This book examines the political thought of Park Chung-hee, the most revered, albeit the most controversial, former president in the history of South Korea. It looks at the trends in the ideological terrain of contemporary South Korean politics, and the legacy of Park Chung-hee’s authoritarian politics.

What should we do about “tainted” public commemorations? Recent events have highlighted the urgency of reaching a consensus on this question. However, existing discussions appear to be dominated by two naïve opposing views – to remove or preserve them. My aims in this essay are two-fold. First, I argue that the two views are not naïve, but undergirded by concerns with securing self-respect and with the character of our engagement with the past. Second, I offer a qualified defence of vandalising (...) tainted commemorations. The defence comprises two parts. I consider two prominent suggestions – to install counter-commemorations and to add contextualising plaques – and argue that they are typically beset with difficulties. I then argue that in some circumstances, constrained vandalism is a response to tainted commemorations which effectively adjudicates the demands of the two opposing views. (shrink)

유한의 시간 속에서 불변의 진리를 논하다! 살아서는 경험할 수 없고 죽어서는 전할 수 없는 삶과 죽음의 근원적 연속성 ◎ 도서 소개 인문학의 세 번째 질문, “나는 어떻게 죽을 것인가?” 최재천, 김상근, 강영안, 황농문… 삶에 던져진 마지막 물음과 인문학에서 찾은 최후의 답! 인생에 관한 대단원의 물음, 나는 어떻게 죽을 것인가. 삶의 황폐화와 사회 가치의 퇴색, 현실 문제에 대한 근원적인 해결책의 부재로 현대인들은 인간과 삶, 죽음에 대한 근원적인 물음을 품기 시작했다. 그 물음 끝에 탄생한 『나는 어떻게 죽을 것인가』는 2015년 봄 플라톤 아카데미가 (...) 주최한 동명의 대중강연을 엮은 것으로, 누적 10만 명 이상 청중들의 열광적인 호응을 불러일으켰다. 1부에서 최재천, 황농문, 김애령, 김종성은 우리 삶의 영역 안에 이미 자리하고 있는 죽음의 본질을 드러내고 2부에서 김상근, 정재현, 강영안, 윤영호는 죽음을 의식하는 삶이 지닌 진정한 의미에 대해 이야기한다. 생태학자, 공학자, 철학자, 건축가, 신학자, 종교학자, 의학자 등 다양한 분야에서 섬세한 시각을 발휘하는 최고 학자 8인은 죽음을 냉철하면서도 따뜻한 시선으로 바라본다. 이를 통해 우리는 삶과 죽음이 그리 멀리 있지 않으며, 죽음에 대한 물음이 도달하는 자리가 결국 삶이라는 점을 깨닫게 된다. 죽음을 삶의 흐름이 가져오는 결과로 보든 고통스러운 삶으로부터의 해방으로 보든 죽음은 우리 삶의 영역 안에 자리하며, 궁극적으로 나를 나일 수 있게 하는 고유한 가치로 발현한다. ◎ 출판사 서평 우리는 어떻게 죽어야 할까? 