Digital mental health can be understood as the in situ quantification of an individual’s data from personal devices to measure human behavior in both health and disease (Huckvale, Venkatesh and Chr...

Alice Dunbar-Nelson is mostly remembered as a poet, activist, and ex-wife of Paul Laurence Dunbar. Her volume The Goodness of St. Rocque and Other Stories (1899) has been largely overshadowed as a result. Yet, the collection contains a portfolio of heroines analogous and contemporaneous to the famed New Woman figure of the fin de siècle. In this article, I consider Dunbar-Nelson’s heroines in light of their New Woman-esque agency and autonomy as they find remedies and power in objects and materials (...) steeped in New Orleans’s cultural heritage. Ceded neither social nor political self-governance nor domestic comfort, this article reads these transcendental, metaphysical objects as sources of self-care. With close analysis of “The Goodness of St. Rocque,” “Tony’s Wife,” and “Little Miss Sophie,” I argue that Dunbar-Nelson’s protagonists exert influence over their lives, specifically in the negotiation of romantic relationships, through voodoo charms, Catholic candles, tarot cards, sewing machines, and knitting needles. Covering courtship, break-ups, and unhappy marriages, I demonstrate the ways in which these empowering spiritual objects respond to health concerns, including malnutrition and domestic violence, in turn, situating them as alternatives to patriarchal and historically racist medical institutions. Valorizing the cultural milieu of New Orleans and the customs of the Caribbean and European heritage, and thereby conveying Dunbar-Nelson’s resistance to white and male supremacist ideologies in late-nineteenth-century Southern America, the article ultimately assesses the parallels with (predominantly white) New Woman fiction, through shared themes of fraught heterosexual dynamics and women’s declining health. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

How does microbiota research impact our understanding of biological individuality? We summarize the interdisciplinary summer school on "Microbiota, Symbiosis and Individuality: Conceptual and Philosophical Issues" (July 2019), which was supported by a European Research Council starting grant project "Immunity, DEvelopment, and the Microbiota" (IDEM). The summer school centered around interdisciplinary group work on four facets of microbiota research: holobionts, individuality, causation, and human health. The conceptual discussion of cutting-edge empirical research provided new insights into microbiota and highlights the value of (...) incorporating into meetings experts from other disciplines, such as philosophy and history of science. (shrink)

In stark opposition to this anti-aesthetic project, Isobel Armstrong evolves a new poetics, forging an alternative aesthetic discourse by remaking its ...

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

The Mental Capacity Act (2005) was designed to protect and empower patients with impaired capacity. Despite an estimated 40% of medical inpatients lacking capacity, it is unclear how many patients undergo capacity assessments and treatment under the Act. We audited the number of capacity assessments on the general medical wards of an English-teaching hospital. A total of 95 sets of case notes were reviewed: the mean age was 78.6 years, 57 were female. The most common presenting complaints were feeling ‘unwell’ (...) (n = 25) and confusion (n = 24). In all, 52 patients had conditions, such as delirium (n = 26) and dementia (n = 15), which often impair capacity. Capacity was assessed in seven (7.4%) patients, all of whom disagreed with the medical team about their treatment. The number of documented assessments fell short of the estimated rate of incapacity, suggesting that some means of improving capacity assessment in busy medical environments is required. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Theological engagement with quantum mechanics has been dominated by the Copenhagen interpretation, failing to reflect the fact that philosophers and physicists alike are increasingly moving away from the Copenhagen interpretation in favor of other approaches. One such approach, Hugh Everett's so-called Many Worlds Interpretation (MWI), is being taken increasingly seriously. As the MWI's credibility grows, it is imperative that metaphysicians, theologians, and philosophers of religion engage with its ideas and their implications. This article does just that, setting out some implications (...) of Everettian Quantum Mechanics that are particularly relevant to theism. It argues that taking seriously the radical consequences of the Everett interpretation means facing at least three major worries for theism pertaining to personal identity, the problem of evil, and salvation. The article concludes by calling on theologians and philosophers of religion to address these worries, in order that these matters of religious significance remain both coherent and credible if the MWI turns out to be correct. (shrink)

