BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

A variety of crucial and still most relevant ideas about nothingness or emptiness have gained profound philosophical prominence in the history and development of a number of South and East Asian traditions--including in Buddhism, Daoism, Neo-Confucianism, Hinduism, Korean philosophy, and the Japanese Kyoto School. These traditions share the insight that in order to explain both the great mysteries and mundane facts about our experience, ideas of "nothingness" must play a primary role. This collection of essays brings together the work of (...) twenty of the world's prominent scholars of Hindu, Buddhist, Daoist, Neo-Confucian, Japanese and Korean thought to illuminate fascinating philosophical conceptualizations of "nothingness" in both classical and modern Asian traditions. The unique collection offers new work from accomplished scholars and provides a coherent, panoramic view of the most significant ways that "nothingness" plays crucial roles in Asian philosophy. It includes both traditional and contemporary formulations, sometimes putting Asian traditions into dialogue with one another and sometimes with classical and modern Western thought. The result is a book of immense value for students and researchers in Asian and comparative philosophy. (shrink)

In the history of philosophy as well as in most recent discussions, empathy is held to be a key concept that enables a basic understanding of the other while at the same time acting as the foundation of our moral emotionality. In this paper I want to show why empathy is the wrong candidate for both of these tasks. If we understand empathy as projection, i.e. a process of imaginary self-transposition, we are bound to presuppose a fully established interpersonal sphere. (...) If we consider empathy as synonymous with compassion it is highly questionable if we ever reach the other person in his or her otherness. Max Scheler and other early phenomenologists offer very fruitful approaches to both problems without resorting to empathy. I will present some of their thoughts and focus especially on Scheler’s claim about the connection between the experience of the real other and the intentionality of compassion. (shrink)

Avec la précarisation des sociétés salariales se sont développées les économies non-marchandes et non-monétaires mais aussi des économies informelles et de survie. L'espace public apparaît alors fragmenté par des inégalités et des injustices là où les individus et les groupes se mobilisent pour l'accès à une « place » et aux biens moraux. Mais en même temps l'espace public contient des espaces intermédiaires où des résistances collectives au processus de précarisation salariale et la lutte pour la reconnaissance produisent des micro-organisations (...) sociales qui naissent de l'agencement, voire la superposition de formes économiques marchandes et non-marchandes liées à une économie solidaire.Growing precarity within wage-based societies has led to the advent of parallel economies that are neither mercantile nor money-based, as well as informal economies and economies of subsistance. The public sphere thus appears to be fractured by inequalities and injustices, given the mobilising of individuals and groups in the struggle for a "place" and access to moral goods. Yet at the same time, we can find intermediate spaces in the public sphere in which collective forms of resistance to the increasing precarity of wage-based existences and the struggle for recognition have led to the emergence of social micro-organisations borne of the coexistence or even interpenetration of market and non-market economic forms related to an economy of solidarity. (shrink)

La société chinoise aujourd’hui peut être définie comme produisant différentes formes de compressed modernities où se contractent et s’entrelacent des temporalités historiques, sociales, politiques, économiques, mais aussi individuelles et collectives. Nous introduisons ici la notion de temporalité « contractée » qui favorise la superposition, l’intensification et la multiplication de risques sociaux, économiques, écologiques et sanitaires. Temporalités et espaces s’agencent en Chine de manière flagrante dans la production de mobilités, migrations et circulations très intenses aujourd’hui. La conquête de soi apparaît comme (...) une question d’intensité liée à l’accélération des temporalités sociales et économiques objectives et subjectives ; se construit alors la figure d’un Individu compressé dans la société chinoise. Les temporalités collectives favorisent des micromobilisations où s’ouvrent des micro-arènes publiques et où se construit, en contexte autoritaire, de la démocratie « par le bas ». (shrink)

Editors’ Note: As a matter of policy, the editors believe that publishing several reviews of selected texts is a valuable exercise which will enable a cross-section of views to be aired.Copies of this report can be obtained from the Nuffield Council on Bioethics, 28 Bedford Square, London WC1B 3EG, U.K.. The report publishes the recommendation of a Working Party set up in January 1995. Following a wide public consultation, the Working Party prepared its report on xenotransplantation which has been endorsed (...) by the Nuffield Council on Bioethics. (shrink)

To find more information on Rowman & Littlefield titles, please visit us at www.rowmanlittlefield.com.

