Phronesis is often described as a ‘practical wisdom’ adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. (...) Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes ‘Clinical phronesis’ as a descriptor for its appearance and role in the daily practice of (exemplary) physicians. (shrink)

In this paper we provide an account of the structural underpinnings of self-awareness. We offer both an abstract, logical account.

We adjudicate a recent dispute concerning the desire theory of well-being. Stock counterexamples to the desire theory include “quirky” desires that seem irrelevant to well-being, such as the desire to count blades of grass. Bruckner claims that such desires are relevant to well-being, provided that the desirer can characterize the object in such a way that makes it clear to others what attracts the desirer to it. Lin claims that merely being attracted to the object of one’s desire should be (...) sufficient for it to be relevant to one’s well-being. The capacity to characterize the desire as Bruckner requires does no work in the explanation of the welfare-relevance of the desire, Lin claims, especially since Lin’s account and Bruckner’s account are extensionally equivalent. In response, we provide a conceptual analysis of desire based on conceptual role semantics. Our analysis shows the plausibility of and motivation for Bruckner’s account. As well, it shows that the extensional equivalence of the accounts is no accident, but due to what it is to have a desire. Lin has not succeeded in providing an alternative to Bruckner’s account, but merely reformulated it, though in an illuminating way that supports Bruckner’s original case. (shrink)

A formalism is developed that treats a robot as a subject that can interpret its own experience rather than an object that is interpreted within our experience. A regulative definition of a meaningful experience in robots is proposed in which the present sensible experience is considered meaningful to the agent, as the subject of the experience, if it can be related to the agent's temporal horizons. This definition is validated by demonstrating that such an experience in evolutionary autonomous agents is (...) embodied, contextual and normative, as is required for the maintenance of phenomenological accuracy. With this formalism it is shown how a dialectic similar to that described in Hegelian phenomenology can emerge in the robotic experience and why the presence of such a dialectic can serve as a constraint in the further development of cognitive agents. (shrink)

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other key (...) informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

This article is intended to revive, through a critical reinterpretation, the bio-psychosocial model of George Engel. Engel’s first description in 1977, was very broad, encompassing too many aspects of medicine. In his later work, he focused his model as an epistemology for clinical medicine. However, what medicine mostly retained were minor aspects of the 1977 article, namely a multi-factorial approach to the etiology of diseases and a call to complement biomedicine with a psychosocial concern in order to re-humanize medicine. We (...) suggest that, properly understood as a clinical epistemology, Engel’s model retains its transformative potential for contemporary medicine.Our discussion begins with a.. (shrink)

This is my response to a book, Globalize Liberation, edited by David Solnit and published in 2004. Media activists James John Bell and Patrick Reinsborough sent me a copy and asked for my thoughts about it; the result turned into an essay of some length, which got a certain amount of exposure and discussion online. Looking at the travails of progressive activism since its publication, I find very little that needs revision, except the tone of relative optimism expressed toward the (...) end. (shrink)

The combination of genuine ethical concerns and fear of learning to use germ-line therapy for human disease must now be confronted. Until now, no established techniques were available to perform this treatment on a human. Through an integration of several fields of science and medicine, we have developed a nine step protocol at the germ-line level for the curative treatment of a genetic disease. Our purpose in this paper is to provide the first method to apply germ-line therapy to treat (...) those not yet born, who are destined to have a life threatening, or a severely debilitating genetic disease. We hope this proposal will initiate the process of a thorough analysis from both the scientific and ethical communities. As such, this proposal can be useful for official groups studying the advantages and disadvantages of germ-line therapy. (shrink)

This collection of essays, though dealing with different topics from section to section, is unified by the idea that, at least in the English-speaking world, ...

