Recreational Drugs European Network (ReDNet) project aims to use the Psychonaut Web Mapping Project database (Psychonaut Web Mapping Group, 2009) containing novel psychoactive compounds usually not mentioned in the scientific literature and thus unknown to clinicians as a unique source of information. The database will be used to develop an integrated ICT prevention approach targeted at vulnerable individuals and focused on novel synthetic and herbal compounds and combinations. Particular care will be taken in keeping the health professionals working directly with (...) young people showing problematic behaviors regularly updated in terms of novel compounds and combinations as well. A user-friendly project website will be developed aimed primarily at delivering the information/prevention approaches, but will also be a way of communicating with project partners and relevant stakeholders (e.g. thematic forum facilities, instant messages, blogs, video chat, wikiblog, newsletters distributed via mailing list). The website will support various ICT prevention tools, including an SMS alert service. Different areas and sections will be aimed specifically at the different target groups. -/- . (shrink)

It is often said that the world is explained by laws of nature together with initial conditions. But does that mean initial conditions don’t require further explanation? And does the explanatory role played by initial conditions entail or require that time has a preferred direction? This chapter looks at the use of the ‘initialness defence’ in physics, the idea that initial conditions are intrinsically special in that they don’t require further explanation, unlike the state of the world at other times. (...) Such defences commonly assume a primitive directionality of time to distinguish between initial and final conditions. Using the case study of the time-asymmetry of thermodynamics and the so-called ‘past hypothesis’ — the hypothesis that the early universe was in a state of very low entropy —, I outline and support a deflationary account of the initialness defence that does not pre- suppose a basic directionality of time, and argue that there is a relevant explanatory asymmetry between initial conditions and the state of systems at other times only if certain causal conditions are satisfied. Hence, the initialness defence is available to those who reject a fundamental direction of time. (shrink)

Today's medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal. What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics (...) meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of "health care services" for the sake of the patient's subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange. Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient's health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics. (shrink)

Uncivil behavior by leaders may be viewed as an effective way to motivate employees. However, supervisor incivility, as a form of unethical supervision, may be undercutting employees’ ability to do their jobs. We investigate linkages between workplace incivility and perceived work ability, a variable that captures employees’ appraisals of their ability to continue working in their jobs. We draw upon the appraisal theory of stress and social identity theory to examine incivility from supervisors as an antecedent to PWA, and to (...) investigate job involvement and grit as joint moderators of this association. Results from data collected in two samples of working adults provided evidence for three-way interactions in relation to PWA. Among employees with high levels of grit, there was no significant relation between supervisor incivility and PWA, regardless of employee job involvement. However, we found some evidence that for those low in grit, having high job involvement was associated with a stronger relationship between supervisor incivility and PWA. Findings attest to the importance of unethical supervisor behavior, showing the potential for supervisor incivility to erode PWA, as well as the importance of grit as a potential buffer. (shrink)

Abordaré la crítica de Axel Honneth a la primera Escuela de Frankfurt y su aparente omisión de Herbert Marcuse. Defenderé a Marcuse contra algunas de las críticas hechas por Honneth a la teoría crítica temprana de la Escuela de Frankfurt. Luego argumentaré que Marcuse siempre estuvo en busca de una subjetividad radical, incluso cuando advirtió contra los mecanismos unidimensionales en curso de producción de sujetos. Finalmente, mostraré que Honneth también construye su proyecto en torno a la búsqueda de una subjetividad (...) radical, pero aborda el problema a través de una teoría de la intersubjetividad que complementa el proyecto de Marcuse. (shrink)

It is common wisdom that today’s medicine focuses too much on treating those who are sick and too little on preventing the sickness in the first place. This essay proposes that Jesus’ teaching in the Sermon on the Mount challenges that assumption and the preventive medicine to which it has given rise. In light of Jesus’ teaching, the essay identifies four apparent problems with much of preventive medicine. It then offers four heuristics that might form a basic Christian logic for (...) medicalizing risk—for discerning when and why it would be fitting, wise, and faithful for Christians to make use of medicine to avoid future illness and death. (shrink)

Cognitive science has recently made some startling discoveries about temporal experience, and these discoveries have been drafted into philosophical service. We survey recent appeals to cognitive science in the philosophical debate over whether time objectively passes. Since this research is currently in its infancy, we identify some directions for future research.

