One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and (...) mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy. (shrink)

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the (...) meaning of “professionalism” itself, thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism. (shrink)

Introduction. This study examines differences in students’ perceived value of three artmaking modalities and whether the resulting creative projects offer similar or different insights into medical students’ professional identity formation. Methods. Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students’ original work. Results. Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities. Discussion. Regardless of type of artmaking, students express concern about (...) encroachments of training on personal identity but hoped that personal and professional selves could be integrated. (shrink)

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over another. I (...) next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of “physician arrogance” as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of “killing suffering”; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer. (shrink)

Medical students’ mask-making can provide valuable insights into personal and professional identity formation and wellness. A subset of first- and second-year medical students attending a medical school wellness retreat participated in a mask-making workshop. Faculty-student teams examined student masks and explanatory narratives using visual and textual analysis techniques. A quantitative survey assessed student perceptions of the experience. We identified an overarching theme: “Reconciliation/reclamation of authentic identity.” The combination of nonverbal mask-making and narrative offers rich insights into medical students’ experience and (...) thinking. This activity promoted reflection and self-care, while providing insight regarding personal and professional development. (shrink)

This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in (...) contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated. (shrink)

The authors would like to correct a misspelling in the name of one of the authors due to a typographical error. The name should read Atur Turakhia, not Artur Turakhia. This does not change the conclusions or interpretations presented.

This article provides a discussion of the limits of both narrative and culture based on a close textual analysis of the short story, “People Like That Are the Only People Here: Canonical Babbling in Peed Onk,” by Lorrie Moore. In this story, a mother describes her experiences on a pediatric oncology ward when her infant son develops Wilms' tumor. The authors examine how the story satirically portrays the spurious claims of language, story, and culture to protect us from an unjust (...) universe and then exposes their false promises. The various personal, professional, and genre-specific narratives we use to create order and coherence from the terror of serious illness are ultimately ineffective. Similarly, the superficially comforting culture of the hospital ward cares more about creating the illusion of control than it does about the suffering of sick children. Language and culture cannot make sense of human anguish, the article concludes, yet they are all we have to hold back the chaos. Mystery and uncertainty, as part of the human condition, must become part of our stories and part of our culture. (shrink)

Personal, creative writing as a process for reflection on patient care and socialization into medicine (“reflective writing”) has important potential uses in educating medical students and residents. Based on the authors’ experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of (...) certainty to reclaiming a personal voice; identifying the patient’s voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one’s writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others’ writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being – are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality. (shrink)

Moving beyond both realist and anti-realist accounts of mathematics, Shapiro articulates a "structuralist" approach, arguing that the subject matter of a mathematical theory is not a fixed domain of numbers that exist independent of each other, but rather is the natural structure, the pattern common to any system of objects that has an initial object and successor relation satisfying the induction principle.

How is feminist metaphysics possible? -- In defense of experience -- Foucault and experience -- The problem of language -- A phenomenology of birth -- A phenomenology of gender -- The neoliberal subject of feminism -- Feminism and neoliberal governmentality -- Feminist politics of inheritance.

The revisionary approach to semantic paradox is commonly thought to have a somewhat uncomfortable corollary, viz. that, on pain of triviality, we cannot affirm that all valid arguments preserve truth (Beall2007, Beall2009, Field2008, Field2009). We show that the standard arguments for this conclusion all break down once (i) the structural rule of contraction is restricted and (ii) how the premises can be aggregated---so that they can be said to jointly entail a given conclusion---is appropriately understood. In addition, we briefly rehearse (...) some reasons for restricting structural contraction. (shrink)

