Using Africana critical theory as a critical framework to analyze W. E. B. Du Bois’s Black Flame trilogy, this study establishes a transdisciplinary theory of the dehumanization of Black students in the United States. As lenses of analysis, critical race theory and Post Traumatic Slave Syndrome reveal how the processes of racialization, colonization, and globalization contribute to the multigenerational traumas many Blacks have experienced in education since Reconstruction.

Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...) the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Recently, concerns have been raised about the phenomenon of 'overdiagnosis', the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises questions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue that (...) "disease" should be considered a vague concept with a nonclassical structure. On this view, overdiagnosed cases are 'borderline' cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a précising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)

Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence (...) itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims. (shrink)

In this chapter, Mary Collins Swabey critiques G. E. Moore's discussion of sense data.

L'analyse d'une cinétique de croissance y est conduite à partir du modèle logistique généralisé de Richards-Nelder. On distingue 2 types de processus dits mono- et multi-logistique. Dans le cas mono-logistique, le phénomène est correctement décrit par une seule fonction logistique. La cinétique de croissance est alors caractérisée par lea propriétés de chacune des phases G 1 à G 4, délimitées par les points singuliers Γmax, V max et Γmin. On appelle structure de croissance la contribution relative de ces différentes phases (...) à l'expression de la croissance totale. Cette distribution temporelle de l'activité de croissance est une représentation discrétisée de la trajectoire y 0 → y max. On appelle processus multi-logistique toute cinétique de croissance correspondant à une somme de 2 ou plusieurs logistiques généralisées. II existe alors un plus grand nombre de points singuliers et donc un plus grand nombre de phases G i que dans le cas monologistique. La structure de croissance définit avec précision la cinetique du phénomène, ainsi que l'importance relative des différentes composantes logistiques au cours du temps. Une application en est donnée avec le grandissement des cellules pleuridiophores de l'Algue Antithamnion plumula. L'allongement de ces cellules est toujours de type bi-logistique. Les caractéristiques de la structure de croissance permettent une discrimination nette du sporophyte et des gametophytes mâle et femelle. Tandis que la composante 1 est pen différente, la composante 2 varie fortement selon la ploïdie du thalle. En revanche, il y a pen de différences entre les deux gamétophytes. Cette notion de structure de croissance est ainsi susceptible d'apporter des résultats originaux. Audelà de cet example, cette approche est proposée comme une méthode de caractérisation simple mais précise de toute cinétique de croissance basée sur lea variations temporelles de l'activité de croissance [couple ]. (shrink)

This article describes the development of a computerized version of a measure of ethical sensitivity to racial and gender intolerance, the Racial Ethical Sensitivity Test. The REST was based on James Rest's 4-component model of moral development and the professional codes of ethics from school-based professions. The new version, Racial and Ethical Sensitivity Test-Compact Disk, consists of 5 videotaped scenarios followed by an interactive "interview" presented on compact discs. Data from a study with 58 students provides initial validation of the (...) REST-CD. Ethical sensitivity to racial and gender intolerance in schools, as measured by the REST-CD, was moderately related to attitudes toward racial and gender equity issues in society as measured by the Quick Discrimination Index. The results provide evidence for both interrater and internal reliability of the REST-CD scores. This study also tests the hypothesized relationship between REST-CD scores and previous multicultural and ethics course work. Students with multicultural and ethics course experience have scored significantly higher on the REST-CD than students without course work. The paper-and-pencil tests are not significantly related to previous ethics/multicultural course work. In this article, we discuss the implications of the results and directions for future research. (shrink)

In this chapter, Marie Collins Swabey critiques naturalism and defends a rationalistic conception of knowledge.

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. (...) In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

In this volume, first published in 1983, Professor Rogers examines the usefulness of a phenomenological approach to sociology. Her broad purpose is to demonstrate the theoretical and methodological advantages phenomenological sociology holds. Thus she offers a selective, introductory exposition of phenomenology, highlighting its relevance for social scientists and undercutting the notion of phenomenology as a non-scientific, subjective, or esoteric method of study.

