Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

This chapter outlines the origins in ordinary language philosophy of a new skills-based approach to working with complex and conflicting values in medicine called values-based practice. Ordinary language philosophy focuses on our use of words as a useful first step in coming to a more complete understanding of their meanings. The theory of values-based practice was developed by applying ideas from ordinary language philosophy to the long-running debate about the "boundary problem" presented by the concept of mental disorder. Ordinary language (...) philosophy turns this debate topsy-turvy: it shows, that the concept of mental disorder instead of being the target problem is a resource for coming to a more complete understanding of the meanings of concepts of disorder as a whole including the concept of bodily disorder; and correspondingly, that the value-laden nature of mental disorder far from being part of the problem points to an evaluative element of meaning in concepts of disorder as a whole, again including concepts of bodily disorder. It is these topsy-turvy results that underpin the development of values-based practice. In a brief concluding section we indicate the potential for further development of values-based practice supported by ordinary language and other philosophies particularly through engagement with non-Western language groups representing diverse traditions of thought and practice in mental health. (shrink)

This Section examines several moral dilemmas and epistemological aporias in clinical practice and shows how clinicians can benefit from the introduction of philosophical methods and discourse. The authors develop these issues having in mind emblematic mental disorders and typical clinical situations. One important claim shared by the Authors is that a great effort has been made to ground psychiatry on evidence-based science, and to tie it to our growing understanding of the human brain. This is obviously an exceedingly important project, (...) but it would be a mistake to assume that the central questions of psychiatry can be completely resolved through scientific inquiry. Science offers guidance for clinical practice only in light of our concepts and normative judgments. (shrink)

In the editorial introduction the stage is set for the chapters in the section by a brief discussion of the relationship between the disciplines of philosophy and psychiatry. Then each chapter briefly is summarized or highlighted.

In this introduction to the Section II, the thrust of the component chapters is described. An important strand in the philosophy of psychiatry since its beginnings has been sociopolitical critiques: criticism which aims to improve and humanize psychiatric practice and mental health systems. From this standpoint, the introduction provides an overview of this tradition, including considerations of "postpsychiatry," value commitments in psychiatry, the recovery movement, racism and sexism in the field, and technology.

A cross-disciplinary discussion of the basis of interpersonal relating is of interest to philosophers and psychiatrists for several reasons. The development of successful clinical practice may depend, at least partly, on having an accurate understanding of the basic character of unimpaired interpersonal relating because such understanding can shed light on the nature and source of its disturbed forms. How we think about the basis of "mind-minding" competencies influences how we think about the prognosis and possible treatment of dysfunctional interpersonal relating. (...) Another reason is that philosophical frameworks influence the way we think about and evaluate possible psychiatric disorders and philosophical discussions may be of direct practical importance to psychiatry given that different theories suggest different potential ways of devising therapies. (shrink)

The editorial introduction sets the stage for the chapter by identifying the roles that concepts and categories play not just in the field of mental health medicine but in the human mind itself. Then, each chapter is summarized or highlighted.

Following on from Section IV on summoning concepts, this section of the Handbook presents theoretically informed descriptions of psychopathologies. The topics of the chapters range from anxiety, depression, and body image disorders, through emotion and affective disorders, to delusion, thought insertion, and the fragmentation of consciousness. These phenomena call, not only for assessment and diagnosis, but also for understanding on the part of both the engaged clinician and the philosophical commentator. They also provide case studies for general philosophical questions about (...) different levels of description and conceptualisation and the relationships between them, and about the contributions to psychological understanding that are made by phenomenology, clinical expert knowledge, and the sciences of the mind. (shrink)

In this introduction to Section VI, the thrust of the component chapters is described. The classification and diagnosis of mental disorders collects a number of philosophical challenges to the field that call for responses from a variety of philosophical resources: hermeneutics, phenomenology, philosophy of mind, narrative theory, philosophy of science, epistemology-to name a few. The authors in this section address the general challenges in the classification of psychopathology, as well as address particular kinds of mental disorders, including autism, dementia, mania, (...) psychotic disorders, and personality disorders. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