아름다운 자연의 원리를 향한 8가지 용기 나는 누구인가, 어떻게 살 것인가, 어떻게 죽을 것인가. 현대인들이 잊고 살지만, 인생에서 가장 중요한 질문이다. 개인의 삶이 점점 황폐해지고 사회 가치가 희미해지는 요즘, 이러한 근원적인 물음은 우리 삶에 더욱 중요해졌다. ‘인간’을 탐구하고 ‘인생’을 공부하는 학문인 인문학 열풍이 거세진 것도 이와 같은 이유다. 그 물음 끝에 탄생한 『나는 어떻게 죽을 것인가』는 2015년 봄 플라톤 아카데미가 주최한 동명의 대중강연을 엮은 것으로, 누적 10만 명 이상 청중들의 열광적인 호응을 불러일으켰다. 마치 눈앞에서 듣는 것처럼 최재천, 김상근, 강영안, 황농문 등 이 시대를 대표하는 학자 8인이 전하는 삶의 지혜와 인문학적 통찰이 뜨거운 감동과 함께 생생하게 전해진다. 위대한 고전과 과학적 진실을 통해 삶과 죽음의 연속성을 이야기하며, 우리 일상에 맞닿은 사례들을 중심으로 죽음이 전하는 메시지를 깊이 있고 흥미롭게 해석했다. 독자들은 이 책을 통해 ‘나는 어떻게 죽을 것인가’라는 생의 마지막 물음에 잔잔한 해답을 얻을 수 있을 것이며, 삶과 죽음은 그 자체로 아름다운 자연의 원리임을 깨닫게 된다. 삶의 순간에 마주한 죽음 죽음의 숙고로 완성하는 삶 생태학자, 공학자, 철학자, 건축가, 신학자, 종교학자, 의학자 등 다양한 분야에서 섬세한 시각을 발휘하는 최고 학자 8인은 죽음을 냉철하면서도 따뜻한 시선으로 바라본다. 1부에서는 우리 삶의 영역 안에 이미 자리하고 있는 죽음의 본질이 드러난다. 원래 하나였던 자연과 인간이 공생하는 법을 알고 평안한 마음으로 살아가는 것이야 말로 아름다운 삶과 죽음을 맞이하는 자세임을 전한 최재천, 죽음을 온전히 의식하는 것이야말로 성숙한 삶을 위해 반드시 필요하다고 역설한 황농문, 받아들일 수밖에 없는 죽음을 인정하고 아름답게 사는 것이야말로 아름다운 죽음을 맞이하는 방법임을 이야기한 김애령, 삶을 오롯이 담고 있는 공간인 건축으로부터 죽음에 접근한 김종성을 통해 우리는 살아서는 절대 경험할 수 없는 죽음에 한 발짝 가까워진다. 2부에서는 죽음을 의식하는 삶의 진정한 의미에 대해 이야기한다. 죽음은 벽이 아닌 평화(Shalom)의 세계로 나아가는 문이라는 희망의 이야기를 담아낸 김상근, 죽음을 숙명과 해방의 대립 구도로 보는 것을 떠나 ‘유한한 초월’, 즉 삶 안에서 죽음을 발견해 남은 삶인 자신의 현재를 사랑하라고 말하는 정재현, 철학의 가장 중요한 임무인 멜레테 타나투, 즉 죽음에 대한 수련을 위해 현상학, 해석학, 윤리학의 시선으로 죽음을 분석한 강영안, 죽음을 절망이 아닌 희망의 순간으로 바꾸기 위해서는 의미 있는 삶을 살아야 한다는 윤영호를 통해 우리는 인간에게 허락된 유한의 시간 속에서 죽음이라는 불변의 진리를 맞이하는 법을 배운다. 이를 통해 우리는 삶과 죽음이 그리 멀리 있지 않으며, 죽음에 대한 물음이 도달하는 자리가 결국 삶이라는 점을 깨닫게 된다. ◎ 본문 중에서 오랫동안 생명에 대해 공부하면서 깨달은 점 중 하나는 지구에 존재하는 모든 생명은 하나의 공통적인 속성을 가지고 있다는 것입니다. 아이러니컬하게도 그것은 죽음입니다. ‘생명’의 가장 보편적인 속성이 바로 ‘죽음’이라는 것입니다. (21쪽) 죽음에 직면하면 온갖 자부심과 자만심, 수치스러움과 실패에 대한 두려움, 외부의 기대들이 모두 떨어져나갑니다. 그리고 진실로 중요한 것들만이 남습니다. (…) 살아 있음이 얼마나 소중한지를 알고 있기 때문입니다. (73쪽) 시간은 많은 것을 피어나게 하고 성장하게 하고 탄생하게 하고 변화하게 합니다. 또 많은 것을 파괴하고 해체하고 늙게 하고 낡게 하고 저물게 하고 죽게 합니다. (…) 인간의 시간은 존재론적인 결함이기도 하고, 유한한 자가 가지고 있는 무한한 슬픔이기도 합니다. (81쪽) 아름다운 삶은 고통이나 슬픔을 경험하지 않는 삶이 아니라 그 고통이나 슬픔을 어떻게 받아들이고 해석하고 이해하느냐를 통해 만들어가는 것입니다. 