Corporate entrepreneurs -- described in the academic literature as those managers or employees who do not follow the status quo of their co-workers -- are depicted as visionaries who dream of taking the company in new directions. As a result, though, in overcoming internal obstacles to reaching their professional goals they can often walk a fine line between clever resourcefulness and outright rule breaking. A framework is presented as a guideline for middle managers and organizations seeking to impede unethical behaviors (...) in the pursuit of entrepreneurial activity. This paper examines the barriers middle managers face in trying to be entrepreneurial in less supportive environments, the ethical consequences that can result, and a suggested assessment and training program for averting such dilemmas. We advise companies that embrace corporate entrepreneurship: (1) establish the needed flexibility, innovation, and employee initiative and risk-taking; (2) remove the barriers that the entrepreneurial middle manager may face to more closely align personal and organizational initiatives and reduce the need to behave unethically; and (3) include an ethical component to corporate training which will provide guidelines for instituting compliance and values components into the state-of-the-art corporate entrepreneurship programs. (shrink)

The thesis that rationality consists in the straight-forward maximization of utility has not lacked critics. Typically, however, detractors reject the Humean picture of rationality upon which it seems based; they seek to emancipate reason from the tyranny of the passions. It is, then, noteworthy when an attack on this thesis comes from ‘within the ranks.’David Gauthier's paper ‘Reason and Maximization’ is just such an attack; and for this reason, among others, it is interesting. It is not successful, though. In defense (...) of this conclusion, we shall begin by relating the essentials of Gauthier's argument. Then we shall examine in some detail Gauthier's claim that the principle of straighforward max-imization fails to be self-supporting. We shall argue that Gauthier's defense of this claim is at best incomplete. Finally, we shall show that the fact that a normative principle is self-subverting or non-self-supporting does not entail that the principle is defective. (shrink)

A well-known relativistic action at a distance interaction of two unequal masses is altered so as to yield purely Newtonian radial forces with fixed particle rest masses in the system center-of-momentum inertial frame. Although particle masses experience no kinematic mass increase in this frame, speeds are naturally restricted to less than the speed of light. We derive a relation between the center-of-momentum frame total Newtonian energy and the composite rest mass. In a new proper time quantum formalism, we obtain an (...) L2(R4 ⊗ R4, C) Hilbert space by varying individual particle rest masses. We propose the use of density operators, recognizing that the auxiliary proper time parameter is not an observable. The quantum formalism is applied to our altered version of the relativistic harmonic oscillator. Our generalized coherent states yield four-dimensional wave packets which follow the correct classical world lines. Appendices contain reviews of classical Hamiltonian reparametrization (incorporating our notion of manifest covariance), and a comparison of this work with the literature. (shrink)

BackgroundPrevious empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice ‘on its own terms’ by turning to the experience of patients.MethodsPhenomenological analysis of in-depth individual interviews with 8 patients.ResultsWe describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point provided by an (...) engaged physician. We draw on Heidegger’s notion of solicitude to show that patients are actively ascertaining the physician’s engagement in their care.ConclusionsThese findings lead us to question the classical “dual discourse” of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician’s solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient. (shrink)

This article briefly reviews concerns related to the “cultural colonialism” of applying Western biomedical models of research ethics to non-Western groups. The feasibility of alternate ethical models is discussed and found wanting. In practical terms, many academic researchers in the United States are funded by federal agencies and are required to adhere to Title 45, Part 46 of the Code of Federal Regulations , legislation that is clearly grounded in the Western biomedical research tradition. Consequently, the question is not whether (...) this system of ethics should be applied but rather how it can be applied most sensitively, appropriately, and wisely. The remainder of this article discusses of how the authors have attempted to do so in each stage of their own research with Hispanic immigrants to the United States. (shrink)

This book is a rich blend of analyses by leading experts from various cultures and disciplines. A compact introduction to a complex field, it illustrates biotechnology's profound impact upon the environment and society. Moreover, it underscores the vital relevance of cultural values. This book empowers readers to more critically assess biotechnology's value and effectiveness within both specific cultural and global contexts.