Quantum mechanics has recently indicated that, at the fundamental level, temporal order is not fixed. This phenomenon, termed Indefinite Causal Order, is yet to receive metaphysical or theological engagement. We examine Indefinite Causal Order, particularly as it emerges in a 2018 photonic experiment. In this experiment, two operations A and B were shown to be in a superposition with regard to their causal order. Essentially, time, intuitively understood as fixed, flowing, and fundamental, becomes fuzzy. We argue that if Indefinite Causal (...) Order is true, this is good evidence in favor of a B‐theory of time, though such a B‐theory requires modification. We then turn to theology, suggesting that a B‐theoretic temporal ontology invites serious reconsideration of the doctrine of salvation. This paper concludes that the best explanation for salvation given a B‐theory is mind‐dependent salvific becoming, a type of psychological soteriological change that occurs through downward causation. (shrink)

This lecture argues that new optical experiences created by the lens and what we now call the virtual image were the foundation alike of ‘high’ science, associated at this historical moment with the telescope, and popular spectacle. They precipitated and renewed an enquiry into the nature and status of the image as the technologies of the phantasmagoria, the kaleidoscope and the diorama penetrated deep into the poets' worlds and words. The projected image, without a correspondence in reality, was a troubling (...) aspect of this modern technology, provoking new understandings of materiality and immateriality. Colour, reflection and refraction became central concerns as a corollary of the debate. Some poets assimilated this imagery into their work, albeit skeptically. Others violently resisted it. The lecture looks closely at image-making in poetic language, and argues that there were both ontological and political stakes in this enquiry. (shrink)

In 1847, Johanne Luise Heiberg, a thirty-year old Danish actress and friend of Søren Kierkegaard, performed the role of Juliet in Shakespeare’s Romeo and Juliet in the Copenhagen theatre. She had played Juliet once before, aged 16, and it was this first performance which helped to launch her prestigious career. The 1847 performance prompted Kierkegaard to write an article for the newspaper Fædrelandet , called 'The Crisis and a Crisis in the Life of an Actress' under the name of Inter (...) et Inter. Its publication contradicted Kierkegaard’s resolve to cease his literary authorship and to write directly under his own name as a religious author. This essay shows what was at stake for Kierkegaard in publishing 'The Crisis and a Crisis in the Life of an Actress' and its pivotal status for him both as a writer and a Christian. Both ‘crises’ of the title refer to a metamorphosis as a return to ‘the beginning’ effected through a series of elliptical characters: the actress, Juliet, Inter et Inter, Kierkegaard himself and the reader. Kierkegaard’s commentary on Frau Heiberg’s performance of Juliet brings together categories of repetition and anxiety in order to understand how “the metamorphosis of the actress” is effected as a return to the 'beginning', mirroring Kierkegaard's own transition from 'literary' to 'religious' writer and ultimately reflecting back on the reader’s own condition as existing individual. (shrink)

Social workers form part of many healthcare teams. This role can involve in-depth conversations with clients and home visits. These encounters can reveal sensitive information, not all of which may be accessible to other members of the healthcare team. Most modern healthcare systems employ shared care records, which are populated by, and accessible to, multiple members of the healthcare team. Shared care records are valued for their capacity to enhance inter-professional communication and improve patient care. But this very capacity may (...) increase an underlying tension between privacy and efficient, effective care. Ethical tensions can arise for health social workers between comprehensive documentation and protecting client privacy by limiting access to privileged information obtained in the context of a social work encounter. This qualitative empirical ethics study investigated health social workers' experiences of tensions between client privacy and maintaining complete records, and how they thought the tension should be resolved. Participant testimony informed a pragmatist approach to identify principles governing recording of sensitive information in shared care records. Three principles were identified: necessity, accuracy, and neutrality. Participants' reports of moral concerns about recording indicate that ethical tensions can occur. The identified principles offer a starting point for managing such tensions. (shrink)

Models of global governance abound: expert governance, networked governance, algorithmic governance, and old-fashioned juridico-political governance vie for explanatory power. This article takes up style as a way of analysing configurations of governance that do not readily fit a particular model of governance. Style is particularly revealing when it comes to deliberately unspecified or over-specified, genre-busting, and bet-hedging ways of imagining governance. The UN’s use of the phrase ‘convening power’ is a case in point. This article looks at how the UN (...) has styled itself as a convening power in the area of counter-terrorism governance. A visual analysis of promotional materials for the UN’s Counter-Terrorism Week suggests that the UN’s self-styling as a convening power is shaped by anxieties as well as aspirations. (shrink)

