The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and (...) suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Challenges to psychiatric stigma fall between a rock and a hard place. Decreasing one prejudice may inadvertently increase another. Emphasising similarities between mental illness and ‘ordinary’ experience to escape the fear-related prejudices associated with the imagined ‘otherness’ of persons with mental illness risks conclusions that mental illness indicates moral weakness and the loss of any benefits of a medical model. An emphasis on illness and difference from normal experience risks a response of fear of the alien. Thus, a ‘likeness-based’ and (...) ‘unlikeness-based’ conception of psychiatric stigma can lead to prejudices stemming from paradoxically opposing assumptions about mental illness. This may create a troubling impasse for anti-stigma campaigns. (shrink)

A book chapter exploring the potential consquences and ethical ramifications of using coercive measures within community mental healthcare. We argue that, althogh the move towards 'care in the community' may have had liberalising motivations, the subsequent reduction in inpatient or other supported residential provision, means that there has been an increasing move towards coercive measures outside of formal inpatient detention. We consider measures such as Community Treatment Orders, inducements, and other forms of leverage, explaining the underlying concepts, aims, and exploring (...) adverse consequences and ethical difficulties. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...) to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

Despite extensive evidence for its effectiveness, ECT remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against ECT, and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.

Charland's article suggests that we need to think more about whether decision-making capacity is impaired in severe addiction, working from the idea that drug dealers rely on this understanding of addiction to draw in their clients. Charland argues that it is possible to make a choice without being in control (to make decisions without having decision-making capacity). I argue in support of Charland's ideas by examining the reasons supporting a medical model of addiction and its importance. (For Charland's article and (...) the full set of commentaries, please see the Research Gate link). (shrink)

The Sophists, who rose to prominence in democratic Athens during the mid-fifth century b.c., understood the art of rhetoric and the importance of being able to transform effective reasoning into persuasive public speaking. Their inquiries-into the gods, the origins of religion, and whether virtue can be taught-influenced the next generation of classical philosophers and formed the foundations of the European prose style and formal oratory. In this new translation each chapter is organized around the work of one character, including Gorgias, (...) Prodicus, Protagoras, and Antiphon, among others. (shrink)

On the 13th June 2014, the Centre for the Humanities and Health (CHH) at King’s College London hosted a one-day workshop on ‘Parentalism and Trust.’ This workshop was the sixth in a series of workshops whose aim is to provide a new model for high-quality open interdisciplinary engagement between medical professionals and philosophers. The term ‘Parentalism’ rather than paternalism is chosen and used throughout because of some of the derisory and unfortunate gender connotations associated with paternalism (and/or its counterpart ‘maternalism’). (...) Medical Parentalism is the position that unwanted interference with a patient’s choices and actions in order to protect and promote her best interests is morally justified. Whilst there are many problems with its justification and implementation, the workshop addressed how such interference depends on a trusting relationship between the doctor and patient, and the extent to which parentalist interferences might undermine this trust. (shrink)

ABSTRACTTime-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses (...) regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski and Ludwig Binswanger. We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski... (shrink)

Food Services generate solid waste from the production process and distribution of meal. The raw material, after a rational flow, is transformed into meals for consumption generating solid waste of variable composition and quantity. Waste recovery actions in the recycling and selective collection in these services act as inhibitors of the inadequate disposal of these wastes in the environment, contributing to environmental sustainability. The objective of this study is to analyze the generation and viability of commercialization of recyclable solid waste (...) in Food Services of companies located in Cuiabá and Várzea Grande, Mato Grosso – Brazil. This is a cross-sectional exploratory study with a convenience sample. The analysis of the generation of residues was carried out using the weighing method and generation indices using descriptive statistics. In order to verify the economic potential of recyclable waste, the value of intermediate consumption was used and sales price data were obtained by means of the publication "Compromisso Empresarial para Reciclagem" CEMPRE. It was found that in six services the largest part of waste was made of plastic, and in two services it was paper and cardboard. The generation of aluminum was more significant in one service, being the residue that added more economic value in the commercialization. The generation of glass and tetra pack packaging were not significant, and the recycling of both is not of interest to the scavengers. The results indicate that the commercialization of recyclable solid waste is viable. (shrink)

