Patient-centeredness can be considered a popular, and at the same time “fuzzy”, concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different “discourses” of patient-centeredness. Three discourses are presented; the first is labelled as “caring for patients”, the second as “empowering patients” and the third as “being responsive”. Each of these discourses has different things to say about the why of patient-centeredness; the patient’s identity; the role of (...) the healthcare professional; responsibilities for medical decision-making, and the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered “Health Information Exchange” are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them. (shrink)

Während der größte Teil der Bevölkerung die kieferorthopädische Therapie, also die Veränderung der Zahn- bzw. Kieferstellung, als eine Behandlung betrachtet, die vor allem auf eine Verbesserung des Erscheinungsbildes zielt, sehen der kieferorthopädische und zahnärztliche Berufsstand sowie auch private und öffentliche Kostenträger in bestimmten Abweichungen von Zahn- oder Kieferstellungen eine Gefährdung der oralen Gesundheit und der Funktionsfähigkeit des Gebisses. Letztere Auffassung bestimmt das ärztliche Handeln in der Kieferorthopädie und begründet auch die Übernahme zumindest bestimmter Leistungen durch die gesetzlichen Krankenkassen. Anhand aktueller (...) wissenschaftlicher Erkenntnisse lassen sich jedoch in vielen Fällen keine (akuten oder potentiellen) gesundheitlichen oder essentiellen funktionellen Beeinträchtigungen und Risiken abweichender Zahnstellungen nachweisen. Ziel dieses Aufsatzes ist es, diesem Widerspruch nachzugehen. Im Folgenden werden wir aufzeigen, welche Faktoren die Anbieter kieferorthopädischer Leistungen beeinflussen, welches die entscheidenden Gründe und Grundlagen für die Behandlung sind und an welchen Kriterien sich die Leistungsübernahme durch die Krankenkassen orientiert. Dabei wird deutlich werden, dass die formalen Kriterien von Behandlung und Kostenübernahme, die tatsächliche Behandlungs- und Kostenerstattungspraxis, die Erwartungen derjenigen, die Behandlungsleistungen in Anspruch nehmen und der aktuelle Stand der Forschung zu erwartbaren Funktionsbeeinträchtigungen durch Zahnstellungsvariationen nicht zwanglos zu vereinbaren sind. Erforderlich erscheint ein interdisziplinärer normativer Diskurs über die Frage, wie die diagnostizierten Spannungen aufzulösen wären. Als Anregung für einen solchen Diskurs werden wir im Ausblick alternative Lösungsstrategien vorstellen. (shrink)

This Handbook offers a broad yet unified treatment of many philosophical issues connected with climate change, ranging from foundational puzzles to detailed applications. It extends to many branches of philosophy that are relevant to the understanding of the premises and implications of the impacts of climate change on human and nonhuman life on Earth. More specifically, the handbook examines the scientific accounts of climate change as well as its causes. It explores the tools offered by social sciences and humanities to (...) study the societal premises and impacts of climate change as well as delving deeper into the ethical and political issues connected with and resulting from climate change. By doing so, it puts it all in an ecological and historical context. In addition, the book offers solutions to some important philosophical puzzles and problems, and indicates paths of interaction between philosophy and other disciplines. The discussion about climate change and the mitigation/adaptation policies spans many areas and levels – from abstract science and philosophy to current on-the-ground politics. However, climate change is also a great a philosophical puzzle. Indeed, its existential and practical relevance can be thought to largely derive from the philosophical complications it engenders. Climate change is applied philosophy par excellence. Preventing dangerous anthropogenic climate change needs very good philosophy applied to concrete and specific practical issues. Climate change is an area where scholars from very different provenances should cooperate on equal terms, having in view a common, and really important, purpose – contribute to preventing great burdens and even the extinction of humankind and the destruction of hospitable and valuable non-human nature. (shrink)

O positivismo jurídico é predominantemente ensinado e aplicado há décadas por profissionais da área jurídica brasileira, geralmente com referência à construção teórica de Hans Kelsen (1881-1973), deixando à margem muitos outros estudos que oferecem importantes formulações e conceitos para a compreensão do Direito contemporâneo. Este artigo se junta a algumas poucas pesquisas sobre outros referenciais teóricos acerca do positivismo jurídico, analisando a regra de reconhecimento no pensamento teórico de Herbert Hart (1907-1992), apresentando-a como incremento e superação da teoria imperativista de (...) John Austin (1790-1859). A partir de pesquisa bibliográfica, mostramos que, em Hart, a regra de reconhecimento (modalidade de regra secundária) apresenta-se indispensável para a certeza necessária ao Direito, bem como para aferir a validade do sistema jurídico. (shrink)