아름다운 삶은 결코 확신이나 확실성으로 가득 찬 삶이 아닙니다. 오히려 삶이 가지고 있는 그늘, 고통, 눈물, 불확실성, 연약함을 끌어안고 나아가는 것, 그것이 진정 아름다운 삶이라고 이야기할 수 있습니다. (106~107쪽) 이런 요소들이 갖춰질 때 건축물로서의 아름다움이 완성되어 제대로 빛을 발하게 됩니다. 우리의 삶 또한 이와 다르지 않다고 생각합니다. 그런 면에서 죽음 또한 우리 삶의 일부라고 말하고 싶습니다. 아름다운 삶이 있어야 아름다운 죽음이 있고, 그때 비로소 하나의 인생이 완성되는 것일 테니까요. (144쪽) 우연의 연속에 불과한 사다리 같은 인생을 살아가야 하는 우리. 그리고 그 운명이 다하면 우리는 죽음이라는 미지의 세계로 뛰어들어야 합니다. 죽음을 맞이한 우리는 그 미지의 세계를 향해 몸을 날려야 합니다. 그것이 우리 인간의 운명입니다. (163~164쪽) 예수는 분노하거나 화를 내는 것이 아니라 오히려 그들에게 평화를 기원합니다. 그것도 두 번씩이나 “샬롬”이라 고 외칩니다. 예수에게 죽음은 벽도 문도 아니었습니다. 후회와 분노를 넘어서는 평화의 길이었습니다. (187쪽) 우리의 본능은 죽음에 저항하며 삶과 죽음의 관계를 가능한 한 멀리 떼어놓으려 합니다. (…) 그런데 여기서 가장 심각한 것은 무엇보다도 삶의 바깥으로 내몰린 죽음이 오히려 삶을 일그러뜨린다는 점입니다. 그 문제를 극복하려는 노력은 곧 우리의 몫입니다. 그래서 바깥으로 내몰렸던 죽음을 삶 속으로 끌고 들어오는 새로운 시도가 필요합니다. (191쪽) 욕망으로 죽음을 덮어버리면 삶이 일그러지고 맙니다. (…) 이렇게 볼 때 죽음에 대한 생각은 삶을 더 풍요롭고 가치 있게 엮어내려는 노력입니다. 그래서 건강한 삶을 위해서는 삶에서 죽음을 보아야 합니다. 그리고 어떻게 하면 밀어냈던 죽음을 삶과 함께 엮어낼 수 있을지에 대해 지혜를 모아야 합니다. (196쪽) 우리의 몸을 이루고 있는 모든 세포들은 생성과 소멸의 과정을 거칩니다. (…) 말하자면 몸은 죽음을 받아들이면서 죽음을 살아가고 있는 것이지요. 몸을 이루고 있는 모든 세포들이 끊임없이 죽음으로써 몸 전체가 살아가는 생명의 역설을 우리 몸은 이미 실천해오고 있습니다. (209쪽) 죽지 않을 것처럼, 아직 죽지 않은 것처럼 살지 말고 이미 죽은 사람으로 살라는 것입니다. “죽음을 기억하라(Memento mori)!”는 말씀이 바로 이를 가리킵니다. 그렇게 되면 지금 사는 삶은 덤으로 사는 것입니다. 덤의 시간들, 순간들, 그것이 바로 지금입니다. 그래서 한마디로 추립니다: “자신의 현재를 사랑하라! Carpe diem!” (219쪽) 하이데거는 그 끝이 있기 때문에 오히려 내가 나 자신이 될 수 있다고 말합니다. 끝이 있으므로 해서 너와 나 구별도 없이 군중 속에 무리지어 사는 그런 삶이 아니라 비로소 누구와도 혼돈되지 않는 나 자신, 존재의 가능성을 발견하게 된다는 것입니다. 왜냐하면 그 죽음은 누구의 죽음도 아닌 나의 죽음이기 때문입니다. (246쪽) 우리가 진심으로 우리의 삶 자체를 내게 주어진 값진 선물이라 생각하고 감사한 마음으로 살아간다면, 죽음은 결코 두려움의 대상이 될 수 없을 뿐 아니라 삶이 정말로 살 만한 것이 되지 않을까 생각합니다. (253쪽) 만약에 우리가 우주라는 하나의 몸에 존재하는 세포라고 가정한다면 어떻게 될까요. 우리는 각자의 이기를 위해 존재하는 것이 아니라 우주라는 몸을 위해 서로 조화를 이루며 봉사하는 존재가 될 것입니다. (…) 서로 믿고 조화를 이루며 봉사하는 삶, 바로 이것이 의미 있는 삶이라고 생각합니다. (275~276쪽) 우리는 죽지 않기 위해 사는 것도 아니고, 죽지 못해 사는 것도 아닙니다. 죽기 위해 열심히 살아가는 것입니다. 의미 있는 삶을 살다가 아름답게 죽음을 마무리하는 것까지가 인생의 완성입니다. 나무는 죽어 새로운 생명으로 태어납니다. 다시 대지로 돌아간 우리 역시 어디선가 다른 생명으로 이어집니다. 죽음은 자연으로의 회귀이며 또 다른 시작입니다. (279쪽). (shrink)

