BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians is a concise and practical guide to ethical decision-making in medicine. The text is aimed at second- and third-year one-semester ethics courses offered in medical schools, health sciences departments, and nursing programs. By taking an applied approach rather than a theoretical approach, this text serves the needs of medical and nursing students, residents, and practicing physicians by sorting through questions of moral principles relevant to the diverse and growing (...) number of healthcare professionals. The many topics covered include truth telling, refusal of treatment, assisted suicide, managing error, and reproductive choice. (shrink)

The central view of this dissertation is that a more comprehensive theory of scientific learning must incorporate insights from the disciplines of methodology and sociology. The standards of methodology play an indispensible role in learning by providing some of the principles necessary for theoretical evaluation. But such principles are not sufficient for socially embedded learning and they do not exclude the operation of social interests within science. It is the institutional structure of science that helps make up what abstract standards (...) alone lack: the material means with which to affect the advancement of learning. Institutions add something of their own dynamic to learning by helping to realize the abstract principles of methodology--they are never simply neutral husks. ;The views of a number of methodologists and sociologists are examined to demonstrate that this view of learning has not always been appreciated. Some methodologists have thought that by developing a theory of scientific method they were ensuring science's insulation from society at large. Such projects expect too much of methodology and the best methodology we have--fallibilism--leaves science open to social influence. Some sociologists have seen the role of a social theory as cutting across that of methodology--as if a social account of learning could only be at the expense of methodology. This had led some to deny methodology any explanatory power and others to limit sociology to accounting for merely the external aspects of scientific development. ;I throughout try to suggest how learning may be best accounted for by a fallibilist methodology combined with an institutional social theory. Such a dual view of learning is helpful because the advancement of learning is at times as dependent on its material constraints as on its intellectual ones. Thus, a comprehensive theory of learning can help science be a more critical enterprise and so contribute to its advancement. (shrink)

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight (...) ethical vignettes.The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rated metrics were depth (3.8/5) and acceptability (3.8/5). There was poor-to-moderate inter-rater reliability characterised by an intraclass coefficient of 0.54 (95% CI: 0.30 to 0.71). Based on panellist feedback, GPT-4 was able to identify and articulate key ethical issues but struggled to appreciate the nuanced aspects of ethical dilemmas and misapplied certain moral principles.This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings. (shrink)

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact (...) on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact (...) on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)

The _Platform Sutra_ records the teachings of Hui-neng, the Sixth Patriarch, who is revered as one of the two great figures in the founding of Ch'an (Zen) Buddhism. This translation is the definitive English version of the eighth-century Ch'an classic. Phillip B. Yampolsky has based his translation on the Tun-huang manuscript, the earliest extant version of the work. A critical edition of the Chinese text is given at the end of the volume. Dr. Yampolsky also furnishes a lengthy and detailed (...) historical introduction which contains much information hitherto unavailable even to scholars, and provides the context essential to an understanding of Hui-neng's work. He gives an account of the history and legends of Ch'an Buddhism, with particular attention to the traditions associated with Hui-neng, quoting or summarizing the most important narratives. He then discusses the various texts of the _Platform Sutra_, and analyzes its contents. (shrink)

Husserlian phenomenology, as the study of conscious experience, has often been accused of solipsism. Husserl’s method, it is argued, does not have the resources to provide an account of consciousness of other minds. This chapter will address this issue by providing a brief overview of the multiple angles from which Husserl approached the theme of intersubjectivity, with specific focus on the details of his account of the concrete interpersonal encounter – “empathy.” Husserl understood empathy as a direct, quasi-perceptual form of (...) intentionality through which the sense of the Other is constituted. Furthermore, his account of empathy is holistically integrated with his overall theory of intersubjectivity, including his discussions of the objectivity of nature, and the social, historical, and communal aspects of subjectivity. Husserl’s theory of empathy continues to cast a long shadow, influencing both the analytic and continental approaches to the problem of other minds, as well as contemporary account of social cognition in the cognitive sciences. (shrink)

