Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the (...) vagueness of unexplicit interrelations between medicine''s stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as Hiatus theoreticus in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine. (shrink)

It is widely maintained that a clinical trial is ethical only if some form of equipoise between the treatments being compared obtains. To be in equipoise between two treatments A and B is to be cognitively indifferent between the statement ‘A is strictly more effective than B’ and its negation. It is natural to claim that equipoise regarding A and B is necessary for randomised assignment to treatments A and B to be beneficent and non‐maleficent and is sufficient for (...) such an assignment to be fair. Cashing this out precisely is difficult, and various forms of equipoise have been discussed which consider whose equipoise is relevant to the decision. This is to make judgement of equipoise something to be managed socially, while its prima facie significance is supposedly cognitive. Recent reconstructions of equipoise‐like concepts in epistemology give clues about how to understand equipoise cognitively. In this paper I examine some of this work and discuss how successful it has been. I suggest that while this work is promising, it still has far to go, and that while equipoise remains the best theory we have of the cognitive justification for clinical trials, it is nonetheless incoherent. (shrink)

The traditional medical epistemology, resting on a biomedical paradigmatic monopoly, fails to display an adequate representation of medical knowledge. Clinical knowledge, including the complexities of human interaction, is not available for inquiry by means of biomedical approaches, and consequently is denied legitimacy within a scientific context. A gap results between medical research and clinical practice. Theories of knowledge, especially the concept of tacit knowing, seem suitable for description and discussion of clinical knowledge, commonly (...) denoted the art of medicine. A metaposition allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied. The consequences of such approaches are discussed. (shrink)

ABSTRACT Accurate self‐administration of antiretroviral medication therapy for HIV/aids is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences (...) on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/aids as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals’ medication‐taking behaviour, speaks to the inherent power inequities in the patient‐provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals’ situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidimensional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient‐centred interventions. (shrink)

The article summarizes the theoretical and methodological knowledge about ecotourism as one of the viable types of tourism in the postmodern era, clarifies the patterns of its formation and development, a variety of approaches to its interpretation, interaction with other types of tourism, features of motivation and management in ecotourism. On the basis of the generalized data a number of perspective educational conditions is modeled: the orientation of the maintenance of pedagogical education on formation of steady positive motivation; (...) updating the content of professional training; availability of educational and methodical support; interrelation of competence, system and personal-activity approaches. Diagnostic methods relevant for postmodern education are selected: methods of diagnosing students' learning motivation; methods of diagnosis of value orientations in career; tests to determine the levels of formation of the components of professional competence. It is proved that the professional training of teachers who are able to use ecological tourism in their professional activities at a high level is one of the important conditions for increasing the interest of children and young people in physical education, tourism and sports, ensuring the necessary physical activity, developing, maintaining and strengthening their health, adaptation to the flexible postmodern society. (shrink)

KANT ARGUES AT GREAT LENGTH in the Critique of Pure Reason that the existence of God cannot be demonstrated by means of theoretical reason. For after dividing all traditional theistic proofs into three different kinds—the ontological, the cosmological, and the physico-theological—Kant argues first that the cosmological and physico-theological implicitly assume the ontological argument and then that the ontological argument is necessarily fallacious. By restricting knowledge in this manner Kant notoriously makes room for faith, that is, in this case, (...) for a practical proof of the existence of God, which he develops in the Critique of Practical Reason. Kant’s reasons for rejecting theoretical proofs of the existence of God have received considerable attention. In particular, Kant’s objection to the ontological argument, namely that existence is not a real predicate, still seems relevant in contemporary philosophy of religion. What has not received much attention, however, is the relationship between Kant’s rejection of theistic proofs in his critical period and his views on the matter in his pre-critical period. For throughout his pre-critical period, but especially in his The Only Possible Argument in Support of a Demonstration of the Existence of God, Kant believes that there is a theoretical proof of the existence of God. One would naturally expect Kant’s criticisms of theistic proofs as developed in the “ideal of pure reason” to apply in straightforward ways to his earlier attempts at a theistic proof. However, Kant rejects the three traditional arguments in The Only Possible Argument just as he does in the first Critique. Further, his reason for rejecting the ontological argument in particular is identical to the one presented in the first Critique: “Existence is not a predicate or a determination of a thing.” Accordingly, Kant understood himself to be developing a theistic proof in The Only Possible Argument that is distinct from the three traditional arguments and is also not subject to the objections he raises against them. Given that Kant rejects all theoretical proofs of God’s existence in his critical period and given that he did not take his critical objections to the traditional proofs to apply to the theistic proof developed in The Only Possible Argument, what is his justification for rejecting his pre-critical argument for God’s existence? (shrink)

Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical (...) decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

Volume 20, Issue 2, February 2020, Page 27-30.

Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's (...) theory of tacit knowing is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical (...) perspectives that foster a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the (...) nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity. (shrink)

The relation between biomedical knowledge and clinicalknowledge is discussed by comparing their respectivestructures. The knowledge of a disease as a biologicalphenomenon is constructed by the interaction of factsand theories from the main biomedical disciplines:epidemiology, diagnostics, clinical trial, therapydevelopment and pathogenesis. Although these facts andtheories are based on probabilities andextrapolations, the interaction provides a reliableand coherent structure, comparable to a Kuhnianparadigma. In the structure of clinical knowledge,i.e. knowledge of the patient with the disease, notonly biomedical (...) knowledge contributes to the structurebut also economic and social relations, ethics andpersonal experience. However, the interaction betweeneach of the participating ``knowledges'' in clinicalknowledge is not based on mutual dependency andaccumulation of different arguments from each, as inbiomedical knowledge, but on competition and partialexclusion. Therefore, the structure of biomedicalknowledge is different from that of clinicalknowledge. This difference is used as the basis for adiscussion in which the place of technology,evidence-based medicine and the gap between scientificand clinical knowledge are evaluated. (shrink)

Taking perceptual experience to consist in a relation of acquaintance with the sensible qualities, I argue that the state of being acquainted with a sensible quality is intrinsically a form of knowledge, and not merely a means to more familiar kinds of knowledge, such as propositional or dispositional knowledge. We should accept the epistemic claim for its explanatory power and theoretical usefulness. That acquaintance is knowledge best explains the intuitive epistemic appeal of ‘Edenic’ counterfactuals involving (...) unmediated perceptual contact with reality (cf. Chalmers, in: Gendler, Hawthorne (eds) Perceptual experience, Oxford University Press, 2006). It explains the elusiveness of knowledge gained through new acquaintances. It coheres with the knowledge-like functional role of acquaintance in the special context of evaluative beliefs and evaluative reasoning, where the objects of acquaintance serve as evidence and inferential basis. And, finally, taking acquaintance to be knowledge is theoretically fruitful: it helps vindicate claims about the relationship between knowledge and concern for others we already find intuitive or outright accept. After developing a novel case for the epistemic claim, I respond to two familiar objections against it: namely, (1) that there are no pre-propositional, pre-conceptual cases of perceptual experience that remain epistemically relevant (Sellars in Empiricism and the philosophy of mind, Routledge, 1968, McDowell, in: Lindgard (ed) John McDowell: Experience, norm, and nature, Blackwell, 2008); and (2) that the category of knowledge appears gerrymandered once we add ‘object’ knowledge to the epistemological mix (Farkas, in: Knowles, Raleigh (eds), Acquaintance: new essays, Oxford University Press, 2019). (shrink)

Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is (...) demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine. (shrink)

The purpose is to identify common and distinctive features of concepts and methodology of the problem of subject within different discourses, implicitly or explicitly relevant to the definition of "clinical" mode of human existence. The research methodology combines techniques of discourse analysis and basic principles of historical and philosophical studies. Originality of the research lies in definition of the clinical philosophical discourse as a special communicative process, where utterances not only focus on disease syndromes, and reveal phenomenology of (...) inner experience of a pathological self, but also structure a certain type of sociality. Clinical discourse represents the space where the patient is treated not as a subject but as an object of disease. Ontology of clinical discourse prevails over ontology of disease, since its structures determine the notion of disease as such. Categorization of the disease, the idea of disease as a phenomenon subdued to professional authority leads to the idea of the need for patient’s isolation from the natural environment and removing him to special social institutions. The clinicist doctrines share the intention to reduce the patient’s self to its bodily dimension, while ignoring social determinants of psychological deviations. Conclusions of the study are summarized in the following positions: the current clinical discourse is based on the positivist-biological trend in humanitarian knowledge and it is the basis for the production and reproduction of medical and pharmaceutical repressive ideology; criticism of philosophical clinical discourse opens the possibility of overcoming the dominance of purely clinicist discourse; such a transformation is possible only after a paradigm shift in understanding the category of subject. (shrink)

This paper is a companion piece to my earlier paper “Fallibilism and Concessive Knowledge Attributions”. There are two intuitive charges against fallibilism. One is that it countenances the truth (and presumably acceptability) of utterances of sentences such as “I know that Bush is a Republican, though it might be that he is not a Republican”. The second is that it countenances the truth (and presumably acceptability) of utterances of sentences such as “I know that Bush is a Republican, even (...) though I’m not certain that he is”, or “I know that Bush it a Republican, even though it isn’t certain that he is.” In “Fallibilism and Concessive Knowledge Attributions”, I argue that fallibilism in epistemology does not countenance the truth of utterances of sentences such as “I know that Bush is a Republican, though it might be that he is not a Republican”. In this paper, I argue that there are independent reasons for thinking that utterances of sentences such as “I know that Bush is a Republican, though I’m not certain that he is” and “I know that Bush is a Republican, though it’s not certain that he is” are unassertible. More specifically, I argue that these are simply instances of Moore’s Paradox, such as “Dogs bark, but I don’t know that they do.” The right account of Moore’s Paradox does not involve the falsehood of the semantic content of the relevant utterances, but rather their pragmatic unacceptability. So the anti-fallibilist intuitions turn out to have pragmatic, rather than semantic import, and therefore do not tell against the truth of fallibilism. Fallibilism in epistemology is often thought to be theoretically desirable, but intuitively problematic. My purpose with these two papers is to show that fallibilism is not intuitively problematic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Chaos and Clinical TheoryDouglas W. Heinrichs (bio)In considering the specific issues raised by these three very thoughtful commentaries, it is helpful to reflect on the status of a theory or model for a specifically clinical discipline—what is it trying to accomplish and how might it proceed to do so? Kellert (2005) sees my proposal in terms of "borrowed knowledge"—the metaphorical application of a theory established in (...) one field of inquiry to another field—and views my application of chaos theory as a "nonliteral use of knowledge from the natural sciences" (p. 239). He likens it to attempts to explore consequences of relativity theory or quantum mechanics for areas other than those for which they were developed. He notes the rhetorical functions—including appeal to the disciplinary prestige of natural science—of such metaphorical borrowings.Although clearly there are significant metaphorical aspects at work here, there are at least two factors that distinguish this model from, say, the metaphorical application of quantum mechanics to a field other than subatomic physics. First, quantum mechanics purports to say something specific about the behavior of the subatomic world. Its development is wed to that specific content area. On the other hand, nonlinear dynamics, including chaos theory, is a formal mathematical model intending to characterize the behavior of any system of elements that possess certain formal relational properties. It does not start out as field or discipline specific. In fact it is not uniquely tied to the natural sciences at all, beyond the fact that it may be easier to obtain the sort of detailed repeated measures needed to demonstrate chaotic behavior in physical systems. So it is not just a question of whether chaos theory is a useful intuitive device for thinking freshly about clinical psychiatry. Rather, it is the quite literal and nonmetaphorical question as to whether some of the observable aspects of persons that are relevant to their psychiatric care behave chaotically, and if so what are the implications.Now it is quite true that direct, mathematically rigorous demonstrations of chaos in clinically relevant data sets is currently limited. In fact, one hoped for consequence of presenting this model is to encourage just such studies, and I suggest several promising directions for doing so. However, there are good reasons for thinking the presence of such chaotic behavior to be likely, and this relates to the notion of a clinical theory.One of the consequences of what Globus (2005) calls "triumphalist biological psychiatry" (p. 229) is the frequent assumption that the model or paradigm of psychiatry—an applied clinical practice, a techne—is synonymous with the paradigm of neuroscience—a basic science or episteme. This is clearly not so for many reasons, including the fact that the former has to incorporate the comprehensive treatment of discrete individuals in a way that the latter does not. Yet the respective theories are related more than metaphorically. [End Page 243] The paradigms of neuroscience and those of other relevant basic sciences, such as psychology, substantially inform the clinical paradigm and the clinical model must be at least compatible with those of the relevant basic sciences. Thus, it is reasonable to assume that if chaotic processes are demonstrable in the nervous system, for which significant evidence already exists, there is good reason to expect them to be reflected in clinically relevant domains. The clinical paradigm should make room for it and its consequences, rather than thinking within an outmoded neuroscience model that makes no room for the implications of nonlinear dynamics. And when this generates a picture more compatible than the old model with our usual sense of what it is to be human, the odds that we are on to something is further enhanced. Of course until such time that enough clinical research based on this model is completed, considerable speculation—indeed aided by metaphorical devices—is involved in generating a concrete sense of how the model would be applied to specific clinical problems, such as the treatment of depressed persons.One clear task of the clinical paradigm is the methodologic integration of interventions growing out of different informing basic sciences. Because chaotic modeling can be applied across various content domains and... (shrink)

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM (...) approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted (...) a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse–patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge. (shrink)