Organic chemists have been able to develop a robust, theoretical understanding of the phenomena they study; however, the primary theoretical devices employed in this field are not mathematical equations or laws, as is the case in most other physical sciences. Instead it is diagrams, and in particular structural formulas and potential energy diagrams, that carry the explanatory weight in the discipline. To understand how this is so, it is necessary to investigate both the nature of the diagrams employed in organic (...) chemistry and how these diagrams are used in the explanations of the discipline. I will begin this paper by characterizing some of the major ways that structural formulas used in organic chemistry. Next I will present a model of the explanations in organic chemistry and describe how both structural formulas and potential energy diagrams contribute to these explanations. This will be followed by several examples that support my abstract account of the role of diagrams in the explanations of organic chemistry. In particular, I will consider both the appeal to ‘hyperconjugation’ in the explanation of alkene stability and how the idea of ‘ring strain’ was developed to explain the relative stability of cyclic compounds. (shrink)

In his pioneering work of moral phenomenology, K. E. Løgstrup offered a phenomenological articulation of a central moment of ethical life: the experience in which “one finds oneself with the life of another more-or-less in one’s hands”. In such circumstances we encounter what Løgstrup calls simply the ethical demand. Løgstrup’s preferred formulation of the content of that demand is taken from the Bible: Love thy neighbor. This neighborly love is expressed in the form of spontaneous, selfless care for the other. (...) We shall have occasion in what follows to return to the content that Løgstrup associates with the ethical demand, but my primary focus here is not its content but its distinctive modality. Løgstrup specifies that modality in a fourfold analysis: the ethical demand is radical, silent, one-sided, and unfulfillable. My concern in what follows will be with the fourth element in this analysis – or what I shall refer to simply as Løgstrup’s unfulfillability thesis. My discussion addresses three specific questions: Is it coherent to suppose that the ethical demand is unfulfillable? Why does Løgstrup hold that the ethical demand is unfulfillable? What kind of response is appropriate in the face of an unfulfillable ethical demand? (shrink)

Ordinairement les manuels de biologie débutent par une exposition des caractéristiques qui distinguent la nature organique de la nature anorganique. En définissant et en limitant aussi exactement que possible son sujet, la biologie, le biologue ne fait pas autre chose que le mathématicien. La présente étude nous montre les obstacles presque insurmontables auxquels se heurtent le biologue et le mathématicien. A les bien considérer, les anciennes distinctions entre l'organisme d'une part et la matière non-organisée ou un système statique matériel, comme (...) la machine, d'autre part, se basant sur la nutrition, la respiration, les échanges vitaux et le mouvement ne tiennent plus debout. L'auteur allègue les expériences récentes de W. M. Stanley (Rockefeller Institute à Princeton) d'où il appert qu'il peut y avoir aussi génération dans les substances qui se secrètent sous la forme de cristaux (cristaux vivants), et s'en rapporte aux fameuses expériences de Driesch sur la régénération. Il y rattache les conceptions de Jordan (Utrecht) -- rapports entre les enchaînements des causes "d'après leur caractère amboceptor"; "le dessein des causes". Les vitalistes portent surtout leur attention sur "la totalité", les mécanistes sur "les parties". Le naturaliste qui se propose uniquement la recherche des causes physico-chimiques des phénomènes physico-chimiques serait parfaitement en droit de se contenter d'une conception mécaniste de la nature. Mais cette conception mécaniste ne suffirait pas à celui qui, comme l'auteur, aspire à comprendre l'organisme dans son ensemble. (shrink)

It is customary to identify transcendental philosophy as the distinctive and original invention of Immanuel Kant. Certainly this was a view that Kant himself did much to encourage. But this chapter argues that traces of the transcendental strategy can be found already among the ancients. One such ancient precedent is associated with the Stoic doctrine of oikeiosis. It is argued that oikeiosis is best understood as a form of normative orientation associated with 'being at home ' in one's body and (...) environment, and that it involves a distinctive form of ontological self-consciousness. This chapter assesses the merits of Stoic claims that oikeiosis figures as a condition on the possibility of desire, pleasure, and even perception, and the chapter considers the case for describing these arguments as examples of transcendental investigation. (shrink)

