This text explores the border between medical and social problems, the boundary between health and social change. The book studies the body as the mediator between individual and collective experience, finding that many health problems, for example the trauma of violence or depression in the course of chronic pain, are less individual medical problems than interpersonal experiences of social suffering. It argues for an ethnographic approach to moral practice in medicine, one that embraces the infrapolitical context of illness, responses to (...) it, the social institutions relating to it and the way it is configured in medical ethics. (shrink)

Thomas Ogden, writing as a practicing psychoanalyst for other practicing analysts, distinguishes between epistemological psychoanalysis and ontological psychoanalysis, while recognizing that the two approaches often overlap. Epistemological psychoanalysis has to do with assisting patients with the interpretation of significant meanings in their psyches, which in turn has an effect on their symptoms, other problems they may be facing, and their understanding of their own lives. Ontological psychoanalysis is about helping individuals transform themselves so that they are, whatever meanings they may (...) eke out, more present to themselves and to others: a change in being and becoming. Ogden associates... (shrink)

Through arresting narratives we meet a woman aiding refugees in sub-Saharan Africa, facing the chaos of a meaningless society and a doctor trying to stay alive during Mao's cultural revolution - individuals challenged by their societies and in existential moral experiences that define what it means to be human.

The guiding inspiration of this book is the attraction and distance that mark the relation between anthropology and philosophy. This theme is explored through encounters between individual anthropologists and particular regions of philosophy. Several of the most basic concepts of the discipline—including notions of ethics, politics, temporality, self and other, and the nature of human life—are products of a dialogue, both implicit and explicit, between anthropology and philosophy. These philosophical undercurrents in anthropology also speak to the question of what it (...) is to experience our being in a world marked by radical difference and otherness. In The Ground Between, twelve leading anthropologists offer intimate reflections on the influence of particular philosophers on their way of seeing the world, and on what ethnography has taught them about philosophy. Ethnographies of the mundane and the everyday raise fundamental issues that the contributors grapple with in both their lives and their thinking. With directness and honesty, they relate particular philosophers to matters such as how to respond to the suffering of the other, how concepts arise in the give and take of everyday life, and how to be attuned to the world through the senses. Their essays challenge the idea that philosophy is solely the province of professional philosophers, and suggest that certain modalities of being in the world might be construed as ways of doing philosophy. Contributors. João Biehl, Steven C. Caton, Vincent Crapanzano, Veena Das, Didier Fassin, Michael M. J. Fischer, Ghassan Hage, Clara Han, Michael Jackson, Arthur Kleinman, Michael Puett, Bhrigupati Singh. (shrink)

Modern socio?cultural studies of medicine demonstrate the symbolic character of much of medical reality. This symbolic reality can be appreciated as mediating the traditional division of medicine into biophysical and human sciences. Comparative studies of medical systems offer a general model for medicine as a human science. These studies document that medicine, from an historical and cross?cultural perspective, is constituted as a cultural system in which symbolic meanings take an active part in disease formation, the classification and cognitive management of (...) illness, and in therapy. Medicine's symbolic reality also forms a bridge between cultural and psychophysiological phenomena; the basis for psychosomatic and socioso?matic pathology and therapy. This in turn becomes a central problem for medical theory and for a philosophical reinvestigation of medicine. (shrink)

This innovative volume is an extended intellectual conversation about the ways personal lives are being undone and remade today. Examining the ethnography of the modern subject, this preeminent group of scholars probes the continuity and diversity of modes of personhood across a range of Western and non-Western societies. Contributors consider what happens to individual subjectivity when stable or imagined environments such as nations and communities are transformed or displaced by free trade economics, terrorism, and war; how new information and medical (...) technologies reshape the relation one has to oneself; and which forms of subjectivity and life possibilities are produced against a world in pieces. The transdisciplinary conversation includes anthropologists, historians of science, psychologists, a literary critic, a philosopher, physicians, and an economist. The authors touch on how we think and write about contingency, human agency, and ethics today. (shrink)