A theoretical term gets its meaning from a set of meaning-constitutive or 'analytic' sentences of the relevant theory. The meanings of theoretical terms may change when the theories change. After a discussion of Kant and Frege, I propose a broadly Quinean view of analyticity, without adopting Quine's meaning skepticism. A sentence of a given theory in a certain language is called analytic if revising the theory so that this sentence is lost entails the abandonment of the given linguistic (...) (alternatively, of the given theoretical) framework. This solution to the problem of defining analyticity is rooted in intuitive judgements of the members of a linguistic community about the identity of languages or theories. (shrink)

Adam Carter has recently presented a novel puzzle about extended knowledge – i.e. knowledge that results from extended cognitive processes. He argues that allowing for this kind of knowledge on the face of it entails that there could be instances of knowledge that are simply ‘engineered’ into the subject. The problem is that such engineered knowledge does not look genuine given that it results from processes that bypass the cognitive agency of the subject. Carter’s solution (...) is to argue that we need to impose an additional autonomy condition on knowledge that excludes such cases of non-autonomous knowledge. In response, two points of criticism are offered. First, that when extended knowledge is properly understood, virtue-theoretic accounts of knowledge can already exclude non-autonomous knowledge without the need of an additional epistemic condition. Second, that the cases that Carter offers of putatively non-autonomous knowledge involve the inclusive folk notion of belief rather than the more restrictive notion of belief that is relevant to epistemology (K-apt belief). Once it is recognized that the belief condition on knowledge concerns this more restrictive notion, then we already have the means to exclude cases of non-autonomous knowledge (regardless of which theory of knowledge one favors). (shrink)

Watson and Crick’s discovery of the structure of DNA led to developments that transformed many biological sciences. But what were the relevant developments and how did they transform biology? Much of the philosophical discussion concerning this question can be organized around two opposing views: theoretical reductionism and layer-cake antireductionism. Theoretical reductionist and their anti-reductionist foes hold two assumptions in common. First, both hold that biological knowledge is structured like a layer cake, with some biological sciences, such as (...) molecular biology cast at lower levels of organization, and others, such as classical genetics, cast at higher levels. Second, both assume that scientific knowledge is structured by theory and that the productivity of scientific research depends on whether the underlying theory identifies the fundamentals upon which the phenomena to be explained and investigated depend. In the first part of this paper, I challenge these assumptions. In the second part, I show how recasting the basic theory of classical genetics made it possible to retool the methodologies of genetics. It was the investigative power of these retooled methodologies, and not the explanatory power of a gene-based theory, that transformed biology. (shrink)

In the introduction to the Leviathan, Hobbes famously defends the anthropological point of departure of his theory of the state by invoking the Delphic injunction ‘Know thyself!’ of which he presents a peculiar reading thereafter. In this paper, I present a reading of the anthropology of the Leviathan that takes this move seriously. In appealing to Delphic injunction, Hobbes wanted to prompt a particular way of reading his anthropology for which it is crucial that the reader relate the presented anthropological (...) views to his self-conception. The anthropology of the Leviathan is thus a kind of manual for a certain kind of self-reflection by which the reader's self-knowledge is to be improved. Furthermore, I will argue that Hobbes' interpretation of the Delphic injunction illuminates several theoretical issues relevant to the epistemology of that kind of ‘self-knowledge’ that was demanded by the Delphic injunction. While Hobbes does not solve all the epistemological problems related with the ideal appealed to by this inscription, he does provide some interesting insights into some general requirements that any epistemological account of Socratic self-knowledge has to meet. (shrink)

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical (...) practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making. (shrink)

This dissertation investigates that which can only be known with the following criteria of knowledge: (i) it is unchangeable; (ii) it cannot be mistaken; (iii) it is identical with its object. It begins by addressing the following questions: what can and cannot exist in solely this sense? Can anything exist in this sense? A further thesis it explores is that the split between the subject of knowledge and the object of knowledge which has given rise to the (...) unexplained and inexplicable residues in the solutions to epistemological problems which have been propounded by Western philosophers. These residues have been a breeding ground for a skepticism which casts doubt on the validity of the philosophic enterprise. It is hoped that this thesis might play some role in indicating a pathway through which faith in the philosophic enterprise may be restored. The approach taken is multi-leveled, at once transcen¬dental, metaphysical, phenomenological and empirical. It is transcendental in that the question is always ‘how is knowledge possible?’ It is metaphysical in that the focal point is always that which is, and not that which seems to be. It is phenomenological in that it is confined to the data of consciousness and makes no attempt to go beyond consciousness. It is empirical in that the final court of appeal for any argument is always pure experience. It is demonstrated that, given the separation of the subject knower from the object of knowledge, knowledge is an impossibility. Separatist views of knowledge are taken up and analyzed, among which are: knowledge as caused by objects; knowledge as the knowledge of an object; knowledge as the correspondence between ideas and objects; knowledge as an act; knowledge as a possession. All these views leave untouched the basic questions: what is knowledge? How is the object of knowledge known? How can knowledge arise in the first place? The existence of the object is then shown to be purely dependent on the existence of the subject, and vice versa. An analysis of experience reveals that no difference between subject and object is ever detected and detectable. The breakdown of experience into subjects and objects is shown to be a purely theoretical interpretation of experience, unjustified and unjustifiable in actual experience. It is finally shown that it is impossible to legitimize ideas of difference, either from the world of objects or from the mind of the subject knower. That there can be an appearance of plurality is demonstrated to rest upon the reality of space and time, existences which prove to be purely ideal. A re-integration of subject and object into the experience from which they have been dirempted provides an explanation of the possibility of know¬ledge, knowledge which is at once certain and of the real. An application of the perspective of non-dualism is suggested to offer philosophic solutions to such epistemological impasses as the relation of language and meaning and the universal and the particular. The relevance of an epistemological inquiry for action is indicated in such a way as to bring knowledge and existence into harmony with each other. The broader aim of the dissertation is to legitimize the philosophic enterprise as a pathway to unchangeable, unmistakable, and unitary knowledge. (shrink)

The debate and implementation of Clinical Ethics Consultation is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop (...) “technical”approaches, e.g., in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the “parties” involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of “neutrality” versus “advocacy” in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of the patient or the relatives are formulated for the practice of CEC. (shrink)

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund (...) Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine. (shrink)

Ethical reasoning and decision-making may be thought of as 9professional skills9, and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient9s problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical (...) practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making. (shrink)

This review examines two works that address the theoretical importance of Latin American political movements over the last two decades. I argue that while Boaventura de Sousa Santos raises the important issue of the political relationship between difference and unity, his work lends itself to ambiguous conclusions regarding this relationship. In particular, de Sousa Santos underestimates Marxism’s potential role as a theory and practice of political union. Nonetheless, his work provides certain insights on epistemology and political temporality that may (...) help Marxism amplify its political relevance today. Álvaro García Linera’s text represents a particular mode by which Marxism may engage with a politics of difference; however, I argue that García Linera’s work contains a tension between difference construed in autonomist, material terms and difference construed as identity. The latter, I suggest, has come to serve in Bolivia as the basis for an ultimately limited political project. (shrink)