One obvious result of DNA exonerations has been the enactment of legislation regulating postconviction DNA testing. But the impact on our criminal justice system goes beyond formal statutory change. The DNA exonerations are changing attitudes towards the death penalty, are focusing attention on how forensic laboratories operate, and are leading to the stricter scrutiny of forensic science.

The existence and uniqueness of a maximum point for a continuous real—valued function on a metric space are investigated constructively. In particular, it is shown, in the spirit of reverse mathematics, that a natural unique existence theorem is equivalent to the fan theorem.

Susan Estrich, Real Rape Cambridge and London: Harvard University Press, 1987, 160 pp.

Despite unprecedented medical advancements and the near eradi­cation of many serious diseases, there are growing epidemics of preventable illness brought about in part by the overemphasis on individual autonomy and the neglect of obligations to others. Insofar as these diseases develop because of individual choice, this permissiveness hampers the moral analysis of growing epidemics like childhood obesity. While society has contributed to its rapid progression, childhood obesity finds its origins in lifestyle choices implemented at home. Consequently, parents have an unparalleled (...) duty to prevent and correct obesity and unhealthy lifestyles in their children. Failure to do so undoubtedly violates a parent’s duty and suggests medical neglect. However, our current understanding of medical neglect is too narrow to be applicable to chronic, preventable illnesses. Relevant principles of tort law may broaden our understanding of neglect to better reflect the nature of parental and societal liability in preventable illnesses. (shrink)

For decades Japan and the Federal Republic of Germany have gone to extraordinary lengths to cultivate as low a profile as possible on defense and national security policy matters. However, since the Gulf War, the Federal Republic has come under growing pressure from its allies to assume a greater international security role. Slowly, reluctantly it has acceded to these demands, albeit at the expense of considerable internal angst and turmoil. At the same time, German decision makers have sought to preserve (...) as much as possible the old approach to security policy. Consequently, the long-standing German norms eschewing the use of military force have been gradually displaced, although not wholly replaced, by norms of multilateralism. Rather than a dramatic break with the past, the Federal Republic's actions in Kosovo and Afghanistan can be seen as the culmination of a series of incremental steps that had begun a decade ago. (shrink)

Dini's theorem says that compactness of the domain, a metric space, ensures the uniform convergence of every simply convergent monotone sequence of real-valued continuous functions whose limit is continuous. By showing that Dini's theorem is equivalent to Brouwer's fan theorem for detachable bars, we provide Dini's theorem with a classification in the recently established constructive reverse mathematics propagated by Ishihara. As a complement, Dini's theorem is proved to be equivalent to the analogue of the fan theorem, weak König's lemma, in (...) the original classical setting of reverse mathematics started by Friedman and Simpson. (shrink)

En este trabajo defenderé la factibilidad de una ciencia jurídica trascendental de las críticas que Jan Sieckmann y Christoph Kletzer han hecho a su carácter constitutivo. Sieckmann argumenta que las propias premisas de la teoría pura del derecho desembocan en una disciplina sin objeto de estudio, mientras Kletzer sostiene que el acto constitutivo se da realmente en la aplicación del derecho. De mi defensa se deriva una exégesis de la relación entre filosofía del derecho, ciencia jurídica y derecho positivo conforme (...) al modelo kantiano de la conexión entre la crítica de la razón pura, la ciencia física y los fenómenos naturales. (shrink)

