The mandala is a polysemantic term referring to several distinct yet interrelated architectural and imperial concepts. In addition to this com plexity, however, the mandala’s multivalency is further compounded by layers of nineteenth- and twentieth-century interpretations that have added reductionistic Jungian associations and/or anachronistic Orientalist expectations onto the image. This essay attempts to strip away such accretions and assumptions. It calls for the recognition of the variety and distinctiveness of early Japanese mandalas and aims to resuscitate the role of the (...) mandala in picturing, but not necessarily producing, enlightenment. As a result, this essay will attempt to return to basics and reconsider two key types of Japanese Buddhist mandalas on their own terms. Specifically, it will provide an iconographic and doctrinal analysis of the eighth-century Taima mandala of Amitābha/Amitāyus Buddha in his Pure Land of the Western Paradise. It will also examine the famous pair of ninth-century Two-World mandalas, which depict the Diamond and the Womb World aspects of Mahāvairocana Buddha, the cosmic buddha of great light who illumines all equally. The essay concludes with a final reflection on the Taima and Two-World mandalas, as both are unique examples and emblematic models for two distinct Japanese Buddhist worldviews. (shrink)

This paper examines the role that religious belief plays in societies' treatment of nonhuman animals, first asking two questions. Does religious belief continue to play a role today in societies' treatment of nonhuman animals, and should it? The paper discusses the interaction of religion, secular ethics, and the law. As with a three-legged stool, each leg or component relies on the next for support. Religious values and claims, as features of the ethical framework by which many people live, have daily (...) implications for nonhuman animals. On a sliding scale, negative to positive, a religious point of view may affect other animals in different ways. Beliefs - religious in nature and origin - about other animals sometimes stand behind the claims and ethical formulations of avowedly nonreligious people and institutions and may be of some interest to philosophers and historians. The paper concludes that only through consideration and involvement of the three separate, yet inter-connected, components can animal abuse be effectively addressed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Mystical Consciousness: Western Perspectives and Dialogue with Japanese ThinkersPamela D. WinfieldMystical Consciousness: Western Perspectives and Dialogue with Japanese Thinkers. By Louis Roy, O.P.Albany: State University of New York Press, 2003. Pp. 229. Hardcover $62.50. Paper $20.95.Mystical Consciousness: Western Perspectives and Dialogue with Japanese Thinkers by Louis Roy presents a stimulating array of thinkers on the subject of consciousness, self-reflective consciousness, and mystical consciousness. Louis Roy's primary sources focus (...) on the somewhat standard canon of via negativa and Zeninfluenced thinkers and practitioners (Plotinus, Eckhardt, Schleiermacher, Nishitani, Hisamatsu, and Suzuki), but he also includes Bergson, Brentano, Heidegger, Hume, Husserl, Nietzsche, Nishida, Sartre, Schelling, and Tillich in his discussion. His secondary sources range widely, so the competing terminologies and conceptual schemes of Crosby, Forman, Granfield, Heiler, Helminiak, James, Johnston, Moore, Morelli, Price, Searle, and Tart can at times be confusing without an outline or chart. He aptly organizes his material into three sections, however: part 1 summarizes major Western philosophies of consciousness, part 2 presents three classic mystical writings from the Western canon, and part 3 compares Western views of the self and nothingness with those of Zen Buddhism. Roy's careful research and terse writing style, moreover, serve as an excellent introduction and basic starting point for further research into each one of these individual thinkers.Of all these sources however, it is evident that Roy favors the fourfold scheme of the Jesuit theologian Bernard Lonergan. As he states in his preface, Roy sets out "to develop an understanding of consciousness, mostly rooted in Bernard Lonergan's works and applied to the mystical life" (p. x). Lonergan traces the trajectory of human intentionality across four levels: (1) averting to an object, (2) knowing it, (3) [End Page 493] judging it to be true, and (4) appreciating its value. Following Lonergan's cue, Morelli has consequently claimed that "Being in love with God is the basic fulfillment of our conscious intentionality" (p. 32), and Michael Sharkey has characterized Lonergan's philosophy as a nondualistic "cognition by communion, and not encounter."1 Roy now articulates a threefold scheme to explicate the transition from everyday objectifying consciousness to this mystical, unitive consciousness.In order to accomplish this transition, Roy establishes a middle baseline B-consciousness that mediates between everyday and mystical consciousness. This analytic scheme can be outlined as follows.2(1) Consciousness C: "consciousness of" things. This everyday positional awareness engenders subject-object dualism.(2) Consciousness B: ordinary "consciousness in" that permeates all mental acts (noesis). This is a baseline non-positional consciousness that pervades and underlies all subject-object distinctions. In moments of self-reflection, this kind of "consciousness-in" can itself become C's object of awareness (what Plotinus calls antilepsis).(3) Consciousness A: mystical (as opposed to ordinary) "consciousness in." This is the same as consciousness B but is present in objectless states. Roy indicates that this highest or deepest consciousness refers to union with God, the divine, the sacred, or emptiness or nothingness in the Zen Buddhist sense. He argues that since consciousness C can become aware of B, then it can avert to, know, accurately judge, and appreciate A as well. Roy writes:Thanks to his [i.e. Lonergan's] efforts, we have come to realize that our conscious intentionality [what Roy calls consciousness-of, also called consciousness C] is able to develop an account of ordinary consciousness [consciousness B] and to employ this account analogically so as to make true judgments about mystical consciousness [consciousness A], without presuming that the latter can be fully comprehended.(p. 188)Throughout the volume, Roy provides ample evidence that we can become aware of our own noetic activity and noematic content (i.e., the act of thinking as well as our thoughts). He also surveys a wide range of apophatic mystics and philosophers who seem to indicate that this intentional process extends to becoming aware of consciousness A's "no-thinking" and "no-thought" as well (what Zen Buddhism terms munen-musō). But can our everyday objectifying awareness truly grasp the subjectless-objectless state of no-thingness so often described by mystics the world over? Can union with the Godhead or... (shrink)