In spite of these efforts in the 1920s and 1930s to initiate ongoing research on contraception, the subject of birth control remained a problem of concern primarily to the social activist rather than to the research scientist or practicing physician.80 In the 1930s, as has been shown, American scientists turned to the study of other aspects of reproductive physiology, while American physicians, anxious to eliminate the moral and medical dangers of contraception, only reluctantly accepted birth control as falling within their (...) professional domain.As a result, the problem of cheap, effective, and safe contraception was not solved by these earliest attempts. Consideration of the subject was initiated afresh by private philanthropy after World War II, sparked by a new wave of interest in population studies.81 Summarizing such efforts to support research in the reproductive sciences, a recent Ford Foundation study has noted: “To initiate and sustain serious research in the reproductive sciences has required for more than half a century concerted effort by interested individuals and private organizations, mainly from outside the mainstreams of the biomedical research community.”82The early laboratory research on chemical contraception described in this paper was but one important outcome of the concerted effort made by reformers in the 1920s to eliminate a variety of social problems thought to derive from excessive fertility. Scientific arguments and expertise were employed to advocate reform as well as to define the appropriate solution to such social problems. Scientists were recruited as advocates for the movement, but they were also employed as researchers in laboratory investigations sponsored by these same reformers.Sponsors of these early laboratory studies noted the difficulty of obtaining first-class investigators.83 The routine analyses necessary for such research, as well as the traditional scientific aversion to applied problems, provide only a partial explanation for this response. The real difficulty lay in recruiting investigators to a field that had previously been taboo. Once opened up — first as socially relevant, and finally as scientifically sound — there was much interest in this area, and the appeal to researchers of the scientific issues surrounding fertility and reproduction soon surpassed that of the reforming value of birth control.A survey of the kinds of experimental investigations sponsored by birth control advocates indicates the range of physiological problems explored by contraceptive research. The most definitive work was done on the efficacy and safety of spermicides, but the potential of other contraceptive methods was also examined. Investigators attempted to develop spermatoxins that would effectively immunize women against sperm, and they also tried to elucidate the mechanism of hormonal control of reproduction. In fact, speculations about the possible hormonal manipulation of fertility were expressed at the Seventh International Birth Control Conference held in Zurich in 1930.84In the 1920s, clinical studies were undertaken to assess the effectiveness of the various birth control methods. Laboratory investigators complemented this work by screening spermicides for safety and testing for their ability to kill sperm. There were a variety of birth control preparations on the market, but no one really knew whether these were effective or even safe.85 Although the physiology of other major organ systems was well advanced, the scientific study of reproductive physiology and contraceptive technology was clearly in its infancy in this period. Routine analyses simply could not be conducted, because the fundamental research establishing baselines had not yet been done. Scientists used this fact to redirect attention to basic research on reproduction.Laboratory research on contraception indicated important unexplored areas for physiological investigation. Social activists, who had encouraged prominent scientists to become interested in both the social value and the genetic implications of birth control, found these investigators revising the goals of their research. The biologists had formed their own network and had begun to seek out funding, reformulating the justification for sponsorship of further investigations. The eugenic motivations underlying these studies, which had initially made them theoretically attractive to biologists, were gradually eroded. Concern with “human evolution” ceded its place to interest in physiological mechanisms. Crew and others began to note that the use of biological theory to justify essentially political decisions had serious limitations. Biologists had become uncomfortable with those very arguments which had originally captured their interest. Recognition of the potential political abuse wrought by applying scientific principles to society was expressed by Crew just one year after the Zurich meeting. Referring to previous assessments of the role of sex in reproduction, he generalized: “In the past the biologist has justified feudalism, Manchester Liberalism, socialism and every other type of social organization and political programme by reference to selected biological phenomena.”86 By 1932 Crew had also begun to question the biological logic of regulated breeding, and had made it clear to his American sponsor that there was no simple correspondence between the practice of birth control and the genetic improvement of the human race.87Biologists further began to recognize, however, that although the hopeful genetic solution to human problems was probably an illusion, contraception still remained one tangible means to alleviate, human misery. Some laboratory scientists, like Crew, acknowledged the applicability of their own particular skills to this problem. For a few brief years, social needs and scientific goals were mutually supportive and closely intertwined. But as laboratory researchers gained interest in the study of reproduction and established their own priorities in this field, they temporarily withdrew from the arena of debate over birth control as an important mechanism for social reform.With the rise of Hitler, the genetic arguments for birth control rapidly lost their appeal. But by that time the scientific problem of how to achieve effective contraception had entered the professional consciousness. Both physicians and scientists began to be aware of birth control as a subject within their domain of expertise, although outside the principal focus of their research. Scientific discussion of birth control permanently altered from a question of justification to a problem of method: How could one achieve reliable and safe contraception? This had been Sanger's and Dickinson's goal from the beginning. Laboratory scientists had indeed been persuaded to undertake this work; this research had in turn affected biologists' perceptions of the whole field of reproductive physiology, encouraging further study of reproductive mechanisms. The promise of new knowledge provided for continued funding of this research, despite the caution by scientists that the social benefits would not be as immediate or as far-reaching as advocates and they themselves had first argued.The activities of birth control activists and their supporting agencies, and the financial backing of private contributors and foundations, notably the Rockefeller philanthropies, provided an important new stimulus to the development of research on the biology of reproduction in the late 1920s and early 1930s. Biologists were able to claim an enlarged realm of issues for scientific study through their activities as advocates and as investigators for the birth control movement. At the same time, they promised as-yet-undiscovered possibilities for regulating human reproduction once its physiology was understood. The knowledge and control that they promised lay in understanding the whole reproductive cycle — not merely in evaluating the toxic effects of presumptive spermicides.Chemical spermicides never summoned the interest of scientists as the contraceptive pill was to do, yet that research did reinforce the widespread perceptions of scientific research as essential to social reform. Spermicide investigations focused research efforts in reproductive biology by challenging traditional taboos, defining problems for further study, and providing laboratory investigators the opportunity to assert the social and scientific value of their own skills. Crew echoed this attitude as he observed in 1934:Man has turned from the adventurous conquest of his environment to the conquest of himself. To-day is the day of biological invention, eagerly used for the control of the undesirable and the unwanted. Sex and reproduction are no longer hedged around by myth and taboo; they are no longer accepted as mysteries that defy understanding. They are matters inviting examination and explanation; they are regarded as expressions of physico-chemical forces, the nature of which is to be displayed. It is accepted that when knowledge is sufficient, control will be absolute, and, though knowledge is not yet sufficient, readers... must be persuaded to the view that this will not always be so.88The synergism between reproductive biology and social needs has been temporary and sporadic, but recurring, since the 1920s. Scientific research programs have clearly been influenced by issues raised by public debate. Nevertheless, reproductive biologists have continued to assert their own professional goals. For the most part, they have rejected problems without inherent scientific interest and have spurned applied research except as it has had a direct bearing on current research themes. This attitude, apparent among American and British investigators in the 1930s, created the intellectual context for the invention and acceptance of the technically sophisticated oral contraceptive pill. It did not foster the production and improvement of the simple, safe, effective, and cheap vaginal contraceptive desired by early birth control advocates. (shrink)