This article draws on the antebellum political thought of Black abolitionists Frederick Douglass and Martin Delany in critically assessing the efficacy of reasonableness in advancing the aims of emancipatory politics in political discourse. I argue, through a reading of Douglass and Delany, that comporting oneself reasonably in the face of oppressive ideology can be counterproductive, if one’s aim is to undermine such ideology and the institutions it supports. Douglass and Delany, I argue, also provide us with a framework for evaluating (...) alternative discursive strategies we might wish to employ in light of the limited value of reasonableness for emancipatory politics. (shrink)

ABSTRACT Constitutive panpsychism is the doctrine that macro-level consciousness—that is, consciousness of the sort possessed by certain composite things such as humans—is built out of irreducibly mental features had by some or all of the basic physical constituents of reality. On constitutive panpsychism, changes in macro-level consciousness amount to changes in either the way that micro-conscious entities ‘bond’ or the way that micro-conscious qualities ‘blend’. I pose the ‘Selection Problem’ for constitutive panpsychism—the problem of explaining how high-level functional states of (...) the brain ‘select’ micro-conscious qualities for bonding or blending. I argue that there are no empirically plausible solutions to this problem. (shrink)

For liberal contractarians, moral and political principles are justified if agreeable to persons as free and equals. But for critics of liberal contractarianism, this justification applies only to those capable of agreement. Understanding why contractarianism suffers from the problem of exclusion helps up understand the distinctive character of contractarianism and the importance of agreement in particular. I suggest contractarianism need not be objectionably exclusive. I first consider why agreement is important in contractarianism, and then introduce the main versions of contemporary (...) contractarianism and their different understandings of agreement. I discuss how agreement results in exclusion in each, and distinguish two kinds of response to the problem of exclusion: differential inclusion and permissive inclusion. Differential inclusion is unsuccessful because it offers those not fully capable of agreement unequal status. Permissive inclusion may either make the circumstances of agreement more open, or characterize the capacities required for inclusion more permissively. I advocate the latter as the most promising response to the problem of exclusion. I outline a more inclusive contractualism based on the capacity to share goals. (shrink)

Breaking off the ordinary flow of experience, the passions create a state of exception. In their suddenness and intensity, they map a personal world, fix and qualify our attention, and impel our actions. Outraged anger drives us to write laws that will later be enforced by impersonal justice. Intense grief at the death of someone in our life discloses the contours of that life to us. Wonder spurs scientific inquiry. The strong current of Western thought that idealizes a dispassionate world (...) has ostracized the passions as quaint, even dangerous. Intense states have come to be seen as symptoms of pathology. A fondness for irony along with our civic ideal of tolerance lead us to prefer the diluted emotional life of feelings and moods. Demonstrating enormous intellectual originality and generosity, Philip Fisher meditates on whether this victory is permanent-and how it might diminish us. From Aristotle to Hume to contemporary biology, Fisher finds evidence that the passions have defined a core of human nature no less important than reason or desire. Traversing the Iliad, King Lear, Moby Dick, and other great works, he discerns the properties of the high-spirited states we call the passions. Are vehement states compatible with a culture that values private, selectively shared experiences? How do passions differ from emotions? Does anger have an opposite? Do the passions give scale, shape, and significance to our experience of time? Is a person incapable of anger more dangerous than someone who is irascible? In reintroducing us to our own vehemence, Fisher reminds us that it is only through our strongest passions that we feel the contours of injustice, mortality, loss, and knowledge. It is only through our personal worlds that we can know the world. (shrink)

I discuss three tiers of technological innovation: mild innovation, or the acceleration by technology of a human activity aimed at a good; moderate innovation, or the obviation by technology of an activity aimed at a good; and radical innovation, or the altering by technology of the human condition so as to change what counts as a good. I argue that it is impossible to morally assess proposed innovations within any of these three tiers unless we rehabilitate a natural-law ethical framework. (...) And I offer some moral starting points within such a framework, in connection with innovations of each of the three types. (shrink)