Embodied cognition is one of the foremost areas of study and research in philosophy of mind, philosophy of psychology and cognitive science. The Routledge Handbook of Embodied Cognition is an outstanding guide and reference source to the key philosophers, topics and debates in this exciting subject and essential reading for any student and scholar of philosophy of mind and cognitive science. Comprising over thirty chapters by a team of international contributors, the Handbook is divided into six parts: Historical Underpinnings Perspectives (...) on Embodied Cognition Applied Embodied Cognition: Perception, Language and Reasoning Applied Embodied Cognition: Social and Moral Cognition and Emotion Applied Embodied Cognition: Memory, Attention and Group Cognition Meta-Topics. The early chapters of the Handbook cover empirical and philosophical foundations of embodied cognition, focusing on Gibsonian, phenomenological and cybernetic approaches. Subsequent chapters cover additional, important themes common to work in embodied cognition, incuding embedded , extended and enactive cognition as well as chapters on embodied cognition and empirical research in perception, language, reasoning, social and moral cognition, emotion, consciousness, memory and learning and development. (shrink)

Typically, a logic consists of a formal or informal language together with a deductive system and/or a model-theoretic semantics. The language is, or corresponds to, a part of a natural language like English or Greek. The deductive system is to capture, codify, or simply record which inferences are correct for the given language, and the semantics is to capture, codify, or record the meanings, or truth-conditions, or possible truth conditions, for at least part of the language.

In The Phenomenology of Religious Belief, the renowned philosopher Michael J. Shapiro investigates how art - and in particular literature and film - can impact upon both traditional interpretations and critical studies of religious beliefs and experiences. In doing so, he examines the work of prolific and award-winning writers such as Toni Morrison, Philip K. Dick and Robert Coover. By placing their work in conjunction with critical analyses of media by the likes of Ingmar Bergman and Pier Paolo Pasolini (...) and combining it with the work of groundbreaking thinkers such as George Canguilhem, Giorgio Agamben and Slavoj Žižek, Shapiro takes a truly interdisciplinary approach to the question of how life should be lived. His assessment of phenomenological subjectivity also leads him to question the nature of political theology and extend the criticism of Pauline theology. (shrink)

Camill Leberer (geb. 1953) gehört zu den profiliertesten deutschen Bildhauern seiner Generation. Das vorliegende Buch untersucht seine durch die Verwendung von Stahl und Glas ausgezeichneten Plastiken erstmals unter dem Aspekt der Immaterialität. Dazu werden Bezüge zur amerikanischen Light and Space Bewegung, zu amerikanischen wie deutschen Stahlkünstlern und zur Gruppe Zero erarbeitet. Unter anderem durch diese wird das ästhetische Prinzip Immaterialität im Werk Leberers anhand der Informationsästhetik Max Benses kunsthistorisch eingeordnet.

Holding life and death in their hands -- Is this for me? -- The intensive care unit. Personnel ; Rhythms ; Economics -- Actors. Patients ; Friends, family, and significant others ; Health care professionals -- Decisions. Informed consent ; Venues ; Affect ; Conflict -- Prognosis. Evidence ; Timing ; Mixed messages ; Negotiation ; Accuracy ; Prognostic framing -- Decision-making scripts. The legal script ; Cognitive scripts ; Conflicts of interest ; Law at the bedside -- Improvisation: decisions (...) in the real world. The patient should decide ; Reprising patient instructions ; Standing in the patient's shoes ; Beneficence ; It's God's decision ; What we want ; Denial, opting out -- Making a difference? The role of physicians ; Opting for a trajectory ; Outcomes ; I thought the law would take care of this ; Does any of this matter? -- The end. Implications ; Before it's too late ; When it's too late ; When "this" happens to me. (shrink)

ABSTRACT Michael Rescorla has argued that it makes sense to compute directly with numbers, and he faulted Turing for not giving an analysis of number-theoretic computability. However, in line with a later paper of his, it only makes sense to compute directly with syntactic entities, such as strings on a given alphabet. Computing with numbers goes via notation. This raises broader issues involving de re propositional attitudes towards numbers and other non-syntactic abstract entities.