Die Fragen "woher kommen wir? Wohin gehen wir?" gehören zu den Fragen, die sich Menschen immer schon gestellt haben. Die Idee des Fortschritts und die feste Überzeugung der Möglichkeit einer besseren Zukunft gehören allen historischen Katastrophen zum Trotz zu den Grundpfeilern eines Denkens, das sich stets auch über seine Herkunft definiert hat: der Geschichtsphilosophie. Das neue Studienbuch erschließt das Thema mit innovativem Blick: Aus der Geschichte lernen? Und wenn ja - was?; die Geschichte des Nachdenkens über Geschichte von der Antike (...) bis zur Gegenwart: Augustinus, Joachim, Machiavelli, Hegel, Marx, Nietzsche; das Problem der Säkularisierung, die Herkunft und Wandlung von Ideen und Werten verstehen und beurteilen;affirmative oder kritische Genealogie, zyklische und teleologische Modelle der Geschichte; erkenntnistheoretische Grundlegung der Geschichtsschreibung, über die Unmöglichkeit, ohne philosophische Implikationen Geschichte zu denken und zu schreiben. (shrink)

Stephen J. Schulhofer, Unwanted Sex: The Culture of Intimidation and the Failure of Law Cambridge, MA: Harvard University Press, 1998, xii + 284 pp.

This article discusses the methodological challenges posed for psychological research on whiteness at the intersection between race and gender in Germany. Much of the current research in the social science field in Germany focuses on violent expressions of racism or Fremdenfeindlichkeit and represents a collective immunization against the knowledge about the history and the historicity of whiteness as a history of seizure. Such approaches are motivated by fear and uncertainty. The author takes this uncertainty not only as a starting point (...) for an investigation into the heavily veiled history of whiteness, but also as a method in itself. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Toward a Non-Cartesian Psychotherapeutic Framework: Radical Pragmatism as an AlternativeLouis S. Berger (bio)AbstractPostmodern criticism has identified important impoverishments that necessarily follow from the use of Cartesian frameworks. This criticism is reviewed and its implications for psychotherapy are explored in a psychoanalytic context. The ubiquitous presence of Cartesianism (equivalently, representationism) in psychoanalytic frameworks—even in some that are considered postmodern—is demonstrated and criticized. The postmodern convergence on praxis as a (...) desirable alternative to Cartesianism is reported, and its relevance for psychoanalysis is considered. The severe conceptual difficulties entailed in formulating such an alternative are discussed, as are those difficulties that would be encountered were psychoanalysis to attempt the shift from explanatory mental science to praxis. The principal psychoanalytic problematics explored are: the paradoxical relationships between theory and therapeutic technique; the therapeutic action; and validation of clinical practices. Initial, nontraditional suggestions for addressing these problems are offered.Keywordspsychoanalysis, therapeutic action, representation, state space, praxis, hermeneutics, Descartes, Heidegger, Wittgenstein“But the inability to bring one’s subject under conceptual control, fixing it propositionally, is not the end of thinking; on the contrary, it were better to say that the breakdown of concepts and the failure of words is an opening that takes us out of the realm where representation and calculation are all that matter to thinking.... [T]his is what happens in the Socratic dialogue where the negativity in which one ends up at a loss for words is at the same time that which sets thinking free.”Bruns 1989, 9“To evolve theory as though our methods and processes of study were essentially the same, or could be the same, as those of other sciences, or could be disregarded when it comes to theory, implies a view of reality that is no longer tenable, least of all in that ambiguous area which we call psychic reality. Nevertheless, all of us are still more or less captives of an erroneous understanding of objectivity and objective reality....”Loewald 1970, 45 [End Page 169]CartesianismCartesianism still underlies and dominates much of today’s thought. It is the label for a network of interrelated ideas and themes:the ontological duality of mind and body; the subjective individualism implicit in the ultimate appeal to direct personal verification; the method of universal doubt which was supposed to lead us to indubitable truths; the doctrine that language and signs are an external disguise for thought; the doctrine that vagueness is unreal and that the philosophic endeavor is one of knowing clearly and distinctly a completely determinate reality; and most fundamentally, the doctrine that we can break out of the miasma of our language or system of signs and have direct intuitive knowledge of objects. (Bernstein 1971, 5–6)[The Cartesian assumptions] constitute a picture of science and the world somewhat as follows: there is an external world which can in principle be exhaustively described in scientific language. The scientist, as both observer and language-user, can capture the external facts of the world in propositions that are true if they correspond to the facts and false if they do not. Science is ideally a linguistic system in which true propositions are in one-to-one relation to facts, including facts that are not directly observed because they involve hidden entities or properties, or past events or far distant events. These hidden events are described in theories, and theories can be inferred from observation, that is, the hidden explanatory mechanism of the world can be discovered from what is open to observation. Man as scientist is regarded as standing apart from the world and able to experiment and theorize about it objectively and dispassionately.(Hesse 1980, vii)Hesse goes on to say that “almost every assumption underlying this account has been subjected to damaging criticism,” a view echoed by others: “Most contemporary philosophers have been in revolt against the Cartesian framework” (Bernstein 1971, 5); “A rejection of the Cartesian view is a central theme for both of the giants of twentieth-century philosophy, Heidegger and Wittgenstein” (Sass 1992, 444n 77); and “The notion of alternative conceptual frameworks has been a commonplace of our culture since Hegel” (Rorty 1982, 3).These criticisms arise... (shrink)

