Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

This paper draws on findings from qualitative interviews with queer and trans patients and with physicians providing care to queer and trans patients in Halifax, Nova Scotia, Canada, to explore how routine practices of health care can perpetuate or challenge the marginalization of queers. One of the most common “measures” of improved cultural competence in health care practice is self-reported increases in confidence and comfort, though it seems unlikely that an increase in physician comfort levels with queer and trans patients (...) will necessarily mean better health care for queers. More attention to current felt discomfort in patient–provider encounters is required. Policies and practices that avoid discomfort at all costs are not always helpful for care, and experiences of shared discomfort in queer health contexts are not always harmful. (shrink)

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

Aims and objectives. Participant narratives from a feminist and queer phe- nomenological study aim to broaden current understandings of trauma. Examin- ing structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Background. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have (...) an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Design. Analysis of the qualitative data was guided by feminist and queer phe- nomenology. This was well suited to understanding queer women’s storied narra- tives of trauma, including disempowering processes of structural marginalisation. Methods. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Results. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that recon- structs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Conclusions. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. Relevance to clinical practice. New trauma-informed assessment strategies recon- struct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re- experiencing the process of coming out as queer in opposition to the expectation of heterosexuality. (shrink)

In this article, the theme of introductory engagement is developed through the conversational interviews and participatory observations I carried out with perinatal nurses and birthing women in the context of a feminist phenomenological methodology. Positioned against the landscape of hierarchical health care practices embedded with power dynamics and disembodied practices, this research explored the ways in which perinatal nurses related to birthing women in the context of relational care. The focus of attention in this article is to describe the theme (...) of introductory engagement by way of a storied phenomenological text. (shrink)

An understanding of autonomy has important significance in North American health care. Although a respect for autonomy is necessary to protect the self-determination and agency of birthing women in hospital settings, I suggest that enactments of autonomy that are independent of relationships offer only an incomplete interpretation of such a vital concept. In this article I explore an understanding of autonomy situated within the context of a relational birthing narrative. In so doing, autonomy becomes conceptualized as contextual and concrete, giving (...) rise to an embodied view of the birthing woman. (shrink)

The following Acknowledgments were omitted in the original publication.

In the first of a trilogy of articles published in the New England Journal of Medicine in May 2015, physician–journalist Lisa Rosenbaum observes that the crucial question regarding conflicts of interest between physicians and commercial industry is the extent to which interactions between the two are “beneficial or harmful to patients?”. She goes on to note that the answer to this question “depends on how you define harm,”1 and argues that many of the claims of harm flowing from COI (...) are incomplete, insufficient, or are based on “suggestive extrapolations from data”. If there are benefits to be gained from physician–industry relationships, and if the evidence... (shrink)

This volume collects twelve essays by Sanford C. Goldberg on the topic of social epistemology. The collection falls into two halves: the first half develops a proposal for a programme for social epistemology, its animating vision, foundational questions, and core concepts; the other half focuses on applications of this programme to particular topics. Goldberg characterizes the research programme as the exploration of the epistemic significance of other minds. This programme is dedicated to an examination of the various ways (...) in which we depend epistemically on others, and to describe the proper way to evaluate beliefs according to the sort of dependence they exhibit. It thus provides the basis for identifying and characterizing various dysfunctions of our epistemic communities. The programme is put into practice by exploring such topics as the epistemic agency exhibited in inquiry, the practices that constitute news coverage, the basis for allegations of what we or others should have known, how reliance on another's testimony contrasts with reliance on an instrument, our reliance on others as consumers of testimony, and the epistemic significance of non-epistemic social norms--moral, political, professional, or relationship-based. (shrink)

In Relying on others [Goldberg, S. 2010a. Relying on others: An essay in epistemology. Oxford: Oxford University Press], I argued that, from the perspective of an interest in epistemic assessment, the testimonial belief-forming process should be regarded as interpersonally extended. At the same time, I explicitly rejected the extendedness model for beliefs formed through reliance on a mere mechanism, such as a clock. In this paper, I try to bolster my defense of this asymmetric treatment. I argue that a (...) crucial assumption lying behind the argument I used to establish interpersonal extendedness in testimony cases does not apply to beliefs formed through reliance on instruments. In this respect, at least, there appears to be something epistemically distinctive about relying on another epistemic agent. (shrink)

In this paper I formulate the thesis of the Division of Epistemic Labor as a thesis of epistemic dependence, illustrate several ways in which individual subjects are epistemically dependent on one or more of the members of their community in the process of knowledge acquisition, and draw conclusions about the cognitively distributed nature of some knowledge acquisition.