This article offers both a feminist and an ethnomethodological reanalysis of Harold Garfinkel's report on Agnes, the intersexed person he studied with several colleagues. Both reanalyses yield similar conclusions. Specifically, while it does illuminate the work of accomplishing gender, the report on Agnes simultaneously illustrates how gender operates as a powerful background expectancy among professional as well as “lay” sociologists.

This paper explores how Schutz’s ideas enrich and extend the ethic of care promulgated by feminist theorists such as Carol Gilligan, Nel Noddings,Sara Ruddick, and Eva Feder Kittay. Using Schutz’s ideas about the I-Thou relationship, systems of relevances, and growing old together, the authorlays a foundation for continuing dialogue between feminist theorists of care and Schutzian phenomenologists.

This paper explores how Schutz’s ideas enrich and extend the ethic of care promulgated by feminist theorists such as Carol Gilligan, Nel Noddings,Sara Ruddick, and Eva Feder Kittay. Using Schutz’s ideas about the I-Thou relationship, systems of relevances, and growing old together, the authorlays a foundation for continuing dialogue between feminist theorists of care and Schutzian phenomenologists.

The work of literary structuralists, particularly Roland Barthes, provides sharper insights into ethnomethodology than symbolic interactionism, labeling theory, or phenomenology. Further, it suggests that the metaphor of text may be fruitful for analysts of everyday life. Greater theoretical benefits derive from that metaphor, however, if one applies it using the ideas of literary theorists outside the structuralist tradition.

In this Volume, published in1998, Fifteen scholars reveal the ways of preserving, conceiving and creating beauty were as diverse as the cultural influenced at work at the time, deriving from antique, medieval and more recent literature and philosophy, and from contemporary notions of morality and courtly behaviour. Approaches include discussion of contemporary critical terms and how these determined writers' appreciation of paintings, sculpture, architecture and costume; studies of the quest to create beauty in the work of artists such as Botticeli, (...) Leonardo, Raphael, Parmigianino and Vasari; and the investigation of changes functioning of the eye and brain, or to technical innovations like those found in Venetian glass. (shrink)

This study examined the laboratory dream content reported by 14 patients with schizophrenia and 15 controls, with a focus on reports obtained from NonREM sleep. Both the controls’ and patients’ frequency of dream recall following awakenings from NonREM and REM sleep were similar to values reported for healthy participants. Patients’ NonREM sleep narratives were shorter than those from controls. When compared to their reports from REM sleep, both groups’ NonREM sleep reports included significantly fewer words and reportable items. The controls (...) were more likely to report a subjective feeling of bizarreness for their REM sleep reports as compared to their NonREM sleep reports. This difference was not observed in patients with schizophrenia. Taken together, these findings suggest few differences between the NonREM sleep mentation of patients with schizophrenia and of controls and that sleep stage cognitive style is comparable in both groups, with NonREM sleep reports being more thought-like, less elaborate and bizarre than REM sleep reports. (shrink)

The filamentous and branched thallus of Antithamnion plumula is constitued of two different kinds of branches with apical growth: the cladomial axes with a continuous or indefinite growth, and the pleuridia with a limited growth. The size of the pleuridia depends on their position with respect to the lateral cladomial axes.The growth kinetics of 35 pleuridia were analysed using Nelder's generalized logistics. Each sigmoidal curve, which was divided into four growth stages from the instantaneous acceleration variations, was thus characterized by (...) ten kinetic parameters: lengths at the time of the changes in growth stage, durations of the growth stages and maximum growth rate. (shrink)

Although little noticed by practicing theorists, narrative voice influences theoretical work. This essay presents a demonstration of voice as method, concentrating on brief segments of works by Garfinkel and Goffman. We attend to two methodological themes: how theorists use voice to establish intellectual autonomy, and how the use of voice influences credibility with readers. Garfinkel maximizes his autonomy by using narrative techniques that isolate him from his readers, and produce little common context with them as a result. Goffman maintains a (...) context for credibility with his readers by using a personal voice, but he uses this voice to request their indulgence as he follows his autonomous muse. Goffman's narrative self-indulgence prevents him from fashioning a coherent theoretical program for his readers, something Garfinkel's distant voice enables him to achieve. (shrink)