (...) of this century. At the heart of this growth were philosophical ideas, and in particular those of Dewey. Philosophy did not have then dictatorial or competitive designs regarding education, the social and political sciences, psychology, or the natural sciences. It freely mingled with them, not just imparting methodological or epistemological rigor but also contributing some insights and giving the hypotheses and conclusions in these fields the character of "experiences." Experience is the guiding theme of this rich and complicated work, covering a multitude of subjects and positions. The treatment is divided into six parts dealing respectively with Dewey's leanings toward unitary experience, organic experience, dynamic experience, functional experience, instrumental experience, and transactional experience. In the study of the intellectual of Dewey's life practically all of his production is critically examined by Deledalle: a monumental task in itself, made possible by the critical bibliography of Milton Hasley Thomas. There is enough early biographical detail to make this work an effective and affectionate intellectual portrait. The best pages of this work are devoted to a thorough explication and comparative study of Dewey's final synthesis of experience. There are very helpful comparative references to Marx, Freud, Bergson, and Heidegger, and also indispensable parallels and contrasts with Peirce, James, and Whitehead. This is not a modest contribution from a regional point of view: Deledalle is, perhaps more than anybody else, aware of an ongoing international dialogue on Dewey, a dialogue that is preserving experience as a problem-complex at the front line of contemporary reflection.--A. de L. M. (shrink)

The structure of Chiodi's book is based on Vuillemin's important hermeneutical thesis that existentialism is one more step in the program of the romantics to give an absolute foundation to finite reality through the establishment of necessary relations between subjectivity and being. These relations, once revealed, would dispel the facticity and contingency in which the natural world is enshrouded. The role of Heidegger in this tradition involves one further dialectical twist, since Heidegger centers all Western Philosophy, including his own, around (...) the problem of ground in the manner proposed by the romantics. The suggested dialectical twist is then Heidegger's Kehre, a step beyond the radical contingency of Dasein in Sein und Zeit. Indeed, this contingency, once reached, shows unequivocally the failure of the romantic program. The ground cannot be ontologically connected with any object nor with the subject; it is rather the necessary history of the ground that determines all categorial differentiations in the world, including the reflective differentiation of subject-objects. Thus it becomes important to distinguish Heidegger from Hegel since, in both, history and necessity are characteristics of the ground. Chiodi gets to the bottom of this matter by pointing to the transfer of negativity from the process of history to the end of history. For Heidegger what is necessary is the repeated withdrawal of the ground so that it may never be confused with that which is known in any revelation or through all of them. This move, though clear, would still leave a fundamental ambiguity in the later philosophy of Heidegger: language, which acts as messenger from the ground to the world, must reflect the superabundance of Being from the standpoint of the ground while it only reflects possibilities of being from the standpoint of the world. This is an ambiguity that Heidegger would want to maintain. Chiodi's interpretation of Heidegger as a neo-platonist totally destroys this ambiguity and with it the very delicate balance created by Heidegger between infinite meaning and the ability of finite words to dwell upon it.--A. de L. M. (shrink)

This reply to Giles Scofield's critique of the authors' article in the June 2008 issue of the Kennedy Institute of Ethics Journal highlights two main topics. First, contrary to what Scofield suggests, using the terms "ethics" and "morality" interchangeably constitutes an oversimplification that blurs important distinctions. Second, in a representative democracy, ethical expertise and consultation need not generate a "tragic choice" of the kind Scofield has in mind.

Objectives To investigate empirically the motivations for not consenting to DNA biobanking in a Swedish population-based study and to discuss the implications. Design Structured questionnaires and semistructured interviews. Setting A longitudinal epidemiological project (PART) ongoing since 1998 in Stockholm, Sweden. The DNA-collection wave took place during 2006–7. Participants 903 individuals completed the questionnaire (participation rate 36%) and 23 were interviewed. All individuals had participated in both non-genetic waves of the project, but refused to contribute saliva samples during the DNA-collection wave. (...) Main outcome measures Motivations behind refusing to consent to DNA biobanking, with subsequent focus on participants' explanations regarding this unwillingness. Results Public refusal to consent to DNA biobanking, as revealed by the questionnaire, was mainly explained by a lack of personal relevance of DNA contribution and feelings of discomfort related to the DNA being used for purposes other than the respective study. Interviews of individuals representing the second motivation, revealed a significant mistrust of DNA biobank studies. The underlying beliefs and attitudes were associated with concerns about integrity, privacy, suspiciousness and insecurity. However, most interviewees were supportive of genetic research per se and interpreted their mistrust in the light of distressing environmental influences. Conclusion The results suggest a need for guidelines on benefit sharing, as well as trustworthy and stable measures to maintain privacy, as a means for increasing personal relevance and trust among potential participants in genetic research. Measures taken from biobanks seem insufficient in maintaining and increasing trust, suggesting that broader societal measures should be taken. (shrink)