Delusions are a common symptom of schizophrenia and dementia. Though most English dictionaries define a delusion as a false opinion or belief, there is currently a lively debate about whether delusions are really beliefs and indeed, whether they are even irrational. The book is an interdisciplinary exploration of the nature of delusions. It brings together the psychological literature on the aetiology and the behavioural manifestations of delusions, and the philosophical literature on belief ascription and rationality. The thesis of the book (...) is that delusions are continuous with ordinary beliefs, a thesis that could have important theoretical and practical implications for psychiatric classification and the clinical treatment of subjects with delusions. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and of attributions of self-knowledge in belief ascription. Presenting a highly original analysis of the debate on the nature of delusions, this book will interest philosophers of mind, epistemologists, philosophers of science, cognitive scientists, psychiatrists, and mental health professionals. (shrink)

Elsewhere I and others have argued that evidence one should have had can bear on the justification of one's belief, in the form of defeating one's justification. In this paper, I am interested in knowing how evidence one should have had (on the one hand) and one's higher-order evidence (on the other) interact in determinations of the justification of belief. In doing so I aim to address two types of scenario that previous discussions have left open. In one type of (...) scenario, there is a clash between a subject's higher-order evidence and the evidence she should have had: S's higher-order evidence is misleading as to the existence or likely epistemic bearing of further evidence she should have. In the other, while there is further evidence S should have had, this evidence would only have offered additional support for S's belief that p. The picture I offer derives from two “epistemic ceiling” principles linking evidence to justification: one's justification for the belief that p can be no higher than it is on one's total evidence, nor can it be higher than what it would have been had one had all of the evidence one should have had. Together, these two principles entail what I call the doctrine of Epistemic Strict Liability: insofar as one fails to have evidence one should have had, one is epistemically answerable to that evidence whatever reasons one happened to have regarding the likely epistemic bearing of that evidence. I suggest that such a position can account for the battery of intuitions elicited in the full range of cases I will be considering. (shrink)

Many epistemologists agree that even very young children sometimes acquire knowledge through testimony. In this paper I address two challenges facing this view. The first (building on a point made in Lackey (2005)) is the defeater challenge, which is to square the hypothesis that very young children acquire testimonial knowledge with the fact that children (whose cognitive immaturity prevents them from having or appreciating reasons) cannot be said to satisfy the No-Defeaters condition on knowledge. The second is the extension challenge, (...) which is to give a motivated, extensionally-adequate account of the conditions on testimonial knowledge in early childhood. Neither challenge can be met merely by endorsing externalism about knowledge; but we can meet both by reconceiving the process that eventuates in the child’s consumption of testimony. My central thesis is that this process should be seen as implicating features of the child's social environment. The result is a novel anti-individualistic externalism about knowledge. (shrink)

A new theory of how the brain constructs emotions that could revolutionize psychology, health care, law enforcement, and our understanding of the human mind Emotions feel automatic, like uncontrollable reactions to things we think and experience. Scientists have long supported this assumption by claiming that emotions are hardwired in the body or the brain. Today, however, the science of emotion is in the midst of a revolution on par with the discovery of relativity in physics and natural selection in biology--and (...) this paradigm shift has far-reaching implications for us all. Leading the charge is psychologist and neuroscientist Lisa Feldman Barrett, whose theory of emotion is driving a deeper understanding of the mind and brain, and shedding new light on what it means to be human. Her research overturns the widely held belief that emotions are housed in different parts of the brain and are universally expressed and recognized. Instead, she has shown that emotion is constructed in the moment, by core systems that interact across the whole brain, aided by a lifetime of learning. This new theory means that you play a much greater role in your emotional life than you ever thought. Its repercussions are already shaking the foundations not only of psychology but also of medicine, the legal system, child-rearing, meditation, and even airport security. Why do emotions feel automatic? Does rational thought really control emotion? How does emotion affect disease? How can you make your children more emotionally intelligent? How Emotions Are Made answers these questions and many more, revealing the latest research and intriguing practical applications of the new science of emotion, mind, and brain. (shrink)

Stanford Encyclopedia Entry on Delusions.