ObjectivesThe purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records.MethodsPregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses. Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and logistic (...) models were evaluated for the associations between substance use and each birth outcome.ResultsThe average maternal age was 30 years, 37% receiving Medicaid. Over 58% were White, 26% were Black, and 13% were Hispanic. Cigarette smoking only showed the highest prevalence among substance u... (shrink)

Juan Huarte de San Juan (1529–88) was a physician of the Spanish Renaissance. He wrote the Examen de Ingenios para las Ciencias, translated as The Trial of Men’s Wits (1989[1575–94]), a book that has been acknowledged as a precursor of educational psychology, organizational psychology, behaviorism, neuropsychology and psychiatry. Huarte suggested that before beginning a course of study, students’ intellectual capabilities (i.e. ingenio) should be matched up with the professional studies that best suit their aptitudes. His book had a great impact (...) in Europe from the late 16th century to the mid-18th century. The influence of the Trial spread throughout many areas including philosophy, politics, linguistics and literature. Although there has been a growing interest in Huarte’s work in recent years, biographical studies have been rare; as a result, the information about Huarte’s life is currently incomplete, scattered and sometimes inaccurate. This study presents a systematic archival research on Spanish original sources. We present a reconstruction of Huarte’s life-story based on 32 original documents (1549–c.1650), some of them first discovered during the present survey. Documents are described according to the General International Standard of Archival Description, ISAD(G). The documents uncovered allow for a reappraisal of Huarte’s biography. (shrink)

The work of Michèle Le Dœuff creatively disrupts established notions of what philosophy might be. Far from being a discipline about the leader and the disciple, a hierarchy of knowledge and paternalism, Le Dœuff proposes a philosophy of dialogue and friendship. The conversations in this book explore how this philosophy can be enacted and explored, and show how openness and generosity can be the starting point of truly rigorous thinking. Introduced and curated by the late philosopher, Pamela Sue Anderson, (...) In Dialogue with Michèle Le Dœuff explores themes like contemporary feminism, joy in philosophy, memory, the significance of friendship to thinking and a key Le Dœuffian concept, the imaginary. Le Dœuff's interlocutors, including Penelope Deutscher, Elizabeth Fallaize and Meenda Dhanda, are some of the most significant thinkers in the fields of feminism and continental thought and provide insights and ways into considering philosophy as a profoundly dialogical exercise. (shrink)

What does it mean to be ethical in psychotherapy? Does adherence to ethical codes and rules make a psychotherapist ethical? This article examines standard ways of thinking about ethics in the field and argues that these ways are inadequate, creating a false dichotomy between the ethical and the clinical, and that they are designed only for formal and contractual relationships, in which psychotherapy is more often personal and affecting. The ethic of care and the approach to ethics of Emmanuel Levinas (...) are presented as additional approaches, along with their challenges to rationality and autonomy. An ethic of listening is then presented, and it is argued that ethics should be not an afterthought, but the primary consideration of clinical utility. (shrink)

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of (...) the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action. (shrink)

This article summarizes a virtual live‐streamed panel event that occurred in August 2020 and was cosponsored by the International Philosophy of Nursing Society (IPONS) and the University of California, Irvine's Center for Nursing Philosophy. The event consisted of a series of three self‐contained panel discussions focusing on the past, present and future of IPONS and was moderated by the current Chair of IPONS, Catherine Green. The first panel discussion explored the history of IPONS and the journal Nursing Philosophy. The second (...) panel involved a reflection on the challenges of doing nursing philosophy in a research‐intensive context of a Canadian university and the history and current movements in nursing philosophy in the Nordic countries. The final panel involved presentations on the future potential for philosophy in/and for nursing, the critical connections between nursing philosophy and nursing theory, dismantling racism in nursing and the potential for process philosophy to help explore nursing's unique efficacy in creating possibilities for health. The panels were followed by a lively Q&A session with participants, of which there were 252 registrants from across the globe. The event underscored the wide and diverse interests of nurses in philosophical discussion and the need for more virtual events and other connective modalities bringing nurses together to discuss and analyze the value and potential of philosophy to better understand and advance nursing theory and practice. (shrink)

