North American psychiatric literature describes the current method of psychiatric diagnostic assessment as "phenomenological"; however, it is unclear what phenomenology 1 means in this context. This paper investigates the meaning and impact of some of the major philosophical and psychiatric definitions of phenomenology on contemporary psychiatric assessment. Employing a comparative analysis of selected definitions of phenomenology, this paper argues that North American psychiatric assessment does not reflect any of these definitions of phenomenology. Instead, within the context of psychiatric assessment, phenomenology (...) has taken on an idiosyncratic, clinical meaning of signs and symptoms. However, this does not mean that phenomenology has had no impact on North American psychiatry. This paper contends that phenomenology has made contributions to psychiatry, particularly in the area of psychotherapy and especially in self-psychological psychotherapy. The importance of the concept of empathy within psychotherapy is evidence of the continuing influence of philosophical phenomenology on psychiatry. This paper concludes that phenomenology can provide an important complementary perspective to the dominant methods of North American psychiatric practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 93-96 [Access article in PDF] Phenomenological Methods in Psychiatry:A Necessary First Step M. Gupta and L. Rex Kay Keywords: behavior, empathy, human science, methodology, natural science, phenomenology. WE ARE GRATEFUL to the journal for prviding the opportunity for exchange and discussion of some of the themes raised in our paper, "The impact of phenomenology on North American psychiatric assessment" and we are (...) pleased to be able to reply to the two excellent commentaries by McMillan and Morley. Both McMillan and Morley question the prospect of employing phenomenology and its methods in psychiatric assessment, and in psychiatric practice more generally. McMillan questions the utility of such a step, and Morley is pessimistic about its feasibility. We shall address each author's concerns in turn.Initially, let us restate the aims of our paper to contextualize our arguments and those made in the commentaries. First, we sought an understanding of what is meant by North American psychiatrists, working within the DSM framework, when they refer to the phenomenological approach to psychiatric assessment. To elucidate this meaning, we compared the contemporary North American usage to a small number of definitions of phenomenology, particularly those definitions that were, and are now, applied to clinical psychiatric work. Contrary to McMillan's suggestion, we did not intend to state definitively what should or should not count as phenomenological, but rather to compare North American psychiatric assessment to what typically has counted as phenomenological. Second, we sought to examine phenomenology's influence on North American psychiatric practice, particularly psychotherapy.Morley argues that such influences usually exemplify the inappropriate appending of phenomenology to psychiatric practice rather than true integration of different paradigms. Although we do not disagree with this general contention, we will argue that the deployment of phenomenological methods in psychiatric assessment is a necessary first step toward the kind of integration he proposes.McMillan makes two related but unintegrated points. First, he argues that objective, behavioral data are phenomenological, according to his broad definition of the term. Second, he proposes that, if the behavioral and the phenomenological are different, we are better off staying with the behavioral when it comes to psychiatric nosology. Let us consider these two points in succession.McMillan seeks to broaden Jasper's definition of phenomenology to include objective observations [End Page 93] as phenomenological. To this end, he distinguishes methods from aims. He summarizes Jasper's definition of phenomenology as "an empirical method for investigating 'individual psychic experience (p 55)" and claims that this is a statement of aim or objectives. He then urges us to "consider the merits of different phenomenological methodologies in terms of their success in achieving this objective" whether or not they utilize "all the methods" of phenomenology. This is much like saying that if we treat waving one's hand as a method for greeting someone, we are then free to treat the objective of the wave as one of greeting someone, and then say that anything that serves as a greeting is, by definition, a "wave." Whatever else McMillan's objective observations are, he has not convinced us that they are phenomenological, anymore than we are likely to convince you that a kiss on the lips is really just a wave.Nonetheless, it is worthwhile seeing what McMillan does with this argument. He tells us that we can "read the first-person experience from behavior in a fairly accurate and informative way." He uses the example of a father gazing at his young child and notes that it is not unreasonable to infer that he is experiencing loving and nurturing feelings. It is, indeed, not unreasonable to draw such an inference. But it is far more reasonable to infer that the father is experiencing a cacophony of feelings, including, but not limited to, love, concern, anxiety, pride, envy, hope, and sadness (Stern 1995, 18-58). If we are able to distinguish which of these feelings is dominant at any given moment—which we are—and if we are also able to track subtle shifts in such feelings... (shrink)

In this groundbreaking book, psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of Evidence-based medicine (EBM), and critically examines their applicability to psychiatry. Highlighting ethical tensions between psychiatry and EBM, she asks the controversial question - should psychiatrists practice evidence-based medicine at all?