What does the unofficial artist see from the public seats of a courtroom? I have drawn occasionally in the UK Supreme Court, with the court’s permission. I have also drawn proceedings in other courts, such as nude appearances of the Naked Rambler, but these sketches have to be from memory: despite calls for greater transparency, it is still illegal to draw in any UK court below the UK Supreme Court. Official court artists seek to draw a newsworthy moment to please (...) their paymasters—news outlets, or lawyers who like a flattering image. I can please myself and pick out private human moments or elements of coded theatre. I write as a non-lawyer, representing the view of the lay person. What are the public, lawyers, parties and judges doing? How do performance nerves affect people? What can a drawing say? I take a practical rather than a theoretical look: I literally get my hands dirty. (shrink)

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of (...) xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research. (shrink)

This paper takes James David Forbes’ Encyclopaedia Britannica entry, Dissertation Sixth, as a lens to examine physics as a cognitive, practical, and social enterprise. Forbes wrote this survey of eighteenth- and nineteenth-century mathematical and physical sciences between 1852 and 1856, when British “physics” was at a pivotal point in its history, situated between a field identified by its mathematical methods – originating in France – and a discipline identified by its university laboratory institutions. Contemporary encyclopedias provided a nexus for publishers, (...) the book trade, readers, and men of science in the formation of physics as a field. Forbes was both a witness, whose account of the progress of physics or natural philosophy can be explored at face value, and an agent, who exploited the opportunity offered by the Encyclopaedia Britannica in the mid nineteenth century to enroll the broadly educated public and scientific collective, illuminating the connection between the definition of physics and its forms of social practice. Forbes used the terms “physics” and “natural philosophy” interchangeably. He portrayed the field as progressed by the natural genius of great men who curated it within an associational culture that engendered true intellectual spirit. Although this societal mechanism was becoming ineffective, Forbes did not see university institutions as the way forward. Instead, running counter to his friend William Whewell, he advocated inclusion of the mechanical arts, and a strictly limited role for mathematics. He revealed tensions when the widely accepted discovery-based historiography conflicted with intellectual and moral worth, reflecting a nineteenth-century concern with spirit that cuts across twentieth-century questions about discipline and field. (shrink)

Special relativity has been understood by many as vindicating a tenseless conception of time, denying the existence of tensed facts and a fortiori objective temporal passage. The reason for this is straightforward: both passage and the obtaining of tensed facts require a universal knife-edge present moment—yet this structure is not easily reconcilable with the relativity of simultaneity. The above being said, the prospects for tense and passage are sometimes claimed to be improved on moving to cosmological solutions of general relativity. (...) In this paper, we evaluate in detail these arguments, finding that there remain several open questions to be addressed if the introduction of tensed facts into the relativistic context is to be compelling. Moreover, we argue that, even setting aside these issues, objective tense stands and falls in relativity for exactly the same reasons that it does in classical philosophical discussions on the matter. (shrink)

This article applies Paul Tillich's existentialist analysis of the human predicament, particularly what it means to exist and to be fallen, to social media. I argue that social media heightens feelings of alienation and estrangement, supporting this claim with evidence from empirical research in psychiatry and communication studies. Thus, I offer an application of a Tillichian approach to an area of culture previously unexamined in this way. I identify three primary ways in which social media exacerbates existentialist emotional states: social (...) media allows us to construct artificial versions of ourselves through the use of filters and photo editing software; it provides the means to quantify social approval in groups the size of which the human brain has not evolved for; it extends the size of our social networks but decreases the quality of interactions. Social media is yet to receive significant philosophical or theological engagement despite its prevalence, particularly within younger generations. I argue that this is a mistake – philosophy has a duty to engage with such a ubiquitous feature of modern life. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