In this chapter we consider the tension between how pain researchers today typically define pains and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, providing evidence that during (...) large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

The process of education, and in particular that involving very young children, often involves students' taking their teachers' word on a good many things. At the same time, good education at every level ought to inculcate, develop, and support students' ability to think for themselves. While these two features of education need not be regarded as contradictory, it is not clear how they relate to one another, nor is it clear how (when taken together) these features ought to bear on (...) educational practice itself. This article, which is largely programmatic, aims to provide tentative answers to these questions. (shrink)

What is it to base a belief on reasons? Existing attempts to give an account of the basing relation encounter a dilemma: either one appeals to some kind of neutral process that does not adequately reflect the way basing is a content-sensitive first-personal activity, or one appeals to linking or bridge principles that over-intellectualize and threaten regress. We explain why this dilemma arises, and diagnose the commitments that are key obstacles to providing a satisfactory account. We explain why they should (...) be rejected anyway, and then offer a new, knowledge-first virtue epistemological theory of the basing relation that shows how we can substantially theorize about mental processes without these commitments. The resulting view plausibly captures the way in which basing is an inherently mental and content-sensitive process. (shrink)

Ernest Lepore and Kirk Ludwig correctly observe that Donald Davidson’s account of radical interpretation is in tension with his Swampman thought experiment. Nonetheless, I argue, they fail to see the extent of Davidson’s tension—and so do not handle it adequately—because they fail to appreciate that the thought experiment pits two incompatible response-dependent accounts of meaning against one another. I take an account of meaning to be response-dependent just in case it links the meaning of terms in an a priori manner (...) to the responses that a suitable subject under suitable conditions could or did have to those terms. That Davidson proposes two such accounts is deeply problematic for his program. After explaining the sense in which Davidson endorses two incompatible response-dependent accounts of meaning, I use that explanation to resolve the tension myself. (shrink)

One of the central points of contention in the epistemology of testimony concerns the uniqueness (or not) of the justification of beliefs formed through testimony--whether such justification can be accounted for in terms of, or 'reduced to,' other familiar sort of justification, e.g. without relying on any epistemic principles unique to testimony. One influential argument for the reductionist position, found in the work of Elizabeth Fricker, argues by appeal to the need for the hearer to monitor the testimony for credibility. (...) Fricker (1994) argues, first, that some monitoring for trustworthiness is required if the hearer is to avoid being gullible, and second, that reductionism but not anti-reductionism is compatible with ascribing an important role to the process of monitoring in the course of justifiably accepting observed testimony. In this paper we argue that such an argument fails. (shrink)

The thesis of Weak Unrestricted Composition says that every pair of objects has a fusion. This thesis has been argued by Contessa and Smith to be compatible with the world being junky and hence to evade an argument against the necessity of Strong Unrestricted Composition proposed by Bohn. However, neither Weak Unrestricted Composition alone nor the different variants of it that have been proposed in the literature can provide us with a satisfying answer to the special composition question, or so (...) we will argue. We will then go on to explore an alternative family of purely mereological rules in the vicinity of Weak Unrestricted Composition, Cardinal Composition: A plurality of pairwise non-overlapping objects composes an object iff the objects in the plurality are of cardinality smaller than $$\kappa $$ κ. As we will show, all the instances for infinite $$\kappa $$ κ s determine fusion and are compatible with junk, and every instance for a $$\kappa > \aleph _0$$ κ > ℵ 0 is furthermore compatible with gunk and dense chains of parthood. (shrink)

What about Confucian bioethics should compel our interest? Apart from the fact that Confucianism grounds the belief system of a great number of people, a Confucian bioethics poses a profound challe...

The Oxford Handbook of Feminist Theory provides an overview of the analytical frameworks and theoretical concepts feminist theorists have developed to challenge established knowledge. Leading feminist theorists, from around the globe, provide in-depth explorations of a diverse array of subject areas, capturing a plurality of approaches. The Handbook raises new questions, brings new evidence, and poses significant challenges across the spectrum of academic disciplines, demonstrating the interdisciplinary nature of feminist theory.