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric (...) knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs. (shrink)

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed (...) to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a shift (...) in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Evidence-based medicine (EBM) made its first appearance in the medical lexicon in 1990 and since then has enjoyed widespread support from within the medical profession, including among psychiatrists. Proponents of evidence-based psychiatry (EBP) point to its ability to demonstrate the efficacy of various psychiatric treatments, promising improved mental health outcomes and more efficient use of healthcare resources as a result. Policymakers and insurers have embraced EBP in hopes that these goals will be realized. However, the question of whether EBM is (...) even applicable to psychiatry remains largely unaddressed, even though it is an urgent one, given the various corporate, professional, and governmental pressures .. (shrink)

In 20141 and 2016,2 respectively, Québec and Canada adopted legislation permitting medical assistance in dying (MAID). In this context, the question of whether persons with mental disorders should be able to access MAID has received considerable scrutiny.Over the last 5 years, I have been involved in the academic and policy debates about assisted dying for persons with mental disorders. Policymakers and clinicians alike demand that public policy be based on 'evidence' by which they tend to mean empirical, usually quantitative, data. (...) There is little acknowledgement that some questions are not empirical and that facts require interpretation.The debate about whether a request for assistance in dying by a person with a... Read More. (shrink)

Scott Waterman's reflection on his experience with chronic pain and alternative treatments raises a fundamental question in medical epistemology: How can we know that an intervention will help people who are suffering?Waterman's details his trial of an alternative therapy with a dubious pathophysiological rationale. Despite the lack of research demonstrating its efficacy, and a lack of therapeutic benefit for him in particular, he acknowledges its benefit to others who were more attitudinally predisposed to it. This leads him to conclude that (...) one's personal beliefs and explanatory hypotheses play a role in the healing process. From this he concludes that data from clinical studies conducted according to... (shrink)

In his paper, A Logic in Madness, Aaron Hauptman describes the evolving clinical picture of Mr. A, a patient with Asperger’s syndrome who presents with symptoms consistent with a major depressive episode. In his case discussion, Hauptman describes the difficulties, both conceptual and practical, faced by the clinical team in trying to help this man recover from his depression. Among these he identifies: ‘the ethics of mandated treatment, definitions of mental illness, rationality in the context of psychiatric disorders, and the (...) limitations on patient autonomy in a psychiatric inpatient setting’. In this response to Hauptman’s paper, I discuss the first and last concerns with emphasis on... (shrink)

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate (...) specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)

In her paper, “Evidence-based medicine in context: A pragmatist approach to psychiatric practice,” Jorid Moen sets out to advance the debate about role of evidence-based medicine in psychiatric practice. She views this debate as dichotomous and unproductive. It is dichotomous in the sense that EBM is linked to foundationalist theories of knowledge, whereas critiques of EBM are often based in anti-foundationalist theory. It is unproductive because neither position offers a way forward. Moen draws on the philosophical tradition of pragmatism in (...) hopes that ‘opposing positions of EBM might be brought to agree that the different perspectives they represent are both relevant and important for psychiatric. (shrink)

Gupta effectively probes the methodological and ethical presuppostions of Evidence Based Medicine, and its more contestable application to psychiatry. She concludes with an endorsement of a very modest reformulation of it as one guide to practice among many.

Assertion is the central vehicle for the sharing of knowledge. Whether knowledge is shared successfully often depends on the quality of assertions: good assertions lead to successful knowledge sharing, while bad ones don't. In Sharing Knowledge, Christoph Kelp and Mona Simion investigate the relation between knowledge sharing and assertion, and develop an account of what it is to assert well. More specifically, they argue that the function of assertion is to share knowledge with others. It is this function that (...) supports a central norm of assertion according to which a good assertion is one that has the disposition to generate knowledge in others. The book uses this functionalist approach to motivate further norms of assertion on both the speaker and the hearer side and investigates ramifications of this view for other questions about assertion. (shrink)

Cloud computing (ClC) has become a more popular computer paradigm in the preceding few years. Quality of Service (QoS) is becoming a crucial issue in service alteration because of the rapid growth in the number of cloud services. When evaluating cloud service functioning using several performance measures, the issue becomes more complex and non-trivial. It is therefore quite difficult and crucial for consumers to choose the best cloud service. The user's choices are provided in a quantifiable manner in the current (...) methods for choosing cloud services. Hence, this study attempts to achieve this objective through construction. decision-making framework so-called cloud services evaluator (CSsEv). The main indicator and its sub-indicators are formed as nodes at levels(n) in tree soft sets (TSSs). Thereafter Single Value Neutrosophic Sets (SVNSs) as branch of neutrosophic sets which conjunction with the Multi-Criteria Decision Making (MCDM) technique to facilitate analysis and evaluation process for the available Cloud services providers. Hence, entropy is employed to obtain indicators and sub_indicators weights and Complex Proportional Assessment utilizes these weights to facilitate the decision process of selecting optimal ClSPs. (shrink)

Machine generated contents note: 1. Spoken, intended and problematic divorce in Hanafi Fiqh; 2. Between person and property - slavery in Qudūrī's Mukhtasar; 3. Pig, purity and permission in Mālikī slaughter; 4. Islamic and other perspectives on evil; 5. The language of love in the Qur'ān; 6. Virtue and limits in the ethics of friendship 7. Drinking and drunkenness in Ibn Rushd.