1-pu. Ttang ŭi soksagim -- 2-pu. Mul ŭi norae -- 3-pu. Pulkkot ch'ŏrŏm -- 4-pu. Param ŭi hŭnjŏk.

Scandals involving celebrities’ moral transgressions are common in both Western and Eastern cultures. Existing literature, however, has been primarily based on Western cultures. We examine differences between South Korea and the United States in consumers’ support for celebrities engaged in moral transgressions and for the brands they endorse. Across six studies, we find that Korean consumers show lower support for celebrities who engaged in moral transgressions. This effect occurs because Korean consumers have a stronger belief that an individual’s competence and (...) morality are interconnected. Thus, Korean consumers are less likely to separate their judgments of celebrities’ morality and competence in professional performance, thereby lowering support for the celebrities. Building on the proposed mechanism, we identify the moderating role of transgression relevance. When a moral transgression is relevant to the domain of the celebrity’s professional competence, the difference in celebrity support between the two countries is attenuated. This difference extends to the support for a brand endorsed by the celebrity transgressor when the brand retains the celebrity endorser, but not when the brand dismisses the endorser. (shrink)

A common assumption in the selection of nonhuman animal subjects for research and the approval of research is that, if the risks of a procedure are too great for humans, and if there is a so-called scientific necessity, then it is permissible to use nonhuman animal subjects. I reject the common assumption as neglecting the central ethical issue of the permissibility of using nonhuman animal subjects and as being inconsistent with the principle of justice used in human subjects research ethics. (...) This principle requires that certain classes of individuals not be subjected to a disproportionate share of the burdens or risks of research. I argue for an extension of this principle to nonhuman animal research and show that a prima facie violation of the principle occurs because nonhuman animals bear an overwhelmingly disproportionate share of the risks of research without sufficient justification or reciprocal benefit. (shrink)