This article examines the legacy of Gramscian thought in Anglophone social sciences. It focuses in particular on three currents or disciplines, namely Cultural Studies, Anthropology, and Gender Studies. All three have sought and sometimes found in Gramscian categories a number of theoretical and political instruments through which to think the structures of domination, individual or collective subjectivity, and their relation to culture, in particular through the use of the dialectical relationship of hegemony/subalternity. Demonstrating how Gramsci was received in the intellectual (...) and political Anglophone context, the article highlights certain genealogies which have sometimes led to what amounts to a number of fully-fledged “translations” of Gramscian concepts, but also to a series of “lighter”, more distant uses. In this perspective, the article focuses on the translation of Gramsci undertaken by the New Left in the Seventies, insofar as this detour has proved of capital importance for the successive interpretations of Gramscian theories in the Anglophone social sciences. (shrink)

Partiendo de una breve descripción de las características del modelo comunitarista de integración social con el propósito de marcar distancia y aclarar algunos malentendidos en lo relativo a sus vínculos con la Sittlichkeit hegeliana, en el presente trabajo se analizan algunos de los textos claves de Hegel en los cuales se aprecia su comprensión de la unidad política. Ligado a ello, se intenta reconstruir la noción de integración que se desprende de dichos textos para, finalmente, concluir con algunas reflexiones en (...) torno al potencial de una teoría de inspiración hegeliana para analizar determinados fenómenos vinculados, en la actualidad, con los conceptos de desintegración y exclusión social.---“Freedom and Inclusion. Reflections on the Concept of Political Integration in Hegel”. Starting from a short description of the features of the communitarian model of social integration with the purpose of keeping one’s distance and of clarifying some misunderstandings concerning its bonds with the Hegelian Sittlichkeit, this paper analyzes some of Hegel’s key texts in which his understanding of the political unity is appreciated. Connected to this, there is an attempt to reconstruct the notion of integration that follows from those texts so that we can finally conclude with some reflections on the potentiality of a theory of Hegelian inspiration for analyzing certain phenomena tied at present with the concepts of social disintegration and exclusion. (shrink)

The history of Italian Jews from 1861 to 1938 is often viewed as the period in which they totally assimilated into the Italian nation. This article, however, argues that rather than their assimilation it was a period of their integration into Italian society. Various approaches to this question are presented, including a review of the literature, with a view to reconsidering the relationship between Jewish culture and Italian culture, or rather non-Jewish culture. Italian Jewish history is shown not to be (...) separated from, but to be “internal” to Italian social, cultural, and political history—part of the dynamic process of change that occurred during this period not only in Italy but throughout Europe. (shrink)

In this article I discuss the history of Italian Jews from the Emancipation to the racial laws of 1938 and their present-day attitudes to Judaism and the State of Israel. My aim is to suggest how the policy of social integration enabled Italian Jews to construct a new identity without losing their ancestral heritage. The example of Italian Jewry is relevant to understanding the growing need in today‘s European Union—now comprising 27 countries with different languages, cultures, and values—of revising the (...) concept of national identity and of exploring ways of constructing a new European identity. (shrink)

Nietzsche’s four Untimely Meditations are a set of works generally rather neglected of this author. They are, however, the outcome of a project placed in a critical situation, along the development of Nietzsche as philosopher. By beginning, particularly, with an analysis of the first Meditation, David Strauss, the Confessor and the Writer, and of the third one, Schopenhauer as educator, we will try to show two philosophical perspectives which, launched in the Meditations, will carry Nietzsche’s path until its end: the (...) path of an “ontology of the modernity”, according with the expression of Foucault, and that of a philosophy as “way of life”, according with the expression of Hadot. (shrink)

Gianfranco Ravasi ha voluto "ripensare" ciò che era già stato indagato e meditato durante la lunga avventura del pensiero umano, a partire dalle culture primitive e dalle antiche civiltà. E ha analizzato le due sorgenti che alimentano il concetto occidentale di anima: le Sacre Scritture e la cultura greca, con i miti di Psiche e di Orfeo e pensatori come Platone, Aristotele e Plotino. Giunti alla fine di questa riflessione ci si rende conto che la storia dell'anima coincide con (...) la storia dell'uomo, creatura di Dio. E un dubbio affiora: che l'agitarsi febbrile dell'umanità contemporanea non sia un avanzare ma un insensibile retrocedere, o uno strano volteggiare sempre sullo stesso spazio, e che proprio “l'anima, con la sua fame di eterno e di infinito” sia ciò che invece ci costringerà a muoverci “sempre oltre, verso un Oltre illimitato”. (shrink)

In my article, I want to focus on the critique Cristina Lafont makes to expertocracy and epistocracy, mainly through the institution of judicial review, to which she dedicates chapter 7 and part of...