Both philosophers and psychologists have argued for the existence of distinct kinds of explanations, including teleological explanations that cite functions or goals, and mechanistic explanations that cite causal mechanisms. Theories of causation, in contrast, have generally been unitary, with dominant theories focusing either on counterfactual dependence or on physical connections. This paper argues that both approaches to causation are psychologically real, with different modes of explanation promoting judgments more or less consistent with each approach. Two sets of experiments isolate the (...) contributions of counterfactual dependence and physical connections in causal ascriptions involving events with people, artifacts, or biological traits, and manipulate whether the events are construed teleologically or mechanistically. The findings suggest that when events are construed teleologically, causal ascriptions are sensitive to counterfactual dependence and relatively insensitive to the presence of physical connections, but when events are construed mechanistically, causal ascriptions are sensitive to both counterfactual dependence and physical connections. The conclusion introduces an account of causation, an "exportable dependence theory," that provides a way to understand the contributions of physical connections and teleology in terms of the functions of causal ascriptions. (shrink)

Unscharfe Grenzen und fließende Übergänge kommen in allen Registern der Erfahrung vor. Von einer positiven Unbestimmtheit kann indes nur dort die Rede sein, wo diese gleichsam zur Sache selbst gehört und nicht nur unserem begrenzten Erkenntnisstand oder mangelnden Realisierungsmöglichkeiten zuzu-rechnen ist. Die gewachsene technologische Verfügungsmacht des Menschen, die sich mittlerweile auf die menschliche Lebenssubstanz selbst erstreckt, hat zu tiefgreifenden Veränderungen des Naturbegriffs geführt, in deren Verlauf die Grenzen zwischen Naturprodukten und Artefakten ständig verschoben werden. Damit tauchen neue Formen von Unbestimmtheit (...) auf, deren begriffliche Bewältigung uns vor besondere Probleme stellt. Wann genau beginnt das zu schützende menschliche Leben? Sind Hirntote wirklich tot? Kann ich eine Gehirntransplantation überleben, meine Existenz sogar in einem Klon fortsetzen? (shrink)

Educational policy and social sciences researchers have been studying dishonest behaviors among students for a long time. In this bibliometric study we examine the extant literature on academic dishonesty until 2017. We also analyze the specific case of the literature on plagiarism since it is arguably one of the most common academic dishonest behavior. We aim at identifying the intellectual structure of the field of academic dishonesty and plagiarism. Results show that Donald L. McCabe and Richard L. Marsh appear as (...) the most productive authors. Furthermore, Whitley, 235–274, 1998) “Factors associated with cheating among college students: A review”, and Pennycook, 201–230, 1996), entitled “Borrowing others’ words: Text, ownership, memory, and plagiarism” are the most cited publications on academic dishonesty and on plagiarism, respectively. Additionally, a strong connection between the McCabe and Treviño articles emerged from the co-citation analysis on academic dishonesty, and also a strong relationship between Pennycook, 201–230, 1996) and Pecorari, 317–345, 2003), suggesting that these articles are strongly connected. Results suggest that these are the most influential authors and articles of the field. (shrink)

ABSTRACTThe understanding of a wide array of practices related to fraud, bribery, corruption, and more widely, illicit practices have been capturing the attention of practitioners and management researchers worldwide. A substantial portion of the extant research has used university students to measure their actual or intended cheating behaviours and often studies have tested for variations across countries and cultures. We highlight some major concerns in this stream of inquiry and discuss both the definition and some inconclusive results in prior studies, (...) namely those deriving from differences in cheating behaviour across different cultural contexts. We suggest the need to examine intentionality, and further advance that intentionality may assume a reactive or a proactive essence. Depending on the social and formal contexts of different countries, both reactive and proactive intentions lead to distinct moral concerns, which we name in this work omorality or immorality. (shrink)

Le terme ktitor accompagne souvent la représentation d'un acte de don dans la peinture murale byzantines et post-byzantines. Même si le terme "ktitor" a été traduit le plus souvent par "fondateur", sémantiquement et historiquement, on retrouve dans le mot le sens de possession. Les ktitores - des propriétaires modaux, offrent leurs dons, dont le destinataire final est Dieu. Les panneaux votifs de Théodore Métochite , du sebastokrator Kalojan , de Stefan Uroš III , de Mircea l'Ancien témoignent des droits, des (...) intentions et de la foi du ktitor. Avec le christianisme, le sens du don s'est inversé et out don humain n'est qu'un contre-don à Dieu pour son sacrifice premier. (shrink)

Recent expansions of federal and state law enforcement databanks to include DNA samples and profiles of innocent persons threaten individual privacy, impose unjustifiable costs on society, and may undermine our pursuit of justice. The move to permanently retain DNA from arrestees and proposals for a universal database should be vigorously opposed on matters of principle, legality, and practicality.