This chapter develops a novel Neo-Moorean view. The view falls squarely within the Radical Neo-Moorean camp, in that it holds that closure holds unrestrictedly, warrant transmits through Moore’s inference, and that there is nothing wrong – epistemically or dialectically – with Moore’s argument. Nevertheless, the account is superior to extant Radical Neo-Mooreanisms in explanatory power: it explains both the precise variety of epistemic failure exhibited by the sceptic, and the intuition of reasonableness when it comes to the sceptic’s resistance to (...) Moore’s argument. It does so in terms of epistemic functions and contrary-to-duty obligations. (shrink)

The main goal of this paper is to introduce the notion of stabilizers in \(L\)-algebras and develop stabilizer theory in \(L\)-algebras. In this paper, we introduced the notions of left and right stabilizers and investigated some related properties of them. Then, we discussed the relations among stabilizers, ideal and co-annihilators. Also, we obtained that the set of all ideals of a \(CKL\)-algebra forms a relative pseudo-complemented lattice. In addition, we proved that right stabilizers in \(CKL\)-algebra are ideals. Then by using (...) the right stabilizers we produced a basis for a topology on \(L\)-algebra. We showed that the generated topology by this basis is Baire, connected, locally connected and separable and we investigated the other properties of this topology. (shrink)

DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be (...) developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions. Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis. Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing. In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient. (shrink)

Le projet révolutionnaire s'est largement identifié à un projet pédagogique, qui déborde de beaucoup les dispositifs scolaires pour s'attacher à une véritable conversion : du sujet au citoyen, de l'homme enchaîné à l'homme libre, du vieil homme à l'homme régénéré. Au coeur de cet ouvrage, on trouvera l'essai consacré à cette entreprise, dont Saint-Just a défini l'ambition ("faire des hommes ce qu'on veut qu'ils soient") et Mirabeau le possible délire : "Avec des moyens appropriés, on pourrait passionner les hommes pour (...) une organisation sociale entièrement absurde, injuste et cruelle". Toutes les études qui accompagnent ce texte central éclairent à leur manière la tentative utopique, magnifique et désespérée, de maîtriser à la fois l'événement et la durée, l'individu et le collectif, l'opinion réfléchie et l'opinion spontanée. Se dessine ainsi le vrai sujet de cet ensemble, que traitaient déjà La Fête révolutionnaire (1976) et L'École de la France (1984) : l'entrée, avec la volonté d'instituer l'homme aussi bien que le citoyen, dans notre culture démocratique. (shrink)

BackgroundIn cancer care, do not resuscitate orders are common in the terminal phase of the illness, which implies that the responsible physician in advance decides that in case of a cardiac arrest neither basic nor advanced Coronary Pulmonary Rescue should be performed. Swedish regulations prescribe that DNR decisions should be made by the responsible physician, preferably in co-operation with members of the team. If possible, the patient should consent, and significant others should be informed of the decision. Previous studies have (...) shown that physicians and nurses can experience ethical dilemmas in relation to DNR decisions, but knowledge about what ethical reasoning they perform is lacking. Therefore, the aim was to describe and explore what ethical reasoning physicians and nurses apply in relation to DNR-decisions in oncology and hematology care.MethodsA qualitative, descriptive and explorative design was used, based on 287 free-text comments in a study-specific questionnaire, answered by 216 physicians and nurses working in 16 oncology and hematology wards in Sweden. Comments were given by 89 participants.ResultsThe participants applied a situation-based ethical reasoning in relation to DNR-decisions. The reasons given for this were both deontological and utilitarian in kind. Also, expressions of care ethics were found in the material. Universal rules or guidelines were seen as problematic. Concerning the importance of the subject, nurses to a higher extent underlined the importance of discussing DNR-situations, while physicians described DNR-decisions as over-investigated and not such a big issue in their daily work.ConclusionThe study revealed that DNR-decisions in oncology and hematology care gave rise to ethical considerations. Important ethical values described by the participants were to avoid doing harm and to secure a peaceful and “natural” death with dignity for their dying patients. A preference for the expression “allow for natural death” instead of the traditional term “do not resuscitate” was found in the material. (shrink)