It is intuitive that free action depends on consciousness in some way, since behavior that is unconsciously generated is widely regarded as un-free. But there is no clear consensus as to what such dependence comes to, in part because there is no clear consensus about either the cognitive role of consciousness or about the essential components of free action. I divide the space of possible views into four: the Constitution View (on which free actions metaphysically consist, at least in part, (...) in phenomenally conscious episodes of a special sort), the Causal-Dependence View (on which free actions are necessarily caused by conscious episodes), the Counterfactaul-Dependence View (on which free actions necessarily counterfactually dependent on conscious episodes of certain types), and the Independence View (on which there are no necessary dependence-relations that hold between free action and conscious episodes). After surveying recent empirical literature that purports to show that consciousness plays a smaller role in generating action than is usually supposed, I conclude that it is plausible that free action depends on consciousness in two ways. First, free action causally depends on consciousness control. Second, free action counterfactually depends on the agent's being responsive to certain reasons. (shrink)

Russellianism is the view that the meaning of a proper name is the individual designated by the name. Together with other plausible assumptions, Russellianism entails the following: Sentences containing proper names express Russellian propositions, which involve the individual designated by the name as a direct constituent, and which can be represented as sets of individuals and properties. Moreover, as they occur in ordinary belief reports, ‘that’-clauses designate Russellian propositions. Such belief reports are true if and only if the subject of (...) the belief report bears the belief relation to the proposition designated by the ‘that’-clause. In defending this doctrine, some Russellians appeal to propositional guises, which, roughly speaking, are ways of grasping propositions. However, some Russellians don’t appeal to such entities. In this paper, I explain the varieties of Russellianism and then argue for Modest Russellianism: Believing a Russellian proposition is essentially mediated by guises, so that an agent can’t believe a Russellian proposition without standing in some appropriate relation to both the proposition and a guise. Nonetheless, guises don’t feature in the semantics of ordinary belief reports, so that an adequate account of the meaning of such belief reports needn’t invoke guises. (shrink)

Este artigo científico procurou investigar o processo de adaptação da Universidade Brasileira aos novos paradigmas impostos pelas políticas neoliberais. A análise se faz a partir de breve histórico do liberalismo e de suas imbricações no ensino. Apontando também a relativização da suposta democratização e modernização do ensino pelas novas perspectivas impostas pelo mercado. São levantadas também questões como autonomia universitária e legitimação da instituição de ensino superior.

This volume is dedicated to the drawing of the implications of the contemporary 'post-secular' social transformation for education. Contributions discuss such topics as the mystical tradition and its social and pedagogic implications; transformative and ecological education; and the relations between secular and religious education in different local contexts.

Husserl introduces a phenomenological concept called “motivation” early in the First Investigation of his magnum opus, the Logical Investigations. The importance of this concept has been overlooked since Husserl passes over it rather quickly on his way to an analysis of the meaningful nature of expression. I argue, however, that motivation is essential to Husserl’s overall project, even if it is not essen- tial for defining expression in the First Investigation. For Husserl, motivation is a relation between mental acts whereby (...) the content of one act make some fur- ther meaningful content probable. I explicate the nature of this relation in terms of “evidentiary weight” and differentiate it from Husserl’s notion of Evidenz, often translated as “self-evidence”. I elucidate the importance of motivation in Husserl’s overall phenomenological project by focusing on his analyses of thing-perception and empathy. Through these examples, we can better understand the continuity between the Logical Investigations and Husserl’s later work. (shrink)

Examines rationality from Aristotle to Foucault, seeking to place reason in a historical context within the Western tradition.