Critical Thinking in Clinical Research explains the fundamentals of clinical research in a case-based approach. The core concept is to combine a clear and concise transfer of information and knowledge with an engagement of the reader to develop a mastery of learning and critical thinking skills. The book addresses the main concepts of clinical research, basics of biostatistics, advanced topics in applied biostatistics, and practical aspects of clinical research, with emphasis on clinical relevance (...) across all medical specialties. (shrink)

Disputes about theory in bioethics almost invariablyrevolve around different understandings of morality or practicalreasoning; I here suggest that the field would do well to becomemore explicitly contentious about knowledge, and start the taskof putting together a clinical epistemology. By way of providingsome motivation for such a discussion, I consider two cases ofresistance to shifts in clinical practice that are, by and large,not ethically controversial, highlighting how differentconceptions of epistemic authority may contribute to clinicians'unwillingness to adopt these changes, (...) and sketching out someinitial suggestions for epistemic analysis of clinical practice. (shrink)

Interoception, the ability to feel the body’s internal sensations, is an essential aspect of emotional experience. There is mounting evidence that interoception is impaired in common mental health disorders and that poor interoceptive awareness is a major contributor to emotional reactivity, calling for clinical interventions to address this deficit. The manuscript presents a comprehensive theoretical review, drawing on multidisciplinary findings to propose a metatheory of reinforcement mechanisms applicable across a wide range of disorders. We present a reconsideration of (...) operant conditioning through the co-emergence model of reinforcement, which is a neurophenomenological account of the interaction between cognition and interoception, and its consequences on behavior. The model suggests that during memory processing, the retrieval of autobiographical memory (including maladaptive cognition) is dependent upon its co-emerging interoceptive cues occurring at the encoding, consolidation and reconsolidation stages. Accordingly, “interoceptive reinforcement” during emotional distress is a common factor to all emotional disorders and a major cause for relapse. We propose that interoceptive desensitization has transdiagnostic benefits, readily achievable through the cultivation of equanimity during mindfulness training and can be integrated in cognitive and behavioral interventions to permit a transdiagnostic applicability. We summarize the contributions of this approach into 10 specific and testable propositions. (shrink)

This paper sets out as its objective the exploration of some of the key passages and most relevant theoretical plexuses of the Grundzüge des gegenwärtigen Zeitalters by Johann Gottlieb Fichte devoted to the theme of historical narrative and, more generally, of historiography. In particular, we will first of all aim to show the specific status of Historie. Secondly, we will try to outline the differences that Grundzüge establishes between the functions of Wissenschaftslehrer and those of Historiker, in an attempt (...) to show, at the same time, the nexus linking the two and the activities they perform. (shrink)

Definition of the problemStaff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these “miserable conditions” as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them (...) but cannot handle them effectively.ArgumentsI propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions.ConclusionThe institutional pathology paradigm, oriented to concrete institutions and organizations, can help “clinical” organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility. (shrink)

My objective in the following study is to present and analyze the objections to the "classical argument" in the sociology of knowledge raised by Leo Strauss and Karl Popper. Building on this expository account, I will attempt to demonstrate (1) that the opposition of Strauss and Popper is more apparent and polemical than real, (2) that the position taken by Strauss and Popper on the viability of a sociology of knowledge is essentially no different from that taken by (...) the discipline's founders: Max Scheler, Karl Mannheim, and Georg Lukács, (3) that whatever the merits of Strauss and Popper's contentions, they become relevant only in the context of a radicalized version of the sociology of knowledge which developed subsequent to their formulation, and (4) that the sociology of knowledge has needlessly and deplorably become the battleground for meta?theoretical disputes that are irrelevant to its practice. (shrink)