Trust is indispensable not only for interpersonal relationships and social life, but for good quality healthcare. As manifested in the increasing violence and tension in patient-physician relationships, China has been experiencing a widespread and profound crisis of patient–physician trust. And globally, the crisis of trust is an issue that every society, either developing or developed, has to face in one way or another. Yet, in spite of some pioneering works, the subject of patient-physician trust and mistrust – a crucial matter (...) in healthcare especially because there are numerous ethical implications – has largely been marginalized in bioethics as a global discourse. Drawing lessons as well as inspirations from China, this paper demonstrates the necessity of a trust-oriented bioethics and presents some key theoretical, methodological and philosophical elements of such a bioethics. A trust-oriented bioethics moves beyond the current dominant bioethical paradigms through putting the subject of trust and mistrust in the central agenda of the field, learning from the social sciences, and reviving indigenous moral resources. In order for global bioethics to claim its relevance to the things that truly matter in social life and healthcare, trust should be as vital as such central norms like autonomy and justice and can serve as a potent theoretical framework. (shrink)

To investigate the phenomenon of patient–physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust leads to increased levels of fear and self-protection by doctors which exacerbate difficulties (...) in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism—the primacy of patient welfare—as well as the traditional Chinese ideal of “medicine as the art of humanity”. Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. (shrink)

Pre-Socratic -- Socrates (469-399 B.C.) -- Plato (429-347 B.C.) -- Existentialism -- Aristotle (384-322 B.C.) -- The ship of Theseus -- Francis Bacon (1561-1626) -- The cow in the field -- David Hume (1711-1776) -- Hedonism -- Prisoner's dilemma -- St. Thomas Aquinas (1225-1274) -- Hard determinism -- Jean-Jacques Rousseau (1712-1778) -- The trolley problem -- Realism -- Immanuel Kant (1724-1804) -- Dualism -- Utilitarianism -- John Locke (1632-1704) -- Empiricism versus Rationalism -- Georg Wilhelm Friedrich Hegel (1770-1831) -- René (...) Descartes (1596-1650) -- A-Theory -- The liar paradox -- Thomas Hobbes (1588-1679) -- Philosophy of language -- Metaphysics -- Jean-Paul Sartre (1905-1980) -- Free will -- Philosophy of humor -- The Enlightenment -- Friedrich Nietzsche (1844-1900) -- The Sorites paradox -- Ludwig Wittgenstein (1889-1951) -- Aesthetics -- Philosoph of culture -- Epistemology -- Twin Earth -- Arthur Schopenhauer (1788-1860) -- Karl Marx (1818-1883) -- Martin Heidegger (1889-1976) -- Voltaire (1694-1778) -- Relativism -- Eastern philosophy -- Avicenna (980-1037) -- Bertrand Russell (1872-1970) -- Phenomenology -- Nominalism -- Gottfried Wilhelm Leibniz (1646-1716) -- Ethics -- Philosophy of science -- Baruch Spinoza (1632-1677) -- Philosopy of religion. (shrink)

The last decade has seen an explosion of interest in the health and welfare of marginalized communities around the world. In one striking indicator, public and private development assistance for health programs increased from $8.65 billion in 1998 to $21.79 billion in 2007 [1]. There has been emergent academic interest as well, with growing ranks of undergraduate and graduate students and professionals adopting the field as their specialty. Despite the burgeoning interest, however, much about the field remains unclear. Reimagining Global (...) Health is an important contribution to this budding field for two reasons: it proposes a cohesive introductory text for a field in desperate need of one, and it seeks to “reimagine” some key concepts in global health in an effort to provide a bold new direction for the field. Its stated aim is to move global health from a mere “collection of problems” into an identifiable discipline .As a textbook, the work succeeds admirably. The book .. (shrink)

Global Mental Health is a field of research and practice that addresses the expansion of universal and equitable mental health care worldwide. This article explores the ways the concept of culture is employed in Global Mental Health literature. Global Mental Health advocates and critics assume an ontological separation between ‘nature’ and ‘culture’ to typify mental illness, linking it predominantly to one or the other of these two categories. Advocates of Global Mental Health view mental disorders as a nature–culture hybrid, while (...) critics see them as typically cultural phenomena. The cultural critique of Global Mental Health can be strengthened by a sociological approach to both the role of critique and the uses of the concept of culture within social sciences. As an alternative to the ontologization of culture, we propose a different theoretical approach to the social issues involved in the expansion of international public health care in mental health: Arthur Kleinman's and Didier Fassin’s moral anthropological approaches. (shrink)