In view of current problem areas, especially with regard to the destruction of nature, the question arises of how we can deal productively with the abysmal flip side of the history of emancipation in Central European thought. The question arises of how a concept of subjectivity, in which the subject maintains responsible sovereignty, is to be thought of without closing itself to its counterpart or negating or even destroying it through its objectifying access. In this book, the author shows that (...) as early as in the work of F.W.J. Schelling, there is an approach that takes this problem into account. (shrink)

What does it mean to act politically? This paper contributes an answer to this question by looking at the role that necessity plays in the political theory of Carl Schmitt. It argues that necessity, whether in the form of existential danger or absolute values, does not affect the sovereign decision, which must be free from normative determinations if it is to be a decision in Schmitt’s sense at all. The paper then provides a reading of Schmitt in line with Weber’s (...) ethics of responsibility, according to which the political actor decides not arbitrarily and irresponsibly, but actively assumes responsibility for the decisions he takes. (shrink)

Ontic structural realists hold that structure is all there is, or at least all there is fundamentally. This thesis has proved to be puzzling: What exactly does it say about the relationship between objects and structures? In this article, I look at different ways of articulating ontic structural realism in terms of the relation between structures and objects. I show that objects cannot be reduced to structure, and argue that ontological dependence cannot be used to establish strong forms of structural (...) realism. At the end, I show how a weaker, but controversial, form of structural realism can be articulated on the basis of ontological dependence. (shrink)

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses’ and nursing students’ moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses’ and nursing students’ moral competence, a (...) literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare. (shrink)

Regulatory Competition -- The Economic Case for Regulatory Competition -- Regulatory Competition and Utilitarianism -- Political Values under Competitive Pressure -- Law as a Contested Commodity -- Conclusion.

_A spirited defense of the Enlightenment against assaults from both the left and the right that explains its urgent implications for our contemporary politics_ Ours is an age when optimism about politics is hard to come by. Ian Shapiro explains why this is so and, without minimizing the daunting challenges, spells out an appropriate response. Written in the indomitable spirit exemplified by Tom Paine, _Uncommon Sense_ is a rich source of insight and inspiration in dark political times. The Enlightenment (...) commitments to reason and science are under assault from the Postmodern Left and the Authoritarian Right. Shapiro explains why the attacks are misguided and politically destructive. He agrees with the critics that there are no universal principles of justice that transcend political battles and no fair, impartial rules to govern the distribution of income, wealth, rights, or opportunities. But abandoning the search for them as futile does not mean junking the Enlightenment’s core political goal: to deploy the tools of reason and science to fight domination. Democracy is essential to vindicating that goal, yet citizens in many democracies are profoundly alienated and many democracies are in danger of failing. Shapiro explains what has gone wrong, debunks ill-considered remedies, and spells out better ones—deepening and extending his previous writing on political theory and democratic politics. (shrink)

In 'How Should We Aggregate Competing Claims', Alex Voorhoeve suggests accommodating intuitions about duties in rescue cases by combining aggregative and non-aggregative elements into one theory. In this paper, I discuss two problems Voorhoeve’s theory faces as a result of requiring a cyclic pattern of choice, and argue that his attempt to solve them does not succeed.

This chapter wades into the growing discussion surrounding embodied cognition and predictive processing. After surveying a recent debate between Jakob Hohwy and Andy Clark, it articulates two outstanding issues facing discussions of compatibility. It argues that headway on these issues can be made by drawing on the resources of philosophy of science.

In this paper I aim to answer two questions: Can spin be treated as a determinable? Can a treatment of spin as a determinable be used to understand quantum indeterminacy? In response to the first question I show that the relations among spin number, spin components and spin values cannot be captured by a single determination relation; instead we need to look at spin number and spin value separately. In response to the second question I discuss three ways in which (...) the determinables model might be modified to account for indeterminacy, and argue that none of them is fully successful in helping us to understand quantum indeterminacy. (shrink)

A consideration of how segments of Orthodox society rewrite the past by eliminating that which does not fit in with their contemporary world-view. This wide-ranging and original review of how this policy is applied in practice adds a new perspective to Jewish intellectual history and to the understanding of the contemporary Jewish world.