Working memory, an important posit in cognitive science, allows one to temporarily store and manipulate information in the service of ongoing tasks. Working memory has been traditionally classified as an explicit memory system – that is, as operating on and maintaining only consciously perceived information. Recently, however, several studies have questioned this assumption, purporting to provide evidence for unconscious working memory. In this paper, we focus on visual working memory and critically examine these studies as well as studies of unconscious (...) perception that seem to provide indirect evidence for unconscious working memory. Our analysis indicates that current evidence does not support an unconscious working memory store, though we offer independent reasons to think that working memory may operate on unconsciously perceived information. (shrink)

Les sciences sociales chinoises sont largement ignorées du monde occidental dans un moment où les savoirs scientifiques circulent le long de nouveaux axes épistémologiques en contexte globalisé. La pensée occidentale s’ouvre à la pensée chinoise, de nouveaux horizons apparaissent dans un contexte de globalisation culturelle où il est impossible d’ignorer la Chine continentale. Les sciences sociales en Chine ont été reconstruites depuis 1979 en rendant compte de vraies spécificités liées à une...

This paper proposes a reading of Kelsen’s basic norm based on Kant’s regulative ideas. I begin by exposing Kant’s conception of the principles of reason. Then I criticize an interpretation of the basic norm along the same lines made by Stanley Paulson. Thirdly I analyze two theses from Hermann Cohen that influenced Kelsen greatly and reinforce my stance on the basic norm. Lastly, I explain how the Kelsenian tenet that the basic norm is the transcendental grounding of the normativity of (...) law can be comprehended based on the role the ideas of reason play in the systematization of knowledge. (shrink)

El propósito central de este ensayo es proponer que entre la democracia y el liberalismo existe una relación pragmática. Para ello primero rechazaré la tesis de que este nexo es de tipo lógico-conceptual, así como la idea de que se trata meramente de un nexo contingente, para lo cual retomaré las concepciones de John Stuart Mill y Hans Kelsen. En suma, lo que sostendré es que los modelos democráticos, en tanto métodos de creación normativa, no implican ni las libertades políticas (...) ni las económicas, aunque sí hay lo que llamaré una relación pragmática entre la democracia y el liberalismo, por lo que ser demócrata y antiliberal, o liberal y no demócrata, es una contradicción performativa. (shrink)

El propósito central de este ensayo es mostrar que el debate actual entre el positivismo excluyente y el incluyente se alimenta de, al menos, tres ideas equivocadas acerca de la relación entre el lenguaje jurídico y el moral, la vinculación entre la ciencia y la práctica del derecho y la concepción de lo que es una ciencia normativa. Expuestos estos errores, esbozo una propuesta para entender estas relaciones, fundada en la concepción neokantiana-kelseniana de la ciencia jurídica. De esta doctrina derivo (...) que el lenguaje jurídico y la ciencia del derecho son, respectivamente, el fundamento conceptual del discurso moral y de la práctica jurídica. Asimismo, rechazo la definición que ve en el carácter normativo de la ciencia jurídica la presencia de juicios de valor. En consecuencia, el debate entre el positivismo incluyente y el excluyente debe ser abandonado o, al menos, reformulado. (shrink)