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.4 (2001) 591-592 [Access article in PDF] J. A. Cover and John O'Leary-Hawthorne. Substance & Individuation in Leibniz. Cambridge: Cambridge University Press, 1999. Pp. x + 307. Cloth, $59.95. This close engagement with Leibniz's modal metaphysics is as rewarding as it is challenging. Crisply written and tightly argued, the book aims to achieve a balance between what the authors describe as their historical (...) objective—to ascertain Leibniz's views on individuation against the backdrop of scholastic philosophy—and their philosophical goal—to investigate the issue of individuation more generally by construing Leibniz as a mediary between scholastic and modern metaphysics (4). The result is an original, if at times contentious, reinterpretation of some of the central tenets of Leibniz's philosophy.Since a full discussion of the work is beyond the scope of this review, we focus on one principal line of argument that supports much of what the authors say about Leibniz. Although in early texts Leibniz occasionally shows sympathy for a relational view of individuation (59-63), his dominant position (developed in the seminal Disputatio metaphysica) is that a substance's principle of individuation is wholly internal to it. For the authors, this becomes a benchmark for the interpretation of Leibniz's later philosophy. On their reading, Leibniz's account of individuation rests on two main theses: "the requirement of separability" (that the existence of any substance is metaphysically independent of that of any other substance except God) and "the requirement that whatever individuates a substance must be wholly internal to it" (87).These theses are heavy with consequences. Concerning the ontological status of relations and relational properties (or extrinsic denominations) the authors convincingly argue that Leibniz embraces a reductionist position, according to which relational properties supervene on a substance's intrinsic accidents, i.e., its perceptions and appetitions. Monadic facts about substances suffice to determine all relational facts, and the latter cannot change without a change in the former (though the converse does not hold). Emphasizing Leibniz's statement that God sees in a complete concept the "foundations" of all that can be predicated of a substance, the authors add to this the more controversial claim that extrinsic denominations are not included in the complete concept of an individual substance (83-4). Thus, the identity of any substance is defined by the totality of its intrinsic denominations, and these in turn determine the relations that hold among substances.The centerpiece of the book addresses the modal dimension of Leibniz's theory of individuation. Here the authors argue that Leibniz adheres to what they call "strong essentialism" rather than "superessentialism." The former, like the latter, holds that a substance could not have a complete concept different than the one it has. However, as a "strong essentialist" Leibniz denies that all of a substance's properties are essential to it. Based on their reading of Leibniz's doctrine of relations, the authors maintain that all and only intrinsic denominations are essential to a substance. From this they infer that Leibniz allows for the transworld identity of substances: the same substance can exist in different possible worlds, worlds distinguished by the fact that they contain different constituent substances. This is possible, according to the authors, because the "laws of harmony" impose no constraint on which substances can coexist in a world. A possible world is defined by the collection of individuals supposed to exist in it, and laws [End Page 591] of harmony are merely relational truths supervening on those substances' intrinsic accidents (109).The authors are candid in admitting that their interpretation cannot be reconciled with all of Leibniz's texts. Their goal instead is to give Leibniz the best he can get, metaphysically speaking: "Our efforts here are to show that the architectonic of Leibniz's own metaphysics is properly captured by strong essentialism, that the important and deepest threads of his thinking better hang together on that construal" (103). Yet one might take issue with their view of what count as Leibniz's "deepest" thoughts. Surely it is a... (shrink)

ABSTRACT Certain problems in commonsense reasoning lend themselves to the use of non-standard formalisms which we call active logics. Among these are problems of objects misidentification. In this paper we describe some technical issues connected with automated inference in active logics, using particular object misidentification problems as illustrations. Control of exponential growth of inferences is a key issue. To control this growth attention is paid to a limited version of an inference rule for negative introspection. We also present some descriptive (...) statistics for comparison with earlier active-logic approaches. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

At the forefront of international concerns about global legislation and regulation, a host of noted environmentalists and business ethicists examine ethical issues in consumption from the points of view of environmental sustainability, economic development, and free enterprise.

Book reviewed in this article: Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth Century England. By Michael MacDonald. Making It Crazy: An Ethnography of Psychiatric Clients in an American Community. By Sue E. Estroff. Mind, Mood, and Medicine: A Guide to the New Biopsychiatry. By Paul H. Wender, M.D. and Donald F. Klein, M.D.