The immanent approach adopted by most contemporary representatives of the Critical Theory tradition has generally the purpose of offering a foundation for social criticism that, without relying exclusively on explicit or factually accepted principles, avoids both the potential arbitrariness of subjective judgment and the appeal to transcendent criteria. However, this project has not yet paid much attention to the socio-epistemic elements related to the intersubjective praxis of criticism. Based on this concern, I intend to explore the possibility of immanent criticism (...) by using the epistemic category of dissonance. I will begin by showing how Davidson’s notion of irrationality can overcome the problematic separation between healthy and pathological behavior found in Festinger’s classical theory of cognitive dissonance and serve as an indicator of epistemic contradictions that can lead to social change. Thereafter, I will explain the link between these approaches and both Brandom’s inferential semantics and Honneth’s normative reconstruction. At the end of the first part, I expect to show an articulated picture of how dissonance can serve as a key for the analysis of inconsistencies present both in the belief systems and in the institutions and practices that constitute forms of life. In the second part, I will reconstruct three possible objections to this comprehensive approach in relation to the role of the individual in processes of social criticism and to the notions of progress and rationality that the approach adopts. I will analyze here what kind of meta-criterion is necessary to overcome the discomfort generated by the experience of dissonance so that it leads to social change. Taking up the Hegelian-Pragmatist idea of accumulation of experiences, I will argue that such a meta-criterion refers to the possibility of gathering and using available and non-endogenous socio-epistemic resources that allow reconfiguring the foundations of the questioned form of life. (shrink)

This contribution is an essay of formal philosophy—and more specifically of formal ontology and formal epistemology—applied, respectively, to the philosophy of nature and to the philosophy of sciences, interpreted the former as the ontology and the latter as the epistemology of the modern mathematical, natural, and artificial sciences, the theoretical computer science included. I present the formal philosophy in the framework of the category theory (CT) as an axiomatic metalanguage—in many senses “wider” than set theory (ST)—of mathematics and logic, both (...) of the “extensional” logics of the pure and applied mathematical sciences (=mathematical logic), and the “intensional” modal logics of the philosophical disciplines (=philosophical logic). It is particularly significant in this categorical framework the possibility of extending the operator algebra formalism from (quantum and classical) physics to logic, via the so-called “Boolean algebras with operators” (BAOs), with this extension being the core of our formal ontology. In this context, I discuss the relevance of the algebraic Hopf coproduct and colimit operations, and then of the category of coalgebras in the computations over lattices of quantum numbers in the quantum field theory (QFT), interpreted as the fundamental physics. This coalgebraic formalism is particularly relevant for modeling the notion of the “quantum vacuum foliation” in QFT of dissipative systems, as a foundation of the notion of “complexity” in physics, and “memory” in biological and neural systems, using the powerful “colimit” operators. Finally, I suggest that in the CT logic, the relational semantics of BAOs, applied to the modal coalgebraic relational logic of the “possible worlds” in Kripke’s model theory, is the proper logic of the formal ontology and epistemology of the natural realism, as a formalized philosophy of nature and sciences. (shrink)

In this paper we analyse the conditions for attributing to AI autonomous systems the ontological status of “artificial moral agents”, in the context of the “distributed responsibility” between humans and machines in Machine Ethics (ME). In order to address the fundamental issue in ME of the unavoidable “opacity” of their decisions with ethical/legal relevance, we start from the neuroethical evidence in cognitive science. In humans, the “transparency” and then the “ethical accountability” of their actions as responsible moral agents is not (...) in contradiction with the unavoidable “opacity” (unawareness) of the brain process by which they perform their moral judgements on the right action to execute. In fact, the moral accountability of our actions depends on what is immediately before and after our “moral judgements” on the right action to execute (formally, deontic first order logic (FOL) decisions). I.e., our moral accountability depends on the “ethical constraints” we imposed to our judgement before performing it in an opaque way. Anyway, our moral accountability depends overall on the “ethical assessment” or explicit “moral reasoning” after and over the moral judgement before executing our actions (deontic higher order logic (HOL) assessment). In this way, in the light of the AI “imitation game”, the consistent attribution of the status of ethically accountable artificial moral agents to autonomous AI systems depends on two similar conditions. Firstly, it depends on the presence of “ethical constraints” to be satisfied in their Machine Learning (ML) supervised optimization algorithm during its training phase, to give the system ethical skills (“competences”) in its decisions. Secondly – and definitely—, it depends on the presence in an AI autonomous system of a deontic HOL “ethical reasoner” to perform an automatic, and fully transparent assessment (metalogical deontic valuation) about the decisions taken by the ethically skilled ML algorithm about the right action to execute, before executing it. Finally, we show that the proper deontic FOL and HOL for this class of artificial moral agents is Kripke’s modal relational logic, in its algebraic topological formalization. This is naturally implemented in the dissipative QFT unsupervised deep learning of our brains, based on the “doubling of the degrees of freedom” (DDF), and then in the so-called “deep-belief” artificial neural networks for the statistical data pre-processing. This unsupervised learning procedure is also compliant with the usage of the “maximin fairness principle”, used as a balancing aggregation principle of the statistical variables in Sen’s formal theory of fairness. (shrink)