This philosophical game changer looks critically at the Golden Rule in the context of game theory to see where it works and where it doesn’t, when it is applicable and when it isn’t. It shows you why knowing the difference can offer you a powerful way to transform your life from one driven by fear to one driven by love.

A growing number of decision theorists have, in recent years, defended the view that rationality is permissive under risk: Different rational agents may be more or less risk-averse or risk-inclined. This can result in them making different choices under risk even if they value outcomes in exactly the same way. One pressing question that arises once we grant such permissiveness is what attitude to risk we should implement when choosing on behalf of other people. Are we permitted to implement any (...) of the rationally permissible risk attitudes, is there some specific risk attitude that is required when choosing for others, or are we required to defer to the risk attitudes of the people on whose behalf we are choosing? This article elaborates on this question, explains its wider practical and theoretical significance, provides an overview of existing answers, and explores how to go about providing a more systematic account of how to choose on behalf of others in risky contexts. (shrink)

In “Obligations of the Gift,” Lee argues that ethical thinking regarding return of genetic research results has been too narrowly focused on individual consent and participants’ “right to kn...

Realists about science tend to hold that our scientific theories aim for the truth, that our successful theories are at least partly true, and that the entities referred to by the theoretical terms of these theories exist. Antirealists about science deny one or more of these claims. A sizable minority of philosophers of science prefers not to take sides: they believe the realism debate to be fundamentally mistaken and seek to abstain from it altogether. In analogy with other realism debates (...) I will call these philosophers quietists. In the philosophy of science quietism often takes a somewhat peculiar form, which I will call naturalistic quietism. In this paper I will characterize Maddy’s Second Philosophy as a form of naturalistic quietism, and show what the costs for making it feasible are. (shrink)

The purpose of this article is to assess the prospects for a Scottish neo-logicist foundation for a set theory. We show how to reformulate a key aspect of our set theory as a neo-logicist abstraction principle. That puts the enterprise on the neo-logicist map, and allows us to assess its prospects, both as a mathematical theory in its own right and in terms of the foundational role that has been advertised for set theory. On the positive side, we show that (...) our abstraction based theory can be modified to yield much of ordinary mathematics, indeed everything needed to recapture all branches of mathematics short of set theory itself. However, our conclusions are mostly negative. The theory will fall far short of the power of ordinary Zermelo-Fraenkel set theory. It is consistent that our set theory has models that are relatively small, smaller than the first cardinal with an uncountable index. More important, there is a strong tension between the idea that the iterative hierarchy is somehow ineffable, or indefinitely extensible, and the neo-logicist theme of capturing mathematical theories with abstraction principles. (shrink)

This article argues that Lara Buchak’s risk-weighted expected utility (REU) theory fails to offer a true alternative to expected utility theory. Under commonly held assumptions about dynamic choice and the framing of decision problems, rational agents are guided by their attitudes to temporally extended courses of action. If so, REU theory makes approximately the same recommendations as expected utility theory. Being more permissive about dynamic choice or framing, however, undermines the theory’s claim to capturing a steady choice disposition in the (...) face of risk. I argue that this poses a challenge to alternatives to expected utility theory more generally. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of (...) the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

This article analyses Simone de Beauvoir’s understanding of temporality in the essays Pyrrhus and Cinéas (1944) and Ethics of Ambiguity (1947) and situates it in relation to the tradition of phenomenology with particular focus on the thought of Martin Heidegger. In Being and Time, Heidegger develops an “ek-static” description of time, a lived experience of time where the past, the future, and the present are united in the authentically grasped moment or Augenblick. The article demonstrates that this notion of temporality (...) is also present in Beauvoir’s essays, and it reinterprets her understanding of the concepts of future and repetition in light of this reading. The article suggests that Beauvoir makes a distinction between authentic and inauthentic attitudes towards the future. It is also suggested that Beauvoir’s accounts of women in terms of immanence or of a repetition of the present that underpins her analysis in The Second Sex should not be taken as ontological, but rather as descriptions of the ways in which time is experienced under oppression. (shrink)