Machine generated contents note: Preface; Introduction; Part I. Global Health, Definitions and Descriptions: 1. What is global health? Solly Benatar and Ross Upshur; 2. The state of global health in a radically unequal world: patterns and prospects Ron Labonte and Ted Schrecker; 3. Addressing the societal determinants of health: the key global health ethics imperative of our times Anne-Emmanuelle Birn; 4. Gender and global health: inequality and differences Lesley Doyal and Sarah Payne; 5. Heath systems and health Martin McKee; Part (...) II. Global Health Ethics, Responsibilities and Justice: Some Central Issues: 6. Is there a need for global health ethics? For and against David Hunter and Angus Dawson; 7. Justice, infectious disease and globalisation Michael Selgelid; 8. International health inequalities and global justice: toward a middle ground Norman Daniels; 9. The human right to health Jonathan Wolff; 10. Responsibility for global health? Allen Buchanan and Matt DeCamp; 11. Global health ethics: the rationale for mutual caring Solly Benatar, Abdallah Daar and Peter Singer; Part III. Analyzing Some Reasons for Poor Health: 12. Trade and health: the ethics of global rights, regulation and redistribution Meri Koivusalo; 13. Debt, structural adjustment and health Jeff Rudin and David Sanders; 14. The international arms trade and global health Salahaddin Mahmudi-Azer; 15. Allocating resources in humanitarian medicine Samia Hurst, Nathalie Mezger and Alex Mauron; 16. International aid and global health Anthony Zwi; 17. Climate change and health: risks and inequities Sharon Friel, Colin Butler and Anthony McMichael; 18. Animals, the environment and global health David Benatar; 19. The global crisis and global health Stephen Gill and Isabella Bakker; Part IV. Shaping the Future: 20. Health impact fund: how to make new medicines accessible to all Thomas Pogge; 21. Biotechnology and global health Hassan Masun, Justin Chakma and Abdallah Daar; 22. Food security and global health Lynn McIntyre and Krista Rondeau; 23. International taxation Gillian Brock; 24. Global health research: changing the agenda Tikki Pang; 25. Justice and research in developing countries Alex John London; 26. Values in global health governance Kearsley Stewart, Gerald T. Keusch and Arthur Kleinman; 27. Poverty, distance and two dimensions of ethics Jonathan Glover; 28. Teaching global health ethics James Dwyer; 29. Towards a new common sense: the need for new paradigms of global health Isabella Bakker and Stephen Gill; Index. (shrink)

In this study, we investigate the use of narrative in online conversations among persons suffering from chronic opiate addiction and evaluate both its positive and negative uses. Illness narratives, as argued by sociologist Arthur Frank and psychiatrist/medical anthropologist Arthur Kleinman, enable patients to give order to life experiences and receive support from others. We wished to explore under what circumstances online support coalesces and breaks apart. The narratives we examined exemplify two topics frequently discussed on the message (...) board: the recovery process and what it means to be ‘clean’. To better understand these narratives from a theoretically based approach, we used the work of rhetorical theorist Kenneth Burke. Burke's description of two human motives, suffering and perfection, led us to an understanding of how unification and division happened within the online community. We found that the recovery narrative primarily embodied the author's suffering and, consequently, received support from other members of the message board. The second narrative centered on what it means to be ‘clean’ through a discussion of the author's desire to court temptation, revealing what Burke calls the rotten nature of perfection. As a result, the author of the narrative provoked disagreements and did not receive support. (shrink)