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

The incredible story of the woman--actress, dancer, yogi, globetrotter--who brought yoga to America and to much of the rest of the western world. Born Eugenia Peterson in early 20th century Russia, Indra Devi was a rebel from earliest childhood. In the 1930s she fled to Berlin, and then--driven by her passion for yoga and a fascination with yogic philosophy (and Theosophy)--she journeyed to India, at a time when unaccompanied young European women were unheard of. In India she performed perhaps her (...) greatest feat--convincing even the most recalcitrant yogis, from Krishnamurti to Krishnamacharya, to reveal to her the secrets of their art. She would go on to share what she learned with men and women around the world--teaching Gloria Swanson and Greta Garbo in Hollywood, then moving to Mexico and later to Buenos Aires--helping to usher in the craze for yoga that continues unabated in the U.S. and throughout the world today. Written with vivid clarity, and describing the extraordinary spread and popularization of a philosophical movement, The Goddess Posebrings Indra Devi's little known but wholly remarkable story to life. (shrink)

Im Zeitalter des sogenannten »Anthropozäns« werden wir Zeugen einer ontologischen Verschiebung: Die modernen Grenzziehungen zwischen Kultur und Natur, Subjekt und Objekt sowie die Vorstellung einer Welt, die aus unabhängigen Entitäten besteht, werden in der aktuellen Umbruchskonfiguration weitreichend destabilisiert. So ist die »Krise« der Moderne auch als eine »Krise« des Seins zu lesen, die die Möglichkeit eines (Anders-)Werdens relationaler Welt/en eröffnen könnte. Aus einer medienphilosophischen Perspektive fragt Lisa Handel danach, wie dieses Aufsprengen der Seinsontologie von der Frage der Medialität her (...) zu denken und situieren ist. Ontomedialität ist »Kartenkunde und Reisebericht« einer Welt, in der Medialität und Ontologie je schon implodiert und ununterscheidbar geworden sind. (shrink)

Dr Jardine finds a unifying principle in Bacon's preoccupation with 'method', the evaluation and organisation of information as a procedure of investigation or ...

The fusion of law and equity in common law systems was a crucial moment in the development of the modern law. In this volume leading scholars assess the significance of the fusion of law and equity from comparative, doctrinal, historical and theoretical perspectives.

This paper argues that the diversity of conflicting comprehensive doctrines in liberal pluralist societies raises a problem of estrangement between citizens and the basic structure of society that Rawls' version of political liberalism does not successfully solve. 'Political estrangement' occurs when someone refuses to accept a political outcome that favors a comprehensive doctrine she rejects, based on what she imagines, correctly or incorrectly, to be true of her fellow citizens' comprehensive doctrines and their effect on political outcomes. Rawls argues that (...) the political conception of justice and the use of public reason ensure the incompatibility of our comprehensive doctrines will not undermine our willingness to to accept political decisions contrary to our own values. However, public reason does not guarantee this result. Imagination can allow us to see that the influence of some reasonable comprehensive doctrines can lead to oppressive political outcomes and public reason restricts us from addressing this fact. Yet, widening public reason to account for this problem is likely to increase the conditions that cause estrangement. The paper concludes that the political conception of justice and public reason may sometimes fail to adequately justify political outcomes in the sense Rawls hopes. (shrink)

The statesman, scientist, and philosopher Francis Bacon (1561-1626) lived a divided life. Was he a noble scholar, or a conniving political crook? Was he a homosexual? Lisa Jardine and Alan Stewart draw upon previously untapped sources to create a controversial nuanced portrait of the quintessential "Renaissance man", one whose achievements, while enormous, were nonetheless sadly circumscribed by his class and station.

Recently, we proposed a fundamental subdivision of the human cortex into two complementary networks—an “extrinsic” one which deals with the external environment, and an “intrinsic” one which largely overlaps with the “default mode” system, and deals with internally oriented and endogenous mental processes. Here we tested this hypothesis by contrasting decision making under external and internally-derived conditions. Subjects were presented with an external cue, and were required to either follow an external instruction or to ignore it and follow a voluntary (...) decision process . Our results show that a well defined component of the intrinsic system—the right inferior parietal cortex—was preferentially activated during the “free-will” condition. Importantly, this activity was significantly higher than the base-line resting state. The results support a self-related role for the intrinsic system and provide clear evidence for both hemispheric and regional specialization in the human intrinsic system. (shrink)