This article brings time and theology together constructively in response to a pressing problem for the doctrine of personal salvation. The problem arises within the physics and metaphysics of time, as these support a so-called temporal B-theory in which time does not pass and reality is comprised of a block universe. Within this static temporal metaphysic, objective change is highly problematized. Yet salvation requires an objective change from fallenness to redemption. So, how can we understand a salvation-transformation in the block (...) universe? In other words, can sinners really change? I argue that on a B-theory of time, a salvation-transformation is best understood as a form of qualitative, phenomenological, and subjective change, rather than a robust ontological change. I conclude that the individual's transformation from fallen to saved is one of mind-dependent becoming. So, sinners can change. But, in this lifetime, that change can only be subjective. (shrink)

Nipah virus is a priority pathogen that is receiving increasing attention among scientists and in work on epidemic preparedness. Despite this trend, there has been almost no bioethical work examining ethical considerations surrounding the epidemiology, prevention, and treatment of Nipah virus or research that has already begun into animal and human vaccines. In this paper, we advance the case for further work on Nipah virus disease in public health ethics due to the distinct issues it raises concerning communication about the (...) modes of transmission, the burdens of public health surveillance, the recent use of stringent public health measures during epidemics, and social or religious norms intersecting with preventive measures. We also advance the case for further work on Nipah virus disease in research ethics, given ethical issues surrounding potential vaccine trials for a high-fatality disease with sporadic spillover events, the different local contexts where trials may occur, and the potential use of unproven therapeutics during outbreaks. Further bioethics work may help to ensure that research and public health interventions for Nipah virus disease are ethically acceptable and more likely to be effective. (shrink)

Non‐Interventionist Objective Divine Action (NIODA), introduced by Robert John Russell, is a model of divine action drawing upon insights from quantum mechanics. It presents an intriguing and significant challenge to classical conceptions of divine action with far‐reaching consequences. When applying NIODA to theistic evolution, however, significant questions emerge that require attention. We identify and assess two sets of concerns. The first relates to quantum physics, particularly whether and how quantum occurrences influence mutations and evolution. We argue that the current empirical (...) evidence is ambiguous in its support of the kinds of quantum action that Russell proposes, though emerging data from quantum biology look promising. The second set of concerns is metaphysical, especially concerning the problem of evil. NIODA gives Godextensive agency over evolution and genetics, which has adverse consequences for theodicy. We propose potential solutions to the problems highlighted in our article, both metaphysical and physical, to improve the viability of NIODA's application to theistic evolution. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes (...) be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence. (shrink)

The majority of biomedical and biological research relies on a few molecular biology techniques. Here we show that eight key molecular biology techniques would not exist without basic biological research.We also find that the scientific reward system does not sufficiently value basic biological research into molecular mechanisms.

A clinical scenario is described where an anaesthetist is concerned about the seemingly high risk/benefit ratio relating to laparoscopic versus standard inguinal hernia operations. Some options for further action by the anaesthetist are introduced. The remainder of the paper explores the question of who can legitimately assess the acceptability of risk/benefit ratios, and defends the use of practice guidelines at the expense of so called clinical freedom. It is argued that respect for persons is not breached by limiting the treatment (...) options offered to patients to those therapies which have a ‘reasonable’ risk/benefit ratio. This ‘reasonableness’ is context dependent, and should be properly decided by those with expertise in the field. (shrink)

A clinical scenario is described where an anaesthetist is concerned about the seemingly high risk/benefit ratio relating to laparoscopic versus standard inguinal hernia operations. Some options for further action by the anaesthetist are introduced. The remainder of the paper explores the question of who can legitimately assess the acceptability of risk/benefit ratios, and defends the use of practice guidelines at the expense of so called clinical freedom. It is argued that respect for persons is not breached by limiting the treatment (...) options offered to patients to those therapies which have a ‘reasonable’ risk/benefit ratio. This ‘reasonableness’ is context dependent, and should be properly decided by those with expertise in the field. (shrink)

A clinical scenario is described where an anaesthetist is concerned about the seemingly high risk/benefit ratio relating to laparoscopic versus standard inguinal hernia operations. Some options for further action by the anaesthetist are introduced. The remainder of the paper explores the question of who can legitimately assess the acceptability of risk/benefit ratios, and defends the use of practice guidelines at the expense of so called clinical freedom. It is argued that respect for persons is not breached by limiting the treatment (...) options offered to patients to those therapies which have a ‘reasonable’ risk/benefit ratio. This ‘reasonableness’ is context dependent, and should be properly decided by those with expertise in the field. (shrink)