O presente ensaio se empenha em problematizar elementos contidos nos conceitos de illness e disease proposto pelo Dr. Arthur Kleinman ; especificamente no capítulo II do seu livro “The illness narratives: surfering, healing and the human condition. Nesta obra Kleinman vai dissecar o fenômeno da enfermidade e suas aflições tendo reflexos nas reações psicológicas e sociais. Ou seja, a disease tendo desdobramento na illness. A questão fundamental a que esse ensaio propõe é pensar uma inversão e refletir (...) se illness altera disease? Minha proposta é adentrar neste caminho pela via das reações emocionais e homeostasia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:Developing Health Care in Severely Resource-Constrained SettingsPaul Farmer and Sadath SayeedThis symposium of Narrative Inquiry in Bioethics catalogues the experiences of health care providers working in resource-poor settings, with stories written by those on the frontlines of global health. Two commentaries by esteemed scholars Renee Fox and Byron and Mary-Jo Good accompany the narratives, helping situate the lived experiences of global health practitioners within the frameworks of sociology and (...) medical anthropology respectively.The burgeoning interest in global health among students, health science trainees, clinical practitioners, social entrepreneurs, philanthropists, and government officials is often linked with substantial moral claims. People working in global health often start with the rhetorical premise that each and every human being, regardless of economic, social, or political circumstances that lie beyond his or her control, deserves equal access to quality health care services. This is a bold position at risk of trivialization, in part because the sentiment is so commonplace among global health equity activists.Despite this relatively recent global outpouring of solidarity and concern, billions of poor people still lack access to basic health services. All too often, interventions that perpetuate existing trade practices and market economics are promoted, usually to the detriment of the poor. As our good friend and colleague Arthur Kleinman warns:The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power.(1999, p.72)If we are serious about reducing health disparities globally, we must be prepared to mobilize resources in Africa just as we would in the United States or in Europe. If we fetishize cost-effective (read: low-cost) interventions for the poor, we must ask whether we use the same metrics in other situations. In other words, we must always strive to address the fundamental structural and social causes of health inequity.We believe that global health must avoid the "iron cage of rationality," to use sociologist Max Weber's words. One unanticipated consequence of the growth of global health as a field is that the "audit culture"—which encourages accountability and effectiveness—can at times reinforce power differentials between donors (whether government agencies or multilateral foundations) and their intended beneficiaries. Agendas are often set not by community members but by global health leaders who rarely demonstrate sustained commitments to a local community. [End Page 73]As the guest editors of this issue, we hope to recapture the soul of global health work through the art of storytelling. Narratives, even when presented as raw and unrefined as many within this issue, remind us of the immense challenges—both programmatic and moral—involved in this work. The profound scarcity of resources available to health providers in poor countries forces ethical questions on doctors, nurses, pharmacists, social workers, and other health care workers, who make difficult choices every day about what to do with the few resources they have. These are the ethical dilemmas of mortal dramas at their most dire. Global health work demands of its practitioners an alternate mode of audit than academic methodologies can provide. Narratives return us to the basic human commitments that led many of us to this work, and they remind us to use words like equality and justice meaningfully.The narratives that follow offer unmitigated perspectives on the working lives of global health practitioners. They highlight the translation of the moral and programmatic challenges of health care delivery into real choices: for example, between a visiting surgeon's desire to treat a patient and his capacity (or really incapacity) to provide follow-up care. They acknowledge the necessity of interdisciplinary cooperation in resource-constrained settings, as well as the difficulties in collaborating across cultures and continents. Most importantly, they make the claim that a newborn in distress in a tent in Port-au-Prince merits the same resources and attention as one in Boston, and that his or her death merits the same indignation. They demonstrate the radical solidarity inherent in the... (shrink)

We present a game mechanic called pseudo-visibility for games inhabited by non-player characters (NPCs) driven by reinforcement learning (RL). NPCs are incentivized to pretend they cannot see pseudo-visible players: the training environment simulates an NPC to determine how the NPC would act if the pseudo-visible player were invisible, and penalizes the NPC for acting differently. NPCs are thereby trained to selectively ignore pseudo-visible players, except when they judge that the reaction penalty is an acceptable tradeoff (e.g., a guard might accept (...) the penalty in order to protect a treasure because losing the treasure would hurt even more). We describe an RL agent transformation which allows RL agents that would not otherwise do so to perform some limited self-reflection to learn the training environments in question. (shrink)

A fundamental question asked in modal logic is whether a given theory is consistent. But consistent with what? A typical way to address this question identifies a choice of background knowledge axioms (say, S4, D, etc.) and then shows the assumptions codified by the theory in question to be consistent with those background axioms. But determining the specific choice and division of background axioms is, at least sometimes, little more than tradition. This paper introduces generic theories for propositional modal logic (...) to address consistency results in a more robust way. As building blocks for background knowledge, generic theories provide a standard for categorical determinations of consistency. We argue that the results and methods of this paper help to elucidate problems in epistemology and enjoy sufficient scope and power to have purchase on problems bearing on modalities in judgement, inference, and decision making. (shrink)

In the following interview, philosophers Leonard Fleck and Arthur Ward discuss the latter’s recent experience of being a nondirected kidney donor. The interview took place in the Center for Bioethics and Social Justice at Michigan State University.