Chapter 1 First Person Access to Mental States. Mind Science and Subjective Qualities -/- Abstract. The philosophy of mind as we know it today starts with Ryle. What defines and at the same time differentiates it from the previous tradition of study on mind is the persuasion that any rigorous approach to mental phenomena must conform to the criteria of scientificity applied by the natural sciences, i.e. its investigations and results must be intersubjectively and publicly controllable. In Ryle’s view, philosophy (...) of mind needs to adopt an antimentalist stance to achieve this aim. Antimentalism not only definitively rejects the idea that mind is a substance separated from the body, it also denies that mental phenomena radically differ from physical phenomena by virtue of several unique features. Most problematically, mental phenomena have a conscious character (mental states are related to specific qualitative feelings) and are accessible only to the first-person (only the subject knows directly what s/he is experiencing inside his/her mind). Ryle takes a strong stance on antimentalism going so far as to maintain that an approach to mind which aims to meet the criteria of scientificity set by the natural sciences must avoid any reference to internal, unobservable mental states. In his view (which is considered a specifically philosophical version of psychological behaviorism and also addresses questions put forward in psychological research), mental states can be redescribed in terms of behavioral dispositions. In this chapter, we address the historical roots of the antimentalist view and analyze its relation to the later tradition of research on mind. We show that, compared to the antimentalist stance, functionalism and cognitivism take a step back when they maintain that direct reference to mental states is necessary since mental states cause and therefore explain human behavior. This step backwards is often interpreted as a return to mentalism. However, this is only partially true. Indeed, we suggest that these later traditions retain one important element of Ryle’s antimentalism, i.e. the idea that mental states must be uniquely identified using external and publicly observable criteria, while excluding any reference to introspection and those qualitative dimensions of a mental state, which are accessible only to the first-person. According to the perspective we put forward, this epistemological stance has continued to influence contemporary research on mind and current philosophical and psychological theories which both tend to exclude the subjective qualities of human experience from their accounts of how the mind works. The issue we raise here is whether this is legitimate or whether subjective qualities do play a role with respect to the way our mind works. The conclusion of this chapter anticipates the argument the book makes in in favor of this latter position, starting from a particular angle, i.e. the problem of how we categorize concepts related to our internal states. -/- Chapter 2 The Misleading Aspects of the Mind/Computer Analogy. The Grounding Problem and the Thorny Issue of Propriosensitive Information -/- Abstract. After the crisis of behaviorism, cognitivism and functionalism became the predominant models in the field of psychology and of philosophy, respectively. Their success is mainly due to the new key they use for interpreting mental processes: the mind/computer analogy. On the basis of this analogy, mental operations are seen as cognitive processes based on computations, i.e. on manipulations of abstract symbols which are in turn understood as informational unities (representations). This chapter identifies two main problems with this model. The first is how these symbols can relate to and communicate with perception and thus allow us to identify and classify what we perceive through the senses. Here we limit ourselves to presenting this issue in relation to the classical symbol grounding problem originally put forward by Harnad on the basis of Searle’s Chinese room argument. An attempt to address the problem raised here will be made in chap. 3. The second point we discuss in relation to the mind/computer analogy concerns the idea of information it fosters. Indeed, following this analogy, information is something available in the external world which can be captured by the senses and transmitted to the central system without being influenced or modified by the procedures of transmission. This perspective does not take into account that – unlike computers – in living beings information is acquired by means of the body. As Ulric Neisser has already pointed out, the body is itself an informational source that provides us with additional sensory experience that influences (modifies or complements) the information extracted from the external world by the senses. To develop this line of analysis and to determine exactly what information is provided by the body and how this might influence cognition, we examine Sherrington’s and Gibson’s positions. Moving on from their views, we qualify bodily information in terms of ‘proprioception’. We use ‘proprioception’ in a broad sense to describe any kind of experience we have of our internal states (including postural information as well as sensations related to the general state of the body and its parts). Following Damasio’s and Craig’s studies, we further elaborate this position, arguing that living beings are equipped with an internal propriosensitive monitoring system which maps all the changes that constantly occur in our body and that give us perceptual (‘proprioceptive’ or propriosensitive) information about what happens inside us. Moreover, relying on Goldie’s and Ratcliffe’s view, we show that emotional information can also be considered as a form of ‘proprioception’ which contributes to determining everything we perceive. This analysis leads us to the second main thesis of this book: ‘proprioception’ is a form of internal perception and it is an essential component of the sensory information we can access and use for all cognitive purposes. -/- Chapter 3 Semantic Competence from the Inside: Conceptual Architecture and Composition -/- Abstract. Concepts are essential constituents of thought: they are the instruments we use to categorize our experience, i.e. to classify things and group them together in homogeneous sets. Here we define concepts as the internal mental information (representations) that allows us, among other things, to master words in natural language. By analyzing the way in which individuals master word meanings we explore a number of hypotheses regarding the nature of concepts. Following Diego Marconi’s research, we differentiate between two kind of abilities that underpin lexical competence – so-called ‘referential’ and ‘inferential competence’ – and we suggest that, in order to support these abilities, concepts must also include two corresponding kinds of information, i.e. inferential and referential information. We point out that the most widely used and acknowledged theories of concepts do not make this distinction, instead broadly characterizing the information used for categorization in terms of propositionally described feature lists. However, we show that while feature lists can explain inferential competence, they do not account for referential competence. To address the issue of referential competence we examine Ray Jackendoff’s hypothesis that to account for the possibility of linking perceptual and conceptual information we need to assume the existence of a (visual) representation that encodes the geometric and topological properties of objects and bridges the gap between the percept and the concept. Furthermore, we analyze the extension of this work by Jesse Prinz who introduced the notion of a proxytype, a perceptual representation of a class of objects that incorporates structural and parametric information related to their appearance. However, as we point out, proxytypes can only explain the relationship between perception and concepts with respect to instances that can be perceived through the senses and that belong to the same class by virtue of their physical similarity. We suggest that this notion be extended to include larger conceptual classes. To accomplish this, we further develop Mark Johnson, George Lakoff and Jean Mandler’s idea of a schematic image and argue that conceptual representations include a perceptual schema. Perceptual schemata are non-linguistic, structured experiential gestalts (patterns or maps) that make use of information taken from all sensory modalities, including body perception. They accomplish a quasi-conceptual function: they allow us to recognize and to classify different instances. In this work, we hypothesize that perceptual schemata are an essential component of concepts, but not identical to them. Instead, we suggest that concepts include both perceptual and propositional information with perceptual schemata providing the ‘perceptual core concept’ that grounds related propositional information. -/- Chapter 4 In the Beginning There Were Categories. The Bodily Origin of Prelinguistic Categorical Organization: The Example of Folkbiological Taxonomies -/- Abstract. Studies of categorization in psychology and the cognitive sciences have made use of the notions of ‘category’ and ‘concept’ without precisely defining what is meant by either; in fact, often these terms have been used as synonyms, making it difficult to address specific issues related to conceptual development. This chapter begins by discussing the definitions of, as well as the distinctions between, ‘categories’ and ‘concepts’ in the classical philosophical tradition (Aristotle, Kant and Husserl). We introduce our view of categories with reference to Husserl. Categorization is defined as the way in which our experience is originally (pre-linguistically) organized in a passive and fully unconscious manner on the basis of universal structuring principles. Conceptualization is explained as a later process in which the earlier categorical macro-classes are further subdivided into more specific and detailed sets; this later process also relies on linguistic learning and exposure to culture. On the basis of Ray Jackendoff, Jean Mandler, George Lakoff and Mark Johnson’s work, we hypothesize that categorization is a two-step process that begins with the formation of homogeneous sets of entities partitioned into regions that describe the ontological boundaries of the objects that humans perceive (categories) and continues at a later stage with the development of more specific classifications (concepts). In this chapter, we mainly address three related issues: Why should we assume that there is categorical organization which precedes the development of a conceptual system? How do categories and concepts relate to each other? Shall we hypothesize that categories are innate or that they are formed before concepts on the basis of information and organizational structure available at a very early developmental stage? We show that categorical partitions are necessary for categorization and, following Mandler, that the general categories we form at an early age do not match our adult superordinate concepts. As for the third issue, we argue that there might be no need to assume that categories are innately present in the human mind, since their formation can be explained – at least in certain cases – by basic mechanisms that work on body (propriosensitive) information. This hypothesis will not be discussed in general, but in relation to a particularly relevant example of categorical partition, i.e. the folk-biological dichotomy between ANIMATE/INANIMATE. This is compared with other dichotomies that derive from it, but are not directly categorical such as LIVING/NON-LIVING and BIOLOGICAL/NON-BIOLOGICAL. -/- Chapter 5 Internal States: From Headache to Anger. Conceptualization and Semantic Mastery -/- Abstract. Here we ask if we can also apply the distinction between referential and inferential competence we introduced in Chapter 3 to words that do not refer to things that are perceived using the external senses, especially to words/concepts that denote bodily experiences (such as pain, thirst, hunger, etc.) or emotions. We introduce and discuss the hypothesis that – even though such words/concepts do not refer to intersubjectively identifiable entities in the external world – they do have a kind of referent that can be accessed via direct perception, more specifically ‘proprioception’, as we have defined it in terms of all propriosensitive information we can consciously access. In the first part of the chapter, we specifically consider terms denoting bodily experiences such as ‘pain’ or ‘hunger’ and argue that their referents are identified and classified from a first-personal point of view on the basis of four main characteristics: their specific intensity, their localization in the body, their co-occurrence with other signals and above all their specific qualitative sensations. Emotions are addressed in the second part of the chapter. We suggest that there is a continuity between bodily experiences and emotions. In particular, we argue for a perceptual theory of emotions in line with that proposed by James and Lange at the end of the 19th century and developed more recently by authors such as Damasio (see also chap. 2§5, §6). The hypothesis we put forward is that the referential information that supports the categorization of emotions and therefore also our mastery of terms referring to emotions consists in the perception (i.e. the ‘proprioception’) of those bodily states and changes in bodily states which constitute our emotional experience. In the context of this discussion we examine some objections to this line of reasoning that arise from a cognitivist perspective and following authors such as Oatley, Johnson-Laird and Frijda, we distinguish between basic emotions that can be identified and classified solely on the basis on how they feel and complex emotions whose identification and classification additionally depends on cognitive factors. To describe how emotions are identified and classified on the basis of how they feel, we rely on Marcel and Lambie’s distinction between an ‘emotion state’ and an ‘emotion experience’. Both notions indicate kinds of feelings that we consciously experience. However, they describe first-order and second order emotion awareness respectively. The emotion state is the feeling we have of the bodily states and changes that occur when we are experiencing an emotion, while the emotion experience is the fully developed and integrated emotion we both experience and are, with reflection, aware of experiencing. On the basis of this differentiation, we also show that the same characteristics that aid in the identification and classification of bodily experiences (specific qualitative sensations; somatic localization; specific intensity; presence/absence of specific concomitant sensations) can also be used for the identification and classification of emotions – at least basic emotions. In the last two sections of the chapter we present some clinical evidence on the semantic competence of people who suffer from Alexithymia and Autism Spectrum Disorder which supports the conclusions of our preceding analyses. -/- Chapter 6 The ‘Proprioceptive’ Component of Abstract Concepts -/- Abstract. In this chapter, we address the issue of whether the mastery of abstract words requires only inferential knowledge and thus, if the concepts that support the mastery of abstract words include only linguistic information. We start by differentiating the notions of ‘abstract’ and ‘general’ which are often erroneously confused. We then identify a strict definition of abstract, as contrasted with ‘concrete’, that applies to words or concepts whose referent cannot be experienced by the senses. We argue that abstract words/concepts would be better described as theoretical, because they are usually conceived as structured sets of inferential knowledge expressed linguistically; that is, as small theories. Pointing out parallels with Carnap’s analysis of this issue in philosophy of science, we hypothesize that words/concepts denoting non-observable entities are not all ‘equally theoretical’, because their link to sensory experience can be stronger or weaker. We revive the distinction, inspired by Quine, between theoretical and intertheoretical concepts/words. This distinction relies on the fact that the former – unlike the latter – retains a strong, although indirect, connection with perception. In Quine’s discussion, perception is understood uniquely in terms of observability, i.e. of external sensory experience. Here we argue, however, that bodily, ‘proprioceptive’ (i.e. propriosensitive) experience can also serve to referentially ground theoretical (i.e. abstract) concepts/words. We frame this issue using the example of the theoretical concept ‘freedom’ and Lakoff’s hypothesis that this concept is developed on the basis of bodily information. We contrast this with the example of ‘democracy’ which more closely resembles an intertheoretical concept/word. Furthermore, we show that one of the classical views put forward in psycholinguistic research to explain how abstract concepts are mentally represented – i.e. Paivio’s Dual Coding Theory – points in the same direction as our analysis. The same is true of Barsalou’s work suggesting that we use internal information to understand at least some abstract words. To sustain this position, we put forward two lines of evidence: the first comes from psycholinguistic studies while the second examines deficits of semantic competence exhibited by people with Autism Spectrum Disorder. On the basis of our analysis, we put forward a classification that distinguishes between different kinds of concreteness and different degrees of abstraction: concepts/words referring to body experiences and basic emotions are described as analogous to concrete concepts/words because they are grounded in perceptual (i.e. propriosensitive) experience, while abstract concepts/words are considered more or less abstract depending on whether they are intratheoretical (and rely entirely on inferential information) or theoretical (and are partially grounded in perceptual – or more often in propriosensitive perceptual – information). In the last section of the chapter we consider two scales that have been used in psycholinguistic research to measure the degree of concreteness vs. abstractness of words and we show that – used conjointly – they can provide a measure of the internal vs. external grounding of specific words. (shrink)