Teleological explanations (TEs) account for the existence or properties of an entity in terms of a function: we have hearts because they pump blood, and telephones for communication. While many teleological explanations seem appropriate, others are clearly not warranted-for example, that rain exists for plants to grow. Five experiments explore the theoretical commitments that underlie teleological explanations. With the analysis of [Wright, L. (1976). Teleological Explanations. Berkeley, CA: University of California Press] from philosophy as a point of departure, we examine (...) in Experiment 1 whether teleological explanations are interpreted causally, and confirm that TEs are only accepted when the function invoked in the explanation played a causal role in bringing about what is being explained. However, we also find that playing a causal role is not sufficient for all participants to accept TEs. Experiment 2 shows that this is not because participants fail to appreciate the causal structure of the scenarios used as stimuli. In Experiments 3-5 we show that the additional requirement for TE acceptance is that the process by which the function played a causal role must be general in the sense of conforming to a predictable pattern. These findings motivate a proposal, Explanation for Export, which suggests that a psychological function of explanation is to highlight information likely to subserve future prediction and intervention. We relate our proposal to normative accounts of explanation from philosophy of science, as well as to claims from psychology and artificial intelligence. (shrink)

On November 2, 2004, California voters elected to radically expand their state criminal DNA database through the passage of Proposition 69. The approved ballot initiative authorized DNA collection and retention from all felons, any individuals with past felony convictions – including juveniles – and, beginning in 2009, all adults arrested for any felony offense. This dramatic database expansion threatens civil liberties and establishes a dangerous precedent for U.S. criminal databases.

Assisted suicide, many argue, honors self‐determination in returning control of their dying to patients themselves. But physician assistance and measures proposed to safeguard patients from coercion in fact return ultimate authority over this “private and deeply personal” decision to medicine and society.

Recent expansions of federal and state law enforcement databanks to include DNA samples and profiles of innocent persons threaten individual privacy, impose unjustifiable costs on society, and may undermine our pursuit of justice. The move to permanently retain DNA from arrestees and proposals for a universal database should be vigorously opposed on matters of principle, legality, and practicality.

Traditional approaches to moral psychology assumed that moral judgments resulted from the application of explicit commitments, such as those embodied in consequentialist or deontological philosophies. In contrast, recent work suggests that moral judgments often result from unconscious or emotional processes, with explicit commitments generated post hoc. This paper explores the intermediate position that moral commitments mediate moral judgments, but not through their explicit and consistent application in the course of judgment. An experiment with 336 participants finds that individuals vary in (...) the extent to which their moral commitments are consequentialist or deontological, and that this variation is systematically but imperfectly related to the moral judgments elicited by trolley car problems. Consequentialist participants find action in trolley car scenarios more permissible than do deontologists, and only consequentialists moderate their judgments when scenarios that typically elicit different intuitions are presented side by side. The findings emphasize the need for a theory of moral reasoning that can accommodate both the associations and dissociations between moral commitments and moral judgments. (shrink)

In the name of Husserl: nursing in pursuit of the things‐in‐themselves A perceived contradiction between the tenets of humanism and positivism secures phenomenology’s endorsement in nursing as an alternative methodology to the natural sciences. Nursing’s humanistic doctrine of valuing the individual is aligned with phenomenology in the belief that both projects investigate the subjective experiences of others. However, the belief that phenomenology opposes objectifying methods does not account for the different understandings of subjectivity that underpin various philosophic positions, such as (...) humanism, phenomenology, hermeneutics and positivism. What is not recognised in nursing inquiry is that the same characteristics which belong to humanism and are subsequently attributed as belonging to phenomenology are grounded, philosophically, in a view that separates the person from her world. But rather than examining the premises on which phenomenology and humanism are based, nurse‐phenomenologists have simply yoked them together in a mutual alliance against a common enemy — Cartesian dualism. This paper focuses on Husserl and argues that the conceptual link between nursing as a humanistic discipline and Husserlian phenomenology cannot be sustained on philosophic and methodologic grounds. Far from being mutual allies, the philosophic underpinnings of humanism and Husserlian phenomenology offer two incommensurable views on the nature of subjectivity. (shrink)