Agent-based models have played a prominent role in recent debates about the merits of democracy. In particular, the formal model of Lu Hong and Scott Page and the associated “diversity trumps ability” result has typically been seen to support the epistemic virtues of democracy over epistocracy (i.e., governance by experts). In this paper we first identify the modeling choices embodied in the original formal model and then critique the application of the Hong-Page results to philosophical debates on the relative merits (...) of democracy. In particular we argue that the “best-performing agents” in Hong-Page model should not be interpreted as experts. We next explore a closely related model in which best-performing agents are more plausibly seen as experts and show that the diversity trumps ability result fails to hold. However, with changes in other parameters (such as the deliberation dynamic) the diversity trumps ability result is restored. The sensitivity of this result to parameter choices illustrates the complexity of the link between formal modeling and more general philosophical claims; we use this debate as a platform for a more general discussion of when and how agent-based models can contribute to philosophical discussions. (shrink)

It is to an over-all situation based upon the complex play of political, social, economic and scientific factors, along with technological and mass media factors unique to our own era, that we owe the general trend toward multi-pluri-inter-trans-disciplinary questions so generally prevalent in our world today.

For thousands of years communication has functioned principally by means of linguistic and iconic messages. In the first case linguistic symbols serve as intermediaries; in the second, images or, more broadly, representations. In order to be transmitted, linguistic and/or iconic symbols need to be re-produced, re-presented, vocally, through writing, painting, sculpture or any other means of re-production. But re-production requires a space that, through use of an appropriate material, serves as its medium; forms to occupy it; rules to control it, (...) and a certain stability. In other words representation is impossible without a certain fixity of the message that alone can ensure its duration, whether short or long being unimportant, but which it needs precisely in order to function as a message. (shrink)

All societies are made up of members who have a certain number of things in common, by virtue of which they understand, identify and communicate with each other, on the one hand, and establish differences with members of other societies on the other. Among the most important of these things is language.In this regard, let us recall two examples raised by Ferdinand de Saussure. The first: “Language is both a social product of the faculty of speech and an ensemble of (...) necessary conventions adopted by the social body to allow for the exercise of this faculty in each individual.” The second: “Speech, distinct from language, is on the contrary an individual act of intelligence and will … by which the speaking subject uses the code of language to express his personal thought.”. (shrink)

A riddle or a joke? I regret having made light of both myself and the reader. However, the concept of complexity has been explored with such intensity and pedantry, has been analyzed from so many points of view – the mathematical, linguistic, physical, chemical, political, psychological, sociological, physiological, algorithmic, logical, religious, and metaphysical – that nothing, not even the title of this piece, can escape it. Indeed the situation has reached the point where we grow misty-eyed over the very thought (...) of the discrete charms of yesterday's simplicity. Sometimes we dream that complexity itself, after having given us so much, muses – now that its task is fulfilled – of flying up miraculously into the sky, like the Virgin Mother (the Assumption); or ourselves wish to experience – for those spirits who prefer to keep their feet on the ground(!) – the “dissolution” with which entropy begins. Isn't it true that certain words, marked by the spirit of their age, are themselves in fact carried away by the spirit of the age? (shrink)

Face à la question des modes de distribution inégalitaire de l’honneur social et de la lutte pour la reconnaissance chez des populations objets de mépris social, le « savoir-être avec » l’Autre est devenu pour le sociologue un enjeu scientifique, méthodologique et épistémologique important. Est proposée ici une ethnographie de la reconnaissance où l’Autre est regardé et reconnu avec son expérience, sa compétence, et son identité plurielle, fluctuante, réversible, inscrit dans une diversité de mondes sociaux organisée par des processus culturels (...) producteurs de hiérarchies et d’inégalités.When faced with unequal forms of distribution of social honour and with the struggle for recognition among populations subject to social contempt, knowing how to be with the Other has become a major methodological and epistemological scientific issue. Here, we are proposing an ethnography of recognition, in which the Other is regarded and recognized with his experience, his competence, and his fluctuating, reversible and varied identity, anchored in a diversity of social worlds organized on the basis of structural processes which produce hierarchy and inequalities. (shrink)

This book reformulates the sociological subdiscipline known as the sociology of knowledge. Knowledge is presented as more than ideology, including as well false consciousness, propaganda, science and art.