The integrity of critical ethnography requires engagement in reflexive practice at all phases of the research process. In this discussion paper, I explore the insights and challenges of reflexive practice in an ethnographic study of the recovery experiences of black trauma patients in a Philadelphia hospital. Observation and interviews were conducted with twelve patients who were admitted to trauma‐designated units of the hospital over the course of a year. During fieldwork, I learned the ways that my background as a professional (...) nurse structured my way of being in clinical space and facilitated a particular interpretation of clinical culture. In analysis, reflection on subjectivities through which I designed this ethnographic research allowed me to see beyond my preconceived and theoretically informed perspective to permit unexpected features of the field to emerge. Reflexive practice also guided my reconciliation of key practical and epistemological differences between clinical ethnographic research and the anthropologic tradition in which it is rooted. I conclude that with careful reflection to the subjectivities that influence the research process, interdisciplinary clinically relevant applied interpretations of critical ethnographic work can be used to generate detailed knowledge across contexts in clinical care, nursing practice, and patient experiences. (shrink)

Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner (...) has provided us with a remarkably lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Reaching understanding is one of our central epistemic goals, dictated by our important motivational epistemic virtue, namely inquisitiveness about the way things hang together. Understanding of humanly important causal dependencies is also the basic factual-theoretic ingredient of wisdom on the anthropocentric view proposed in the article. It appears at two levels. At the first level of immediate, spontaneous wisdom, it is paired with practical knowledge and motivation ( phronesis ), and encompasses understanding of oneself (a distinct level of self- (...) class='Hi'>knowledge having to do with one’s dispositions capacities, vulnerabilities, and ways of reacting), of other people, of possibilities of meaningful life, and of relevant courses of events. It is partly resistant to skeptical scenarios, but not completely. On the second and reflective level, understanding helps fuller holistic integration of one’s first order practical and factual-theoretic knowledge and motivation, thus minimizing potential and actual conflicts between all these components. It also participates in the reflective control whose exercise is needed for full reflective wisdom, the crucial epistemic-practical virtue or human excellence. (shrink)

Evaluating the impact of clinical ethics support services remains a challenging task. 1 Against this background, we applaud the authors for developing a theoretical framework that aims to explain how repeated moral case deliberations may promote ‘practical wisdom’ in healthcare professionals and improve the quality of care in health facilities. 2 In our view, it is of particular value to draw attention to the learning processes that may be induced by ethics support services. Understanding such learning processes on (...) the individual and organisational level is a prerequisite for longitudinal research designs that may be suitable to study the impact of specific ethics support services on criteria deemed relevant in patient care. 3 In our comment, we would like to focus on one aspect, which we deem necessary to be able to explain the possible impact of ethics support on the quality of healthcare. This is the... (shrink)