. On June 13, 2013, the Supreme Court issued a unanimous decision in Association for Molecular Pathology v. Myriad Genetics, holding that a naturally occurring DNA segment that has merely been “isolated” is not patent eligible, and effectively overturning a longstanding policy that had allowed for patents to be issued on thousands of human genes. Drawing largely on the expert testimony and arguments presented during the court proceedings, this paper provides an overview of the discovery and patenting of the BRCA1 (...) and BRCA2 genes at issue in the case, the impacts of gene patents on biomedical research and innovation and clinical practice, and the legal analysis presented by the plaintiffs throughout the case for how patents issued on genes violate the Patent Act and the U.S. Constitution. Finally, it discusses how the Court’s decision in this case marked an extraordinary victory not only for the plaintiffs directly involved, but more generally for women, patients, researchers, civil liberties, and the future of medicine. (shrink)

On November 2, 2004, California voters approved Proposition 69, “The DNA Fingerprint, Unsolved Crime, and Innocence Protection Act” by a margin of approximately 60 to 40 percent. Given the limited amount of information provided to voters during the initiative process, it is unclear how many of the yea-sayers were apprised of the full implications of this measure. Indeed, by voting “yes” on Proposition 69, California has elected to house the most radical and costly state criminal DNA database in the country. (...) This dangerous expansion of California's database poses tremendous threats to civil liberties and social justice while offering little, if anything, by way of increasing the safety of its citizens.Prior to November 2, California law required the permanent retention of DNA samples from felons convicted of serious, violent crimes. The new law expands the database to include DNA samples from all felons and individuals with past felony convictions - including juveniles - and, beginning in five years, all adults arrested for any felony offense. (shrink)

Religious systems are organised semiotic structures providing people with values and rules, identities, regularity, and meaning. Consequently, a person moving out of a religious system might be exposed to meaning-ruptures. The paper presents the situation of young people who have been in Yeshiva, a rabbinic high-school, and who have to join secular university life. It analyses the changes to which they are exposed. On the bases of this case study, the paper examines the following questions: can the religious symbolic system (...) internalised by a person in a religious sphere of experience be mobilised as a symbolic resource once the person moves to a secular environment? If yes, how do religious symbolic resources facilitate the transition to a secular life? And if not, what other symbolic and social resources might facilitate such transitions? (shrink)

Scientific and ‘intuitive’ or ‘folk’ theories are typically characterized as serving three critical functions: prediction, explanation, and control. While prediction and control have clear instrumental value, the value of explanation is less transparent. This paper reviews an emerging body of research from the cognitive sciences suggesting that the process of seeking, generating, and evaluating explanations in fact contributes to future prediction and control, albeit indirectly by facilitating the discovery and confirmation of instrumentally valuable theories. Theoretical and empirical considerations also suggest (...) why explanations may nonetheless feel intrinsically valuable. The paper concludes by considering some implications of the psychology of explanation for a naturalized philosophy of explanation. (shrink)

Use of electronic health records within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement—all at once. However, this multifunctionality is also one of the main reasons care providers struggle with the EHR. These problems have often been described but are rarely approached from a philosophical point of view. We argue that a postphenomenological case study of the EHR could lead to more in-depth insights. (...) We will focus on two concepts—transparency and multistability—and translate them to the specific situation of the EHR. Transparency is closely related to an embodiment relation in which the user becomes less aware of the technology: it fades into the background, becoming a means of experience. A second key concept is that of multistability, referring to how a technology can serve multiple purposes or can have different meanings in different contexts. The EHR in this sense is multistable by design. Future EHR design could incorporate multistable information differently, allowing the provider to focus on patient care when interacting with the EHR. Moreover we argue that the use of the EHR in the daily workflow should become more transparent, while awareness of the computer in the specific context of the patient-provider relationship should increase. (shrink)

We explore how principles predicting the success of a medical information commons advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data (...) collaborations to improve health and healthcare. (shrink)

Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas (...) Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide. (shrink)

Recent theoretical and empirical work suggests that explanation and categorization are intimately related. This paper explores the hypothesis that explanations can help structure conceptual representations, and thereby influence the relative importance of features in categorization decisions. In particular, features may be differentially important depending on the role they play in explaining other features or aspects of category membership. Two experiments manipulate whether a feature is explained mechanistically, by appeal to proximate causes, or functionally, by appeal to a function or goal. (...) Explanation type has a significant impact on the relative importance of features in subsequent categorization judgments, with functional explanations reversing previously documented effects of [”]causal status’. The findings suggest that a feature’s explanatory importance can impact categorization, and that explanatory relationships, in addition to causal relationships, are critical to understanding conceptual representation. (shrink)