The questions -- The purpose of morality and law -- The past and the future -- What is religion? -- What is the rule of law? -- The families of religion : western religions -- The families of religion : eastern religions -- The families of law -- A brief tour of secular law -- Money, banks and corporations -- Secularisation and religious decline -- Reasons for the decline of religiosity -- Secularisation of government -- The rise of the lawyers (...) -- Who rules the world : lawyers or economists? -- What is wrong with the law? -- Scientific progress and the law -- A way of living -- A billion years from now. (shrink)

One of the hallmark themes of Karl Popper’s approach to the social sciences was the insistence that when social scientists are members of the society they study, then they are liable to affect that society. In particular, they are liable to affect it in such a way that the claims they make lose their validity. “The interaction between the scientist’s pronouncements and social life almost invariably creates situations in which we have not only to consider the truth of such pronouncements, (...) but also their actual influence on future developments. The social scientist may be striving to find the truth; but, at the same time, he must always be exerting a definite influence upon society. The very fact that his pronouncements do exert an influence destroys their objectivity.” (Popper 1963. (shrink)

Arendt Contra Sociology re-assesses the relationship between Hannah Arendt's work and the theoretical foundations of sociology, bringing her insights to bear on key themes within contemporary theoretical sociology. Departing from the view of Arendt as a political theorist who sought to rescue politics from society, and political theory from the social sciences, this book re-examines her distinctions between labour, fabrication and action as a theory of the fundamental ontology of human societies, revisiting her criticism of the tendency of many sociological (...) paradigms to conflate the activity of fabrication with that of action. (shrink)

From the legendary inventor Daedalus to Goethe's tragic Faust, from the automata-making magicians of E.T.A Hoffmann to Mary Shelley's Victor Frankenstein – ...

In late March of 2020, a new hashtag, #FilmYourHospital, made its first appearance on social media. The hashtag encouraged people to visit local hospitals to take pictures and videos of empty hospitals to help “prove” that the COVID-19 pandemic is an elaborate hoax. Using techniques from Social Network Analysis, this case study examines how this conspiracy theory propagated on Twitter and whether the hashtag virality was aided by the use of automation or coordination among Twitter users. We found that while (...) much of the content came from users with limited reach, the oxygen that fueled this conspiracy in its early days came from a handful of prominent conservative politicians and far right political activists on Twitter. These power users used this hashtag to build awareness about the campaign and to encourage their followers to break quarantine and film what is happening at their local hospitals. After the initial boost by a few prominent accounts, the campaign was mostly sustained by pro-Trump accounts, followed by a secondary wave of propagation outside the U.S. The rise of the #FilmYourHospital conspiracy from a single tweet demonstrates the ongoing challenge of addressing false, viral information during the COVID-19 pandemic. While the spread of misinformation can be potentially mitigated by fact-checking and directing people to credible sources of information from public health agencies, false and misleading claims that are driven by politics and supported by strong convictions and not science are much harder to root out. (shrink)

O objetivo deste texto é discutir a tarefa filosófica de elucidação do conceito de conseqüência lógica. Primeiramente, serão eleitos dois critérios de adequação para uma elucidação desse conceito: (1) preservação da verdade nas instâncias, ou adequação material e (2) garantia da verdade da conclusão na inferência válida, ou adequação epistêmica. Em seguida serão apresentadas a proposta de Tarski (1956) e as correspondentes críticas de Etchemendy (2008). Conclui-se com comentários a respeito da natureza das investigações lógicas.

The notion of risk plays a central role in economics, finance, health, psychology, law and elsewhere, and is prevalent in managing challenges and resources in day-to-day life. In recent work, Duncan Pritchard (2015, 2016) has argued against the orthodox probabilistic conception of risk on which the risk of a hypothetical scenario is determined by how probable it is, and in favour of a modal conception on which the risk of a hypothetical scenario is determined by how modally close it is. (...) In this article, we use Pritchard’s discussion as a springboard for a more wide-ranging discussion of the notion of risk. We introduce three different conceptions of risk: the standard probabilistic conception, Pritchard’s modal conception, and a normalcy conception that is new (though it has some precursors in the psychological literature on risk perception). Ultimately, we argue that the modal conception is ill-suited to the roles that a notion of risk is required to play and explore the prospects for a form of pluralism about risk, embracing both the probabilistic and the normalcy conceptions. (shrink)