Many Faculties of Education in the UK and elsewhere have ‘social justice’ written into their mission statements. But are they concerned by questions of social justice in education, or has the term become somewhat vacuous and devoid of substantive meaning? The present article subjects recent discourses about social justice in education to scrutiny and finds them wanting in various respects, in particular when juxtaposed with historical accounts of justice by philosophers such as Aristotle or Aquinas. Among the complaints made here (...) is that most educational accounts (a) make do with a ‘negative’ conception of social justice as focused on specific cases of injustices without any positive conception of what social justice means in its entirety, (b) foreground institutional justice at the expense of justice as a moral or civic virtue, (c) fail to connect the identification of justice or injustice to an account of phronesis or practical wisdom for integrating values, (d) shy away from associating social justice with the ‘common good’ and (e) fail to get to grips with some thorny normative questions about the role of justice in the ordering of goods in a hierarchy towards the highest good. Along the way, various remedies are suggested. (shrink)

How do we appreciate a work of art? Awarded a Guggenheim Fellowship to explore connections between art, mind, and brain, Arthur Shimamura takes findings from psychological and brain sciences to address ways of understanding our aesthetic responses.

Whistleblowers remain essential as complainants in allegations of research misconduct. Frequently internal to the research team, they are poorly protected from acts of retribution, which may deter the reporting of misconduct. In order to perform their important role, whistleblowers must be treated fairly. Draft regulations for whistleblower protection were published for public comment almost a decade ago but never issued. In the face of the growing challenge of research fraud, we suggest vigorous steps, to include: organizational responsibility to certify the (...) accuracy of research including audit, required whistleblower action in the face of imminent or grave harm to subjects, strengthened legal protections against retaliation including prompt enactment of Federal whistleblower protections and consideration of criminalizing the most egregious cases of research misconduct. (shrink)

Use of normothermic regional perfusion (NRP) for organ recovery in donation after circulatory death (DCD) raises two crucial, and intertwined, ethical questions. The first is whether the use of NRP...

The paper presents an analysis and interpretation of axiology and ethics as seen by the writer and philosopher Ayn Rand. The author follows the assumption that, in a situation where indifference is observed with regard to values (cf. Simmel, Sloterdijk), a return of philosophical reasoning to the idea of objectivity of values could be worthwhile. Therefore, he examines a specific type of axiological objectivism that can be found in Rand’s work. In the present paper, the suggested comparison with Baden neo-Kantism (...) as well as phenomenological axiology serves to capture the specifics of Rand’s axiological approach. These lie in placing emphasis on such a relationship between facts and values in which values result from the facts of reality, as well as in the very understanding of the objectivity of values that Rand identifies with long-term life goals and identifies them as an objective necessity for an individual’s life. Following the analysis of Rand’s axiology, the author focuses on her understanding of ethics, which he places in contrast to Kant’s deontology, as well as morality, which he views through the prism of a business relationship based on the exchange of values. The aim of the paper is to, by means of an analysis and interpretation of Rand’s ideas, show that objective values can be understood as a necessary prerequisite for consequential ethics and an individual living a happy life without being anchored in transcendence or social consensus. (shrink)

We study whether it is possible to generalise Seidenfeld et al.’s representation result for coherent choice functions in terms of sets of probability/utility pairs when we let go of Archimedeanity. We show that the convexity property is necessary but not sufficient for a choice function to be an infimum of a class of lexicographic ones. For the special case of two-dimensional option spaces, we determine the necessary and sufficient conditions by weakening the Archimedean axiom.

Originally published in 1951, this concise book presents an engaging study of the works and influence of the renowned English philosopher Ralph Cudworth, the leader of the Cambridge Platonists. A bibliography of writings by and about Cudworth is also included, together with an appendix section on his manuscripts. The text was an early work by Australian philosopher and historian of ideas John Passmore. This book will be of value to anyone with an interest in Cudworth, the Cambridge Platonists and the (...) historical development of philosophy. (shrink)