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

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

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

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

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

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

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

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

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

The authors developed this textbook in response to an increasing interest in ethics, and a growing number of courses on this topic that are now being offered in educational leadership programs. It is designed to fill a gap in instructional materials for teaching the ethics component of the knowledge base that has been established for the profession. The text has several purposes: First, it demonstrates the application of different ethical paradigms (the ethics of justice, care, critique, and the profession) through (...) discussion and analysis of real-life moral dilemmas that educational leaders face in their schools and communities. Second, it addresses some of the practical, pedagogical, and curricular issues related to the teaching of ethics for educational leaders. Third, it emphasizes the importance of ethics instruction from a variety of theoretical approaches. Finally, it provides a process that instructors might follow to develop their own ethics unit or course. * Part I provides an overview of why ethics is so important, especially for today's educational leaders, and describes a multiparadigm approach essential to practitioners as they grapple with ethical dilemmas. * Part II deals with the dilemmas themselves. Ethical dilemmas written by the authors' graduate students bring readers face-to-face with the kinds of dilemmas faced by practicing administrators in urban, suburban, and rural settings in an era full of complexities and contradictions. * Part III focuses on pedagogy and provides teaching notes for the instructor. The authors discuss the importance of self-reflection on the part of both instructors and students, and model how they thought through their own personal and professional ethical codes as well as reflected upon the critical incidents in their lives that shaped their teaching and frequently determined what they privileged in class. (shrink)

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

Stewart Shapiro's ambition in Vagueness in Context is to develop a comprehensive account of the meaning, function, and logic of vague terms in an idealized version of a natural language like English. It is a commonplace that the extensions of vague terms vary according to their context: a person can be tall with respect to male accountants and not tall (even short) with respect to professional basketball players. The key feature of Shapiro's account is that the extensions of (...) vague terms also vary in the course of conversations and that, in some cases, a competent speaker can go either way without sinning against the meaning of the words or the non-linguistic facts. As Shapiro sees it, vagueness is a linguistic phenomenon, due to the kinds of languages that humans speak; but vagueness is also due to the world we find ourselves in, as we try to communicate features of it to each other. (shrink)

Two currently much discussed views about truth, truth pluralism and truth relativism, are found in Sellars’s writings. I show that his motivations for adoping these views are interestingly different from those shared by most of their recent advocates. First, I explain how Sellars comes to embrace a version of truth pluralism. I argue that his version overcomes a difficulty confronting pluralists, albeit at a serious cost. Then I argue that Sellars’s truth pluralism isn’t motivated by his interest in domains of (...) discourse beyond the “matter-of-factual.” Rather, the key to his truth pluralism, his analysis of truth as “semantical assertibility,” is motivated by the same consideration that leads him to adopt truth relativism. This is his interest in applying semantic notions to discourse that embodies conceptual structures other than ours. Despite their common motivation, I conclude that Sellars’s relativism is independent of, and indeed stands in tension with, the analysis of truth that underlies his pluralism. (shrink)

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

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

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

Introduction -- The freedom of philosophy -- Reason and madness -- The death of man -- The anonymity of literature -- From archaeology to genealogy -- The prison -- Repressed sexuality -- A true sex -- Political power, rationality, and critique -- Practices of the self.

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

We examine George Boolos's proposed abstraction principle for extensions based on the limitation-of-size conception, New V, from several perspectives. Crispin Wright once suggested that New V could serve as part of a neo-logicist development of real analysis. We show that it fails both of the conservativeness criteria for abstraction principles that Wright proposes. Thus, we support Boolos against Wright. We also show that, when combined with the axioms for Boolos's iterative notion of set, New V yields a system equivalent to (...) full Zermelo-Fraenkel set theory with a principle of global choice. This advances Boolos's longstanding interest in the foundations of set theory. (shrink)

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

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

This important new collection considers Jurgen Habermas's discourse theory from a variety of feminist vantage points. Feminist scholars have been drawn to Habermas's work because it reflects a tradition of emancipatory political thinking rooted in the Enlightenment and engages with the normative aims of emancipatory social movements. The essays in Feminists Read Habermas analyze various aspects of Habermas's work, ranging from his moral theory to political issues of identity and participation. The contributors share a conviction about the potential significance of (...) Habermas's work for feminist reflections on power, norms and subjectivity. (shrink)

Intensified job demands originate in the general accelerated pace of society and ever-changing working conditions, which subject workers to increasing workloads and deadlines, constant planning and decision-making about one’s job and career, and the continual learning of new professional knowledge and skills. This study investigated how individual characteristics, namely negative and positive affectivity related to competence demands, and multitasking preference moderate the association between IJDs and cognitive stress symptoms among media workers. The results show that although IJDs were associated with (...) higher cognitive stress symptoms at work, that is, difficulties in concentration, thinking clearly, decision-making, and memory, competence demands-related negative affectivity explained the most variance in cognitive stress symptoms. In addition, IJDs were more strongly associated with cognitive stress symptoms at work in individuals with high competence demand-related negative affectivity, and low multitasking preference. Altogether, the present findings suggest that HR practices or workplace interventions to ease employees’ negative affectivity from increasing competence demands at work could usefully support employees’ effective cognitive functioning when confronted with IJDs. (shrink)