Buddhist teachings and modern science are analogous both in their approach to the search for truth and in some of the discoveries of contemporary physics, biology, and psychology. However, despite these congruencies and the recognized benefits of science, Buddhism reminds us of the dangers of a tendency toward scientific reductionism and imperialism and of the sciences’ inability to deal with human moral and spiritual values and needs. Buddhism and science have human concerns and final goals that are different, but as (...) long as the boundaries between them are not trespassed, they can be mutually corrective and allied to benefit humankind. Buddhism must be open to the discoveries of science about the physical world as must all religions today, but no matter how much it may have to modify some of its ancient beliefs, its basic truths—the truths about human suffering and its release—will remain untouched. (shrink)

The paper asks: are all tautologies true in a language with truth-value gaps? It answers that they are not. No tautology is false, of course, but not all are true. It also contends that not all contradictions are false in a language with truth-value gaps, though none are true.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 335-342 [Access article in PDF] "Dispersing the Cogito: A Response to Vivian's Rhetorical Self" Philip Lewin Bradford Vivian ("The Threshold of the Self," Philosophy and Rhetoric 33. 4: 303-18), in seeking to disrupt the cogito, claims that acts of creative self-constitution by a "rhetorical self" become possible as subjectivity is dispersed across subject positions. However, the apparent ability of the rhetorical self to (...) freely choose which positions it will inhabit, as well as its apparent capacity to undergo subjectification without being marked by its habitation of those positions, seem to reintroduce several of the cogito's essential features.Vivian argues that "there is a historicity to our being and its expression, to our subjectivity and its elaboration" (303). His essay provides a clear and cogent account of how subjectivity might arise as the result of a series of rhetorical acts whose audience is the self. One's self, then, is a local and ongoing aesthetic formation, continually becoming and coming into being; to the extent that the aesthetic nature of this process is produced by persuading one's self to adopt some styles of life over others, then this process is a thoroughly persuasive phenomenon. The aesthetic composition molded by this continually renewed persuasion might best be described as the rhetorical self. (312; emphasis in original) Vivian clears away a good deal of the underbrush that often prevents us from getting a hold on the problematics of selfhood and subjectivity. I find much that is praiseworthy in the essay, particulary its explication of the contingent and shifting nature of the processes through which the self is formed and reformed. But there is a key theoretical elision in Vivian's argument that does much to restore the legitimacy of the Cartesian cogito that he is at pains to disrupt. The result is a model of self that revises Cartesianism by dispersing subjectivity among various subject positions, [End Page 335] but that, in a number of other important ways, preserves essential features of the cogito, as though each fragment of the dispersed cogito were itself a complete mini-cogito.Vivian's account elides the rhetorical process of self-formation. In a typical passage at the end of the essay, he comments, "In order to compose and cultivate one's being in the world, one must persuade one's self to choose and orchestrate certain styles of life from among those available into an entire aesthetics of being" (316-17). The questions this claim provokes are: How does this process of self-persuasion actually take place? What aspect or agency of psyche is doing the persuading? To conceive of the self as Vivian does--a self "conceived as a form--a rhetorical form--that exists only in its continual aesthetic creation, in its indefinite becoming" (304)--suggests a kind of autonomy and self-transparency in self-formation that has discouragingly Cartesian overtones.The terms with which Vivian has chosen to work, namely, subjectivity and the rhetorical self, do not address these issues of self-persuasion. Instead, they serve to mask them. Subjectivity, for Vivian, refers to the positions the self finds itself assuming within discursive regimes, positions whose formation entails moments both of self-persuasion and of subjection to existing social exigency. Subjectivity (so conceived) has the property of being an effect of multiple acts of subjectification, of voluntary acquiescence to preexisting subject positions. "Discourse creates subjects by first creating subject positions from which to speak" (313). The subject is not original, but rather follows from "an entire 'assemblage' of subject positions that are the willful creation of no one, but are instead formed by the complex operations of discourse" (313). The theoretical difficulty with this way of accounting for subjectivity lies in its elision of agency; how shall we make sense of the rhetorical self? More specifically, how does a necessary immersion into discursive practices couple with rhetorical acts of self-persuasion? What motivates self-persuasion? Are all the factors involved in self-persuasion fully conscious and under voluntary control? If not, how are we... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 335-342 [Access article in PDF] "Dispersing the Cogito: A Response to Vivian's Rhetorical Self" Philip Lewin Bradford Vivian ("The Threshold of the Self," Philosophy and Rhetoric 33. 4: 303-18), in seeking to disrupt the cogito, claims that acts of creative self-constitution by a "rhetorical self" become possible as subjectivity is dispersed across subject positions. However, the apparent ability of the rhetorical self to (...) freely choose which positions it will inhabit, as well as its apparent capacity to undergo subjectification without being marked by its habitation of those positions, seem to reintroduce several of the cogito's essential features.Vivian argues that "there is a historicity to our being and its expression, to our subjectivity and its elaboration" (303). His essay provides a clear and cogent account of how subjectivity might arise as the result of a series of rhetorical acts whose audience is the self. One's self, then, is a local and ongoing aesthetic formation, continually becoming and coming into being; to the extent that the aesthetic nature of this process is produced by persuading one's self to adopt some styles of life over others, then this process is a thoroughly persuasive phenomenon. The aesthetic composition molded by this continually renewed persuasion might best be described as the rhetorical self. (312; emphasis in original) Vivian clears away a good deal of the underbrush that often prevents us from getting a hold on the problematics of selfhood and subjectivity. I find much that is praiseworthy in the essay, particulary its explication of the contingent and shifting nature of the processes through which the self is formed and reformed. But there is a key theoretical elision in Vivian's argument that does much to restore the legitimacy of the Cartesian cogito that he is at pains to disrupt. The result is a model of self that revises Cartesianism by dispersing subjectivity among various subject positions, [End Page 335] but that, in a number of other important ways, preserves essential features of the cogito, as though each fragment of the dispersed cogito were itself a complete mini-cogito.Vivian's account elides the rhetorical process of self-formation. In a typical passage at the end of the essay, he comments, "In order to compose and cultivate one's being in the world, one must persuade one's self to choose and orchestrate certain styles of life from among those available into an entire aesthetics of being" (316-17). The questions this claim provokes are: How does this process of self-persuasion actually take place? What aspect or agency of psyche is doing the persuading? To conceive of the self as Vivian does--a self "conceived as a form--a rhetorical form--that exists only in its continual aesthetic creation, in its indefinite becoming" (304)--suggests a kind of autonomy and self-transparency in self-formation that has discouragingly Cartesian overtones.The terms with which Vivian has chosen to work, namely, subjectivity and the rhetorical self, do not address these issues of self-persuasion. Instead, they serve to mask them. Subjectivity, for Vivian, refers to the positions the self finds itself assuming within discursive regimes, positions whose formation entails moments both of self-persuasion and of subjection to existing social exigency. Subjectivity (so conceived) has the property of being an effect of multiple acts of subjectification, of voluntary acquiescence to preexisting subject positions. "Discourse creates subjects by first creating subject positions from which to speak" (313). The subject is not original, but rather follows from "an entire 'assemblage' of subject positions that are the willful creation of no one, but are instead formed by the complex operations of discourse" (313). The theoretical difficulty with this way of accounting for subjectivity lies in its elision of agency; how shall we make sense of the rhetorical self? More specifically, how does a necessary immersion into discursive practices couple with rhetorical acts of self-persuasion? What motivates self-persuasion? Are all the factors involved in self-persuasion fully conscious and under voluntary control? If not, how are we... (shrink)

Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of (...) morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)