Companies are increasingly engaging in corporate activism, defined as taking a public stance on controversial sociopolitical issues. Whereas prior research focuses on consumers’ brand perceptions, attitudes, and purchase behavior, we identify a novel consumer response to activism, unethical consumer behavior. Unethical behavior, such as lying or cheating a company, is prevalent and costly. Across five studies, we show that the effect of corporate activism on unethical behavior is moderated by consumers’ political ideology and mediated by desire for punishment. When the (...) company’s activism stand is [incongruent/congruent] with the consumer’s political ideology, consumers experience [increased/decreased] desire to punish the company, thereby [increasing/decreasing] unethical behavior toward the company. More importantly, we identify two moderators of this process. The effect is attenuated when the company’s current stance is inconsistent with its political reputation and when the immorality of the unethical behavior is high. (shrink)

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

The term, "objectionable commemorations”, refers to a broad category of public artefacts – such as, and especially, memorials, monuments and statues – that are regarded as morally problematic in virtue of what or whom they honour. In this regard, they are a special class of public artefacts that are subject to public contestation. In this paper, we survey the general ethical and political issues on this topic. First, we categorise the arguments on offer in the literature, concerning the objectionable nature (...) of such commemorations. Second, we review common political responses to objectionable commemorations. Finally, we identify fruitful areas for further philosophical inquiry on this topic. (shrink)

In an increasingly globalized world, the accessibility of healthcare and medication has expanded beyond local healthcare systems and national borders. This study aims to investigate the transnational health and self-care experiences of 11 Japanese women who have resided in South Korea for a minimum of six months and have utilized oral contraceptives, including those that were acquired over-the-counter (OTC). Data were gathered through semi-structured interviews and analyzed by utilizing the NVivo software. The analysis yielded three significant thematic categories, namely (1) (...) experiences and perceptions of obtaining and utilizing contraceptive pills, including OTC access; (2) individual and social perceptions of pills and their accessibility in Japan, insights from actual users; and (3) enhancing pill accessibility, transnational health and self-care experiences and perspectives. Participants acknowledged that oral contraceptives are a global product and experienced communication challenges with healthcare providers as a result of differing understandings of these medications. Additionally, this study identified transnational strategies, such as purchasing an adequate supply of pills just before departure and seeking pills from local families or acquaintances. This study not only highlights the implications of clinical care for transnational patients but also underscores their critical global perspectives on access to oral contraceptives. Furthermore, it proposes two models for improving accessibility within the Japanese healthcare system, even in prescription-only contexts, by introducing OTC options. (shrink)

우리 시 21편을 통해 현대 철학을 쉽고 재미있게 배운다! 김수영, 김춘수, 황동규, 황지우, 기형도, 최영미 등 우리에게 친숙한 현대 시인의 시를 통해 현대 철학의 주요 개념을 알기 쉽게 설명한 『철학적 시 읽기의 즐거움』. 노장사상을 전공한 동양철학자이면서 서양철학의 흐름에도 해박한 저자, 강신주는 시는 짧지만, 그 속에 철학책 한 권 못지않은 무한한 고뇌와 사유의 세계를 담고 있다고 말한다. 이 책은 우리에게 신선한 충격과 사고의 전환을 가져다준 들뢰즈, 푸코, 사르트르 같은 현대 철학자들의 사유가 우리 현대 시인들의 시와 어떻게 행복하게 만나는지 보여준다. 그리고 그 (...) 철학자들이 고뇌했던 문제들이 우리 현대 시인들이 고민했던 문제들과 다르지 않다는 점을 감각적인 문장으로 녹여낸다. (shrink)

This chapter contains sections titled: Getting Under Her Skin Revolutionary Politics and Feminist Body Consciousness Homosociality Skinship Bonding, and Corporeal Feminism Meeting Narrative Needs Pricks as Needles Odd Girls Out ‘By the Father's Hand’: The Tattoo Taboo, Public Anxiety, and India(n) Ink The Skin She's In: Keeping Tattooing Personal and Political.

