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The COVID-19 pandemic has highlighted the difficult task of balancing access to misinformation with respect for patient decision-making. Due to its innate antagonism, the paradigm of “physician paternalism” versus “patient autonomy” may not adequately capture the clinical relationship. The authors hypothesized that most patients would, in fact, prefer significant physician input as opposed to unopinionated information when making medical decisions. There is a lack of empirical data corroborating this in the United States. To that end, a survey was distributed to (...) 650 individuals through Amazon Mechanical Turk, of which 499 responses met pre-determined quality criteria. Most respondents believed their doctor's insight would be better than their own if injured or gravely ill. When asked to affirm preferences separately, a significantly higher proportion of respondents preferred guidance from their doctor when making medical decisions compared to being presented with unopinionated information ( p < 0.001). Encouragingly, 93.1% believed that the doctor's primary goal was their health. When asked directly to compare physician guidance to unopinionated information, 69.1% respondents stated they would prefer physician guidance. We found a consistent association between educational/economic background and affirmative responses ( p < 0.001), suggesting particular attention should be paid to patients that are disadvantaged with respect to these demographic factors. The belief in a shared goal, and a consistent preference for physician input, suggests that patients endorse a more collaborative view of the clinical dynamic than is suggested by the paternalism-autonomy paradigm. This pilot study suggests physicians should not be afraid to communicate conviction with regard to treatment decisions. (shrink)

Molecular Revolution in BrazilFélix Guattari and Suely Rolniktranslated by Karel Clapshow and Brian HolmesYes, I believe that there is a multiple people, a people of mutants, a people of potentialities that appears and disappears, that is embodied in social, literary, and musical events.... I think that we're in a period of productivity, proliferation, creation, utterly fabulous revolutions from the viewpoint of this emergence of a people. That's molecular revolution: it isn't a slogan or a program, it's something that I (...) feel, that I live....--from Molecular Revolution in BrazilFollowing Brazil's first democratic election after two decades of military dictatorship, French philosopher Félix Guattari traveled through Brazil in 1982 with Brazilian psychoanalyst Suely Rolnik and discovered an exciting, new political vitality. In the infancy of its new republic, Brazil was moving against traditional hierarchies of control and totalitarian regimes and founding a revolution of ideas and politics. Molecular Revolution in Brazil documents the conversations, discussions, and debates that arose during the trip, including a dialogue between Guattari and Brazil's future President Luis Ignacia Lula da Silva, then a young gubernatorial candidate. Through these exchanges, Guattari cuts through to the shadowy practices of globalization gone awry and boldly charts a revolution in practice.Assembled and edited by Rolnik, Molecular Revolution in Brazil is organized thematically; aphoristic at times, it presents a lesser-known, more overtly political aspect of Guattari's work. Originally published in Brazil in 1986 as Micropolitica: Cartografias do desejo, the book became a crucial reference for political movements in Brazil in the 1980s and 1990s. It now provides English-speaking readers with an invaluable picture of the radical thought and optimism that lies at the root of Lula's Brazil. Félix Guattari, post-'68 French psychoanalyst and philosopher, is the author of Anti-Oedipus, The Anti-Oedipus Papers, 2006), and other books. Semiotext has published the first two volumes of his complete essays, Chaosophy and Soft Subversions, and will publish the final volume, Chaos and Complexity, in 2008. Suely Rolnik is a psychoanalyst, cultural critic, and curator who lives and works in São Paulo, Brazil. She was a close collaborator of Guattari during her exile in Paris from the military dictatorship in Brazil. (shrink)

Public debate on acceptable farm animal husbandry suffers from a confusion of tongues. To clarify positions of various stakeholder groups in their joint search for acceptable solutions, the concept of animal welfare was split up into three notions: no suffering, respect for intrinsic value, and non-appalling appearance of animals. This strategy was based on the hypothesis that multi-stakeholder solutions should be based on shared values rather than on compromises. The usefulness of such an artificial value distinction strategy was tested in (...) a small series of experiments. The results demonstrate that the chosen concept to distinguish between values is effective in a stakeholder context. Farmers’ views on doing good to animals appeared to be largely based on their value to prevent suffering and predominantly focused on the provision of regular care. Their priority for this value is clearly shared with other stakeholders, providing a basis for joint solutions. The concept of intrinsic value does not play a discernable role in farmers’ considerations. Based on the varying views on welfare, it can be inferred that there is a gradual rather than a principal difference between government legislation and farmers’ values, whereas public perception and acceptance of farm practices remains complicated. Distinction between value groups and focusing on a selected notion (such as no suffering) proved to be effective in bringing representatives of stakeholder groups together, but is unlikely to bridge the emotional gap between commercial farm practices and public ideals. (shrink)

Dostoevsky wrote that love in action is a harsh and terrible thing compared to love in dreams. That reality is particularly evident in medicine, where there is an almost universal, involuntary participation of physicians and other healthcare workers in the suffering of their patients. This paper explores this phenomenon through the paradigm of ‘mystery’ as explained by the French existentialist philosopher Gabriel Marcel. A mystery is different from a problem in the sense that the former requires the active immersion of (...) the person involved in order to be truly experienced. It is a ‘meta-problem’ that cannot be analyzed objectively and separately from the person that it affects, without changing the nature of the thing experienced. The authors contend that the human suffering encountered in medicine is one such phenomenon, and the paper draws on illustrations of this concept in art and literature. Awareness of the subtle but important difference between mystery and problem may help physicians better understand their personal entanglement with the suffering of patients. (shrink)

This paper provides a finer analysis of the well-known form of the Local Deduction Theorem in contraction-free logics . An infinite hierarchy of its natural strengthenings is introduced and studied. The main results are the separation of its initial four members and the subsequent collapse of the hierarchy.

En lisant la République et le Timée de Platon, ce livre propose une enquête sur les deux formes de temporalité irréductibles (celle de la cité armée, celle de l'âme immortelle) pour éclairer la question principale, celle de la nature et de la structure de l'âme, de la cité et du cosmos.

Intentionally or not, our clinical practice is informed by our philosophical premises. A subtle misunderstanding can have frequent, though insidious, implications in day-to-day clinical encounters....

In his paper "What Metaphors Mean", Donald Davidson attacks various theories of the metaphorical meaning. His radical thesis is that the metaphor has except the literal meaning no other (metaphorical or secondary) meaning. He refuses primarily the idea that the metaphor is some sort of communication-the speaker puts a hidden message in it and the recipient have to decode it. Davidson supported this negative attitude with a number of more or less conclusive arguments. I would like to discuss some of (...) them in this essay. My interpretation of Davidson's argumentation can be summed up as that the idea of the metaphorical meaning is not nonsensical, but it is unsuitable for explaining the intricate role of metaphors in our language. A positive theory of metaphor was only suggested by Davidson, but not properly elaborated. This was a task of his followers, in the first place of Richard Rorty. He emphasized, however, the causal character of a metaphorical effect, which radicalizes Davidson's account. As opposed to Rorty, Davidson shared with his predecessors an opinion that in a metaphor one thing is seen as another thing. None of the authors was able to explain this metaphorical definition of the metaphor. (shrink)