For most of the past generation, clinicians have been taught to treat patients' pain until the patient says it is relieved. The opioid crisis has forced both clinicians and patients to reconsider that approach. This essay considers how Christians in particular might assume and seek to overcome their experiences of persistent pain. Wise and faithful responses to pain, especially chronic pain, can take their bearings from how early Christians made sense of the place of both medicine and suffering in a (...) faithful life. This results in not asking medicine to resolve persistent pain, especially not through the use of opioids. Resisting the impulse to medicalize chronic pain will require patience on the part of those who suffer, and both patience and fortitude on the part of the clinicians to whom they present. (shrink)

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, (...) to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one (...) unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated. (shrink)

Doctors often refuse patients' REQUESTS, even when patients request interventions that are legal and permitted by the medical profession. This is a fact about the practice of medicine so familiar that it is easy to overlook.Doctors' refusals are neither new nor infrequent, and only a small minority occasion any controversy. Surgeons refuse to operate when they believe a surgery is unlikely to succeed. Physicians refuse medications when they believe the medications are unlikely to be helpful. Clinicians refuse requested interventions because (...) of concerns about safety or efficacy, and they refuse because of less tangible concerns that are no less real. Some pediatricians refuse to supplement the growth hormone of boys... (shrink)

While the COVID-19 pandemic riveted public attention on questions regarding how to respond reasonably to risk of illness, everyday medical care involves more mundane forms of pharmaceutical risk management for conditions like high blood pressure, prediabetes, or high cholesterol. This essay, and the collection it introduces, explore medicalization of risk as a theological problem, drawing on resources such as the Sermon on the Mount that caution us about the potential dangers of risk management to Christian discipleship. Medicalization of risk threatens (...) to become an idol that promises immanent security at the cost of one’s relationship with God and others. It misleads contemporary society as to the true human end and medicine’s own capabilities to provide temporal salvation. The essays in this special issue illustrate these problems with respect to pharmaceutical risk management. (shrink)

Habermas's paradigm of communicative action is usually taken to be pretty much dominated by consensus, "Yes-saying." What if this were a radically one-sided perception? We take up this unorthodox position by arguing that "no-saying" in this paradigm is typically overlooked and underemphasized. To demonstrate this, we consider how negativity is figured at the most basic onto-ethical level in communicative action, as well as expressed in civil disobedience, a phenomenon to which Habermas assigns the remarkable role of "touchstone" (Prufstein) of constitutional (...) democracy. Once the importance of no-saying is drawn out, the paradigm looks distinctly less hostile to dissensus and agonism in democratic life. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession.1.

Market metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues’ analysis of modernization in their book The Homeless Mind and place that analysis in conversation with Max Weber’s 1917 lecture “Science as a Vocation” to argue that the rise of market metaphors betokens the carry-over to medical practice of various features from the institutions of technological production and bureaucratic administration. We refer to this carry-over as the product presumption. The product presumption (...) foregrounds accidental features of medicine while hiding its essential features. It thereby confounds the public understanding of medicine and impedes the professional achievement of the excellences most central to medical practice. In demonstrating this pattern, we focus on a recent article, “Physicians, Not Conscripts—Conscientious Objection in Health Care,” in which Ronit Stahl and Ezekiel Emanuel decry conscientious refusals by medical practitioners. We demonstrate that Stahl and Emanuel’s argument depends on the product presumption, ignoring and undermining central features of good medicine. We conclude by encouraging conscientious resistance to the product presumption and the language it engenders. (shrink)

The rapidly expanding universe of information, media, and learning experiences available through digital technology is creating unique opportunities and vulnerabilities for children and adolescents. These issues are particularly salient during the developmental window at the transition from childhood into adolescence. This period of early adolescence is a time of formative social and emotional learning experiences that can shape identity development in both healthy and unhealthy ways. Increasingly, many of these foundational learning experiences are occurring in on-line digital environments. These expanding (...) vulnerabilities and opportunities are being further amplified for young adolescents growing up in low resourced settings around the world. Cultural and contextual factors influence access, use, and appropriation of digital technology. Further, neurobehavioral changes associated with the onset of puberty often coincide with entry into social media and more autonomous use of technology. In low-and-middle-income countries (LMICs), disparities in access, use, and appropriation of digital media can amplify prevailing economic gaps, and compound gender inequalities during early adolescence. In LMICs, adolescents are often the early adopters of mobile technology and social media platforms. While the impact of social media on the well-being, particularly mental health, of young adolescents has been a focus of research in high-income countries (HICs), much less is known about the impacts of social media use on young adolescents in LMICs. In this paper, we review what is known about the interaction between digital media and early adolescent development. We highlight crucial gaps in the evidence in LMICs; and describe some hypotheses and areas for future research to address these compelling issues. (shrink)