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

We study the problem of existence of maximal chains in the Turing degrees. We show that: 1. ZF+DC+"There exists no maximal chain in the Turing degrees" is equiconsistent with ZFC+"There exists an inaccessible cardinal"; 2. For all a ∈ 2ω.(ω₁)L[a] = ω₁ if and only if there exists a $\Pi _{1}^{1}[a]$ maximal chain in the Turing degrees. As a corollary, ZFC + "There exists an inaccessible cardinal" is equiconsistent with ZFC + "There is no (bold face) $\utilde{\Pi}{}_{1}^{1}$ maximal chain of (...) Turing degrees". (shrink)

A central idea of public reason liberalism is that the exercise of political power is legitimate when supported only by reasons which all citizens accept. Public reason serves as a necessary standard for evaluating the legitimacy of political decisions. In this paper, I examine the directive to employ public reason from the citizens’ perspective. I suggest that employing public reason potentially involves them engaging in different types of compromise. I consider how acknowledging these compromises sheds light on public reason liberalism. (...) Public reason may not offer a necessary standard for evaluating the legitimacy of decisions, and the evaluation it offers may not have great weight relative to other moral and political considerations. (shrink)

Medical professionals are expected to act in the interest of patients, the public, and the pursuit of medical knowledge. Their disinterested pursuit offers them credibility and authority. But what happens when doctors' supposed impartiality comes under fire? Medicine and Morality considers the ways in which moral and scientific norms in Canadian medicine have emerged and evolved over time. Critics of biomedicine tend to discuss conflict of interest as a contemporary phenomenon - namely in relation to the damaging influence of the (...) pharmaceutical industry on medical practice and research. But Helen Kang examines three moments in the history of the medical profession in Canada, spanning more than 150 years, when doctors' moral and scientific authority was questioned. Kang shows that, in these moments of crisis, the profession was compelled to re-examine its priorities, strategize in order to regain credibility, and redefine what it means to be a good doctor. Medicine and Morality reveals that professional medicine defines integrity, objectivity, accountability, neutrality, and other ideals according to its social, political, historical, and economic struggles with the state, the media, and even the public. In other words, moral and scientific standards in medicine are determined in direct relation to, not in spite of, conflict of interest. (shrink)

The theory of ‘Confucianization of law’ put forward by T’ung-tsu Ch’ü in his book titled Law and Society in Traditional China has a great academic influence in the world. However, ‘Confucianization...

The paper is a critique of traditional and formal models of theological education that historically have developed in the West and are generally adopted by Asian theological schools in Asia. Globalisation and the emergence of Asian Diasporas presented new problems and opportunities for rethinking appropriate models of contextual training. Building on works by Robert Banks, Ian Stackhouse and David Kelsey, the paper will explore contextual models for the Chinese Christian Diasporas in Britain, and suggest some contributions for the renewal of (...) theological education in Asia. (shrink)

Conscientious disobedients often face the demand to differentiate themselves from criminals whose law-breaking actions are not undergirded by conscientious convictions. In public and philosophical discourse, conscientious disobedients are often criticised on the basis that their actions render them no different from criminals. I provide a qualified defence of disobedients in this essay. I argue that the differentiation demand can be satisfied even by disobedients who engage in what are typically regarded as radical acts of disobedience. In practical terms, this means (...) that even disobedients who engage in actions such as arson, looting, rioting, vandalism or vigilantism can also successfully differentiate themselves from criminals. (shrink)

ABSTRACT In recent years, progressive activists around the world have fought to remove ‘problematic’ commemorations – typically, monuments commemorating and honoring individuals responsible for injustice, or even unjust events. Many of these problematic commemorations are vandalized before they are eventually removed. In this essay, I consider how the vandalism of problematic commemoration can transform the public honoring of a target, to a public repudiation or humiliation of that target. I discuss four obstacles to realizing the transformative potential of vandalism, and (...) how they may be mitigated or overcome. (shrink)