Some scientists are happy to follow in the footsteps of others; some like to explore novel approaches. It is tempting to think that herein lies an epistemic division of labor conducive to overall scientific progress: the latter point the way to fruitful areas of research, and the former more fully explore those areas. Weisberg and Muldoon’s model, however, suggests that it would be best if all scientists explored novel approaches. I argue that this is due to implausible modeling choices, and (...) I present an alternative ‘epistemic landscape’ model that demonstrates the alleged benefits from division of labor, with one restriction. (shrink)

This study describes the ways in which professionals in two contexts of health care: general practice and homeopathic consultations, respond to patients' affective expressions of a trouble or a problem. The focus is on the turns of professionals that display understanding, compassion or agreement with the patient's account. Different types of affiliative turns are described and their consequences for the following interaction are scrutinized in relation to the institutional task of solving the patients' health-related problems. It is shown that in (...) both contexts, affiliation is oriented to as working towards closing the sequence of troubles-telling and serves to shift back to problem-solving activity, whilst in homeopathy, it may also serve as a means to problem-solving and thus help to complete the institutional task at hand. Some implications of these observations for professional—client interaction will be described. To conclude, the role of emotion in institutional interaction will also be discussed. (shrink)

This paper defends revealed preference theory against a pervasive line of criticism, according to which revealed preference methodology relies on appealing to some mental states, in particular an agent’s beliefs, rendering the project incoherent or unmotivated. I argue that all that is established by these arguments is that revealed preference theorists must accept a limited mentalism in their account of the options an agent should be modelled as choosing between. This is consistent both with an essentially behavioural interpretation of preference (...) and with standard revealed preference methodology. And it does not undermine the core motivations of revealed preference theory. (shrink)

A neuropsychological perspective on auditory verbal hallucinations links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH – such as thought insertion. In this paper, I propose that an APS framework offers (...) a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI. (shrink)

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

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

To be healed is to make ourselves whole, embracing our lost voices and forgotten selves that have been denied and therefore hidden. Debbie Shapiro examines this intimate connection between the mind and body in Your Body Speaks Your Mind, revealing insights into how our emotional and psychological states affect us physically. Comparing various medical approaches, Shapiro intersperses case studies, research and exercises as she explores the bodymind connection -- how unresolved thoughts and feelings affect our health and manifest (...) as illness in specific parts of the body. This healing guide explores the structural body from the head to the toes, and the inner relationship of each part. We are given tools for using the power of the mind and heart to heal the body through breath awareness, movement, re-laxation, meditation, creative visualization, and other complementary healing techniques. In Your Body Speaks Your Mind, we find that the path back to health is a journey of self trust and inner strength. In the process we come to a different purpose, one that gives rise to a new priority: that of our salvation, our freedom, and a discovery of our true potential. (shrink)

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

Next SectionIntensification of poverty and degradation of health infrastructure over recent decades in countries most affected by HIV/AIDS present formidable challenges to clinical research. This paper addresses the overall standard of health care (SOC) that should be provided to research participants in developing countries, rather than the narrow definition of SOC that has characterised the international debate on standards of health care. It argues that contributing to sustainable improvements in health by progressively ratcheting the standard of care upwards for research (...) participants and their communities is an ethical obligation of those in resource-rich countries who sponsor and implement research in poorer ones. (shrink)

This first book of the series, contains the theory and technique on how to recognize your own presence and your connectedness to everything else, experiencing oneness, through the state of awareness. Making emphasis on how to clear the soul from any blockages, emotions or other filters that may affect that experience of recognizing the true self.

Discourse ethics represents an exciting new development in neo-Kantian moral theory. William Rehg offers an insightful introduction to its complex theorization by its major proponent, Jürgen Habermas, and demonstrates how discourse ethics allows one to overcome the principal criticisms that have been leveled against neo-Kantianism. Addressing both "commun-itarian" critics who argue that universalist conceptions of justice sever moral deliberation from community traditions, and feminist advocates of the "ethics of care" who stress the moral significance of caring for other individuals, Rehg (...) shows that discourse ethics combines impartiality with solidarity. He provides the first systematic reconstruction of Habermas's theory and explores its relationship to the work of such contemporary philosophers as Charles Taylor. His book articulates a bold alternative to the split between the "right" and the "good" in moral theory and will greatly interest philosophers, social and legal scholars, and political theorists. (shrink)