Over the past decade, scores of articles have been published debating whether and when it is ethical for physicians to refuse requests from patients for legal, professionally permitted interventions. Numerous voices have condemned "conscientious refusals" for obstructing patients' access to needed and "standard" health-care services, for imposing physicians' personal ideologies on patients, and for contradicting physicians' professional ethical obligations. Conversely, other voices argue that conscientious refusals are essential for maintaining the integrity of clinicians as moral agents, for assuring the renown (...) of the broader medical profession, and for preventing the imposition of moral viewpoints onto minorities... (shrink)

The stories in this collection can be described as stories of transgression. The writers have learned that public expressions of religious faith or reasoning are to be kept separate from the practices of caring for patients. Mixing the two is dangerous. Yet, as the stories indicate, many health practitioners cannot help themselves: their religion comes through, shaping their encounters with patients in all manner of ways. Religion comes through not as a distraction from medicine but as integral to their efforts (...) to care well for their patients. (shrink)

In the United States and Europe, an increasing emphasis on equality has pitted rights claims against each other, raising profound philosophical, moral, legal, and political questions about the meaning and reach of religious liberty. Nowhere has this conflict been more salient than in the debate between claims of religious freedom, on one hand, and equal rights claims made on the behalf of members of the lesbian, gay, bisexual, and transgender community, on the other. As new rights for LGBT individuals have (...) expanded in liberal democracies across the West, longstanding rights of religious freedom -- such as the rights of religious communities to adhere to their fundamental teachings, including protecting the rights of conscience; the rights of parents to impart their religious beliefs to their children; and the liberty to advance religiously-based moral arguments as a rationale for laws -- have suffered a corresponding decline. Timothy Samuel Shah, Thomas F. Farr, and Jack Friedman's volume, Religious Freedom and Gay Rights brings together some of the world's leading thinkers on religion, morality, politics, and law to analyze the emerging tensions between religious freedom and gay rights in three key geographic regions: the United States, the United Kingdom, and continental Europe. What implications will expanding regimes of equality rights for LGBT individuals have on religious freedom in these regions? What are the legal and moral frameworks that govern tensions between gay rights and religious freedom? How are these tensions illustrated in particular legal, political, and policy controversies? And what is the proper way to balance new claims of equality against existing claims for freedom of religious groups and individuals? Religious Freedom and Gay Rights offers several explorations of these questions. (shrink)

What would it be for a process to happen backwards in time? Would such a process involve different causal relations? It is common to understand the time-reversal invariance of a physical theory in causal terms, such that whatever can happen forwards in time can also happen backwards in time. This has led many to hold that time-reversal symmetry is incompatible with the asymmetry of cause and effect. This article critiques the causal reading of time reversal. First, I argue that the (...) causal reading requires time-reversal-related models to be understood as representing distinct possible worlds and, on such a reading, causal relations are compatible with time-reversal symmetry. Second, I argue that the former approach does, however, raise serious sceptical problems regarding the causal relations of paradigm causal processes and as a consequence there are overwhelming reasons to prefer a non-causal reading of time reversal, whereby time reversal leaves causal relations invariant. On the non-causal reading, time-reversal symmetry poses no significant conceptual nor epistemological problems for causation. _1_ Introduction _1.1_ The directionality argument _1.2_ Time reversal _2_ What Does Time Reversal Reverse? _2.1_ The B- and C-theory of time _2.2_ Time reversal on the C-theory _2.3_ Answers _3_ Does Time Reversal Reverse Causal Relations? _3.1_ Causation, billiards, and snooker _3.2_ The epistemology of causal direction _3.3_ Answers _4_ Is Time-Reversal Symmetry Compatible with Causation? _4.1_ Incompatibilism _4.2_ Compatibilism _4.3_ Answers _5_ Outlook. (shrink)