This paper argues that a combination of increasing inequality, hypocrisy, population growth and adverse global environmental change imperils our civilisation. Selected examples of existing inequality and the immoral treatment of human beings are provided from countries of the Asia Pacific. There is also limited discussion of the global eco-social crisis, stressing the links between environmental scarcity and the human responses of resentment, conflict, terrorism and ill-governance. The essay contends that just as the lives of unborn humans similar to us are (...) of interest and value to bio-ethicists, so too should be the lives and descendants of people who are unlike us, even if such people are perceived to be substantially different to ourselves in terms of status, culture and spending power. It is argued that it is in the interests of ourselves, society, and global civilisation that the lives of such people are considered and where possible improved in order to foster the “sustainability transition” needed to secure our collective future. The essay concludes with a discussion of an important element for securing our future: the development and implementation of alternative economic systems which will provide more accurate indicators of global progress. (shrink)

Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United (...) States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a 6-month assessment (...) interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI. (shrink)

Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and (...) life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted. In addition, we explore the processes that led to this situation and suggest ways to promote early recognition and intervention for similar cases in the future. (shrink)

Individual choice and freedom are repeatedly invoked in contemporary policy debates, including those with a focus on risk behaviors such as smoking and health insurance coverage. The idea of making the right choice with regard to health and well-being has been fortified by the neoliberal discourse of self-reliance, personal autonomy, and responsibility. This neoliberal view, stemming from the conceptualization of freedom of philosopher John Stuart Mill justifying the freedom of the individual in opposition to unlimited state control, holds that success, (...) good health, and favorable educational outcomes are largely due to individual effort. Correspondingly, so too is failure, including failure of.. (shrink)

Considered together, Butler and Whitehead draw from a wide palette of disciplines to develop distinctive theories of becoming, of syntactical violence, and creative opportunities of limitation. The contributors of this volume offer a unique contribution to and for the humanities in the struggles of politics, economy, ecology, and the arts.

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

The coronavirus disease 2019 pandemic is altering dynamics in academia, and people juggling remote work and domestic demands – including childcare – have felt impacts on their productivity. Female authors have faced a decrease in paper submission rates since the beginning of the pandemic period. The reasons for this decline in women’s productivity need to be further investigated. Here, we analyzed the influence of gender, parenthood and race on academic productivity during the pandemic period based on a survey answered by (...) 3,345 Brazilian academics from various knowledge areas and research institutions. Productivity was assessed by the ability to submit papers as planned and to meet deadlines during the initial period of social isolation in Brazil. The findings revealed that male academics – especially those without children – are the least affected group, whereas Black women and mothers are the most impacted groups. These impacts are likely a consequence of the well-known unequal division of domestic labor between men and women, which has been exacerbated during the pandemic. Additionally, our results highlight that racism strongly persists in academia, especially against Black women. The pandemic will have long-term effects on the career progression of the most affected groups. The results presented here are crucial for the development of actions and policies that aim to avoid further deepening the gender gap in academia. (shrink)

Inattentional blindness is described as the failure to perceive a supra-threshold stimulus when attention is directed away from that stimulus. Based on performance on an explicit recognition memory test and concurrent functional imaging data Rees, Russell, Frith, and Driver [Rees, G., Russell, C., Frith, C. D., & Driver, J. . Inattentional blindness versus inattentional amnesia for fixated but ignored words. Science, 286, 2504–2507] reported inattentional blindness for word stimuli that were fixated but ignored. The present study examined both explicit and (...) implicit memory for fixated but ignored words using a selective-attention task in which overlapping picture/word stimuli were presented at fixation. No explicit awareness of the unattended words was apparent on a recognition memory test. Analysis of an implicit memory task, however, indicated that unattended words were perceived at a perceptual level. Thus, the selective-attention task did not result in perfect filtering as suggested by Rees et al. While there was no evidence of conscious perception, subjects were not blind to the implicit perceptual properties of fixated but ignored words. (shrink)

This essay argues for a Le Dœuffian dialogue with Spinoza's Ethics, intending the increase of affective knowledge and bodily power. This intention requires a striving to learn: first, what perhaps we do not already know; second, what our bodies can do; and third, to increase in joy. From this dialogue the reader can gain Spinozist knowledge of bodies, minds, affections, as well as gaining the power to affect and to be affected by other bodies. One of the features of this (...) Le Dœuffian practice is a collective exploration of what makes dialogue productive and joyful, opening up new possibilities, especially for women in philosophy today. (shrink)