In Cosmopolitan Theology, author Namsoon Kang proposes a theology that embraces and at the same time moves beyond collective identity position and group-based allegiances. It crosses borders of gender, race, nationality, religion, ethnicity, sexuality, and ability. Kang offers a vision of a global community of radical inclusion, solidarity, and deep compassion and justice for others. Blending theology with philosophy, she crosses borders of academism and activism, and the discursive borders of modernism, postmodernism, feminism, and postcolonialism. Cosmopolitan Theology sheds (...) a new light both in academia and the community of Christian believers by providing a public relevance of Jesus' teaching of neighbor-love, hospitality, and solidarity in our world today. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChong Siow Ann, Associate ProfessorDr. G appears to experiencing symptoms of schizophrenia, which is arguably the most severe mental disorder and which afflicts about one in a hundred people. This is a psychotic disorder that causes disturbances and distortions in thinking, including neurocognitive impairments, perception and behaviour. There is no cure for this often devastating disorder. Current antipsychotic medications can alleviate some of the symptoms but it often (...) comes at a price as these antipsychotics have burdensome side effects.A feature of this disorder is anosognosia, which is a lack of awareness or “insight” that an illness is present. This lack of insight presents a particular challenge because these individuals would, as in the case of Dr. G, refuse needed treatment as they do not perceive that they are ill. This is not necessarily an all-or-none phenomenon but is rather more complex and multidimensional; there might be an unawareness or recognition on behalf of the patient that they are suffering from a mental illness, the failure to appreciate the necessity of treatment; and/or the inability to recognise and define the psychotic symptoms like unusual thoughts and hallucinations as signs of illness1 and in many instances, all three are present. It is also by no means uncommon. Studies have found that between 60% and 80% of people with schizophrenia lack awareness of their illness to varying degrees.2This phenomenon remains an enigma. Some regard it as a form of psychological defence against the harsh reality of a psychotic illness — awareness of having a chronic and devastating illness might lead to demoralisation, hopelessness and suicide.3 Recent research, however, [End Page 250] indicates that this psychological denial plays a small part, if any, and instead has found an association with certain neuropsychological and neurocognitive deficits,4 as well as functional and structural brain abnormalities in the frontal lobe of the brain.5The prevailing clinical view thus is that this is an intrinsic and organic aspect of the schizophrenic illness which has nothing to do with wilfulness but rather the incapacity to perceive the presence of the illness. Edwin Fuller Torrey, an eminent psychiatrist and executive director of the Stanley Medical Research Foundation, calls anosognosia the “single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications”, and he has remarked that “to keep talking about civil liberty is illogical. Patients are anything but free when they’re at the beck and call of their own delusions”.6It is also this view that it is a product of a brain disorder that some — particularly patients — find unacceptable. At one level, it does not take into context the person’s own experiences, and at a deeper level it calls into question the conception of the self with its capacity to exercise judgements and the autonomy to make decisions.This is a perennial ethical issue in psychiatry when people with severe mental illnesses refuse treatment. This becomes a Catch-22 situation where part of the illness that needs treatment is also preventing any treatment to be given: implicit in the principle of informed consent for treatment is that the person should be aware of the nature and course of their illness and acknowledge the need for treatment. While there are laws for involuntary commitment, the bar is usually high in that there must be a clear and present risk of harm to the person or others. Alan Stone, a professor of law and psychiatry at Harvard University proposed a possible justification for involuntary treatment based on his “thank-you theory” which assumes that patients will become well and subsequently agree that the intervention was in their best interests but research suggests that only half of these patients would admit so.7One suggested mechanism is the use of advance directives — psychiatry’s version of the living will in which people can specify what sort of medical care they would like should they become mentally unwell and unable to exercise appropriate judgement. An intrinsic part of this might include a “Ulysses contract” — just as Ulysess instructed his crew to lash him to the mast of the his ship so that he could... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex interaction (...) of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)