In this article I critically discuss Professor Oladele Abiodun Balogun’s reflections on the proper final ends of doing philosophy and related sorts of abstract, speculative, or theoretical inquiry. Professor Balogun appears to argue that one should undertake philosophical studies only insofar as they are likely to make a practical difference to people’s lives, particularly by contributing to politico-economic development, or, in other words, that one should eschew seeking knowledge for its own sake. However, there is one line of (...) thought from Professor Balogun, about philosophy being able to make life meaningful, that I argue ultimately––perhaps contrary to his intentions––entails that it can be appropriate to some degree to pursue philosophy that is unlikely to ameliorate poverty and similar social ills. My central aims in this article are to identify Professor Balogun’s strongest argument against pursuing any knowledge for its own sake and to argue that an appeal to meaningfulness constitutes a strong, competing reason to seek out some of it. (shrink)

Accurately assessing youth mental health involves obtaining reports from multiple informants who typically display low levels of correspondence. This low correspondence may reflect situational specificity. That is, youth vary as to where they display mental health concerns and informants vary as to where and from what perspective they observe youth. Despite the frequent need to understand and interpret these informant discrepancies, no consensus guidelines exist for integrating informants’ reports. The path to building these guidelines starts with identifying factors that reliably (...) predict the level and form of these informant discrepancies, and do so for theoretically and empirically relevant reasons. Yet, despite the knowledge of situational specificity, few approaches to integrating multi-informant data are well-equipped to account for these factors in measurement, and those that claim to be well-positioned to do so have undergone little empirical scrutiny. One promising approach was developed roughly 20 years ago by Kraemer and colleagues. Their Satellite Model leverages principal components analysis and strategic selection of informants to instantiate situational specificity in measurement, namely components reflecting variance attributable to the context in which informants observe behavior, the perspective from which they observe behavior, and behavior that manifests across contexts and perspectives. The current study represents the first construct validation test of the Satellite Model. A mixed-clinical/community sample of 134 adolescents and their parents completed six parallel surveys of adolescent mental health. Adolescents also participated in a series of simulated social interactions with research personnel trained to act as same-age, unfamiliar peers. A third informant viewed these interactions and completed the same surveys as parents and adolescents. We applied the Satellite Model to each set of surveys and observed high internal consistency estimates for each of the six-item trait, context, and perspective components. Scores reflecting the trait, context, and perspective components displayed distinct patterns of relations to a battery of criterion variables that varied in the context, perspective, and source of measurement. The Satellite Model instantiates situational specificity in measurement and facilitates unifying conceptual and measurement models of youth mental health. (shrink)

In the nearly one hundred years that have elapsed since Freud’s publication of his pioneering work with “Little Hans,” psychoanalysis has transformed not only our clinical work with children, but has immeasurably enriched our understanding of normal child and adolescent development as well as developmental deviations and derailments. We have gradually come to understand childhood and adolescence as a complex tapestry of developmental themes, conflicts, and crises; sometimes discontinuous or discrete, at other times, harmonious and integrated, yet always occurring (...) within a transactional matrix of environmental influences and internal experience. In this transdisciplinary anthology, eight authors explore the changing terrain of child and adolescent psychoanalysis and psychoanalytic therapy. The contributions, which reflect theoretical and clinical heterogeneity, are both innovative and varied, and range from the highly abstract and theoretical to those that consider very specific dimensions of clinical process. Collectively, they make a compelling case for the continued relevance of psychoanalytic ideas in the treatment of children and adolescents. With insightful contributions by expert psychoanalysts, clinical social workers, and clinical psychologists, Psychoanalytic Approaches to the Treatment of Children and Adolescents: Tradition and Transformation is essential reading for child and adolescent therapists. Psychoanalytic Approaches to the Treatment of Children and Adolescents will increase your knowledge of: the function of play in normal development--and within the treatment relationship psychoanalytic theories and research investigations linking early object loss to depression the nature of adolescent depression the theoretical and clinical dimensions of a two-systems approach to understanding psychopathology and the clinical process the dynamic meaning and clinical management of drug and alcohol abuse, promiscuity, eating disorders, violence, and other self-destructive behaviors the complexities of treating children with neuropsychological deficits. (shrink)

The idea that humans are clearly distinguished from other animals and from the natural world in general is a cornerstone of European philosophy and culture at least from the sixteenth century onward. Often, this idea is related to understandings of ‘humanism’ that emerged in that period and legitimized regimes of power and control over non-European cultures; it also sanctioned the exploitation of the natural world in the form of extractive capitalism. Critiques of Eurocentric mindsets hinge on certain understandings of ‘humanism,’ (...) arguing for a transformation or even abandoning of humanist traditions in the sense of ‘posthumanism’ or ‘critical posthumanities.’ In their selective interpretation of European humanism—exemplified with Immanuel Kant’s philosophy—the current critique shows elements of an Occidentalist construction of humanism. If we want to overcome the idea that humans—and within that group particularly the white, male, educated Europeans—are the ‘masters of the world,’ we are confronted with conceptual challenges that need philosophical and theoretical reflection. The ontological and epistemological implications of non-anthropocentric ways of thinking and knowing provide a clear alternative to some problematic aspects of European philosophy and humanism. Engaging with new interpretations of other-than-human agency, relational understandings of animism, and intra-active production of knowledge can provide a relevant contribution to the ongoing discussion across intellectual, cultural, and political fields, an approach that takes the specificity of human animals seriously without identifying them as the center of knowledge and power. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case (...) deliberation, healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

IntroductionClinical ethics committees (CECs) support and enhance communication and complex decision making, educate healthcare professionals and the public on ethical matters and maintain standards of care. However, a consistent approach to training members of CECs is lacking. A systematic scoping review was conducted to evaluate prevailing CEC training curricula to guide the design of an evidence-based approach.MethodsArksey and O’Malley’s methodological framework for conducting scoping reviews was used to evaluate prevailing accounts of CEC training published in six databases. Braun and Clarke’s (...) thematic analysis approach was adopted to thematically analyse data across different healthcare and educational settings.Results7370 abstracts were identified, 92 full-text articles were reviewed and 55 articles were thematically analysed to reveal four themes: the design, pedagogy, content and assessment of CEC curricula.ConclusionFew curricula employ consistent approaches to training. Many programmes fail to provide CEC trainees with sufficient knowledge, skills and experience to meet required competencies. Most programmes do not inculcate prevailing sociocultural, research, clinical and educational considerations into training processes nor provide longitudinal support for CEC trainees. Most CEC training programmes are not supported by host institutions threatening the sustainability of the programme and compromising effective assessment and longitudinal support of CEC trainees. While further reviews are required, this review underlines the need for host organisations to support and oversee a socioculturally appropriate ethically sensitive, clinically relevant longitudinal training, assessment and support process for CEC trainees if CECs are to meet their roles effectively. (shrink)

The two main points of this contribution are the following: (1) Applied mathematical theories might complement physical theories in an essential way; some applied mathematical theories allow us to understand phenomena we are unable to explain by resorting to physical theories alone, (2) In the case of social sciences it might be necessary to account for examined phenomena by resorting to the idea of goal-oriented activity (the causal approach typical for natural science might be unsatisfactory). Weinberg's idea of grand reductionism (...) ignores the two above mentioned facts and hence overestimates the foundational role of physics and its methodology. (shrink)