Research suggests that institutions affect the levels of corruption in a country. We take these arguments a step further and examine whether it is the presence of inclusive institutions and/or the credible and consistent implementation of institutions that matter, as regards corruption. We use a novel approach to theoretically conceptualise and empirically operationalise institutions along two analytically distinct dimensions: the nature of the institutions (the de jure dimension), and the extent to which they are credibly and consistently implemented over time (...) (the de facto dimension), using a panel dataset for 148 countries covering 2012 to 2018. We find that formal institutions are most effective in reducing corruption when the rules are credibly and consistently implemented. Furthermore, this effect appears to operate differently at different levels of national income. The nature of the formal institutions appears important across income levels, but particularly so at the upper middle income level, while the credible and consistent implementation of these institutions is primarily influential at upper middle income levels. We explain why this may be the case and elaborate on the policy implications. (shrink)

The Many-Interacting-Worlds (MIW) approach to a quantum theory without wave functions proposed in [8] leads naturally to numerical integrators of the Schrödinger equation on comoving grids. As yet, little is known about concrete MIW models for more than one spatial dimension and/or more than one particle. In honour of Detlef Dürr, we report on a further development of the MIW approach to treat arbitrary degrees of freedom and provide a numerical proof of concept for ground states in 2d. The latter (...) is part of a systematic numerical study [22] that includes also 1d ground and excited states. With this step towards the treatment of higher degrees of freedom we hope to stimulate their further study. (shrink)

Philosophy of science is the organized expression of a growing intent among philosophers and scientists to clarify, perhaps unify, the programs, methods and results of the disciplines of philosophy and of science. The examination of fundamental concepts and presuppositions in the light of the positive results of science, systematic doubt of the positive results, and a thorough-going analysis and critique of logic and of language, are typical projects for this joint effort. It is not necessary to be committed to a (...) belief that science and philosophy are or should be one, or else that “never the twain shall meet.” If anything, there is to be expected a wholesome regard for the value of established science in furnishing a foil for philosophy and a check on its old extravagances. This does not mean that even the best-established science may not be subject to most devastating criticism by analysis of its foundations. In fact, despairing of the philosophy of the schools, science has done it largely for itself. The theories of gravitation, atomicity, electro-magnetism, evolution, relativity and quanta have all arisen through drastic revisions of complacent fundamental “truths.”. (shrink)

The death of Jesse Gelsinger in 1999 during a gene therapy trial raised many questions about the ethical review of medical research. Here, the author argues that the principle of justice is interpreted too narrowly and receives insufficient emphasis and that what we permit in terms of bodily invasion affects the value we place on individuals. Medical research is a societally supported activity. As such, the author contends that justice requires that invasive medical research demonstrates sufficiently compelling societal benefit. Many (...) consider this societal benefit to be self evident. However, medical research is a complex activity; it yields new treatments but also creates financial rewards and affects health resource allocation. As research evolves into a multibillion pound, multinational enterprise, justice requires a much broader analysis of societal benefit. Without such evaluation we risk undermining the value of bodily integrity and of research participants. (shrink)

The possibility of a harmony between the psychological doctrine of Aristotle and that of Plato marks a significant issue within the context of the debate surrounding Aristotle’s putative opposition to or harmony with Plato’s philosophy. The standard interpretation of Aristotle’s conception of the soul being purely hylomorphic leaves no room for harmonisation with Plato, nor does a functionalist interpretation that reduces Aristotle’s psychological doctrine to physicalist terms. However, these interpretations have serious drawbacks, both in terms of ad-hoc explanations formulated in (...) the developmentalist mode, and the misconstruing of some of the fundamental features of Aristotle’s psychological doctrine. A dualist interpretation that accepts Aristotle’s doctrine of some part of the soul being properly incorporeal, separable and immortal overcomes these drawbacks and, significantly, opens the door for Platonic harmonisation. Furthermore, it can be shown that the kind of immortality in question is also in line with the Platonic stance, due to a deep similarity between the conceptions of metaphysical and moral personhood held by Plato and his student. However, this Aristotelian dualism is not Platonic dualism simpliciter. Rather, it is best understood in terms of the division of labour between Aristotle and Plato suggested by the Neoplatonic commentators generally, and Simplicius in particular. I argue that though questions surrounding these issues and particularly the issue of reincarnation remain, an account of Aristotle’s psychological doctrine as dualist and in harmony with Plato’s view of the soul can be shown to be stronger than both standard hylomorphic and functionalist accounts, both exegetically and philosophically. (shrink)