Background The often poor prognosis associated with cancer necessitates empowering patients to express their care preferences. Yet, the prevalence of Advance Directives (AD) among oncology patients remains low. This study investigated oncologists' perspectives on the interests and challenges associated with implementing AD. Methods A French national online survey targeting hospital-based oncologists explored five areas: AD information, writing support, AD usage, personal perceptions of AD's importance, and respondent's profile. The primary outcome was to assess how frequently oncologists provide patients with information (...) about AD in daily clinical practice. Additionally, we examined factors related to delivering information on AD. Results Of the 410 oncologists (50%) who responded to the survey, 75% (n = 308) deemed AD relevant. While 36% (n = 149) regularly inform patients about AD, 25% (n = 102) remain skeptical about AD. Among the respondents who do not consistently discuss AD, the most common reason given is the belief that AD may induce anxiety (n = 211/353; 60%). Of all respondents, 90% (n = 367) believe patients require specific information to draft relevant AD. Physicians with experience in palliative care were more likely to discuss AD (43% vs 32.3%, p = 0.027). Previous experience in critical care was associated with higher levels of distrust towards AD (31.5% vs 18.8%, p = 0.003), and 68.5% (n = 281) of the respondents expressed that designating a “person of trust” would be more appropriate than utilizing AD. Conclusion Despite the perceived relevance of AD, only a third of oncologists regularly apprise their patients about them. Significant uncertainty persists about the safety and relevance of AD. (shrink)

BackgroundThe ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity (...) they are trained to.MethodsWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days.Results525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient’s (210 answers, 40%) and relative’s communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in “at risk” hospital settings.ConclusionSelf-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life. (shrink)

The contributors to this volume have approached the problem of characterizing and classifying emotions from the perspectives of neurophysiology, psychology, and ...

A decision under ‘complete uncertainty’ is one where the decision maker knows the set of possible outcomes for each decision, but cannot assign probabilities to those outcomes. This way, the problem of ranking decisions is reduced to a problem of ranking sets of outcomes. All rankings that have emerged in the literature in this domain imply transitivity. In the current study, transitivity is subjected to an empirical evaluation in two experiments, where subjects are asked to choose between sets of monetary (...) consequences. After analysis with a Bayes Factor, very few violations of transitivity were found. It can be concluded that transitivity seems a plausible condition for the ranking of sets of monetary consequences. (shrink)

We consider first order modal logic C firstly defined by Carnap in “Meaning and Necessity” [1]. We prove elimination of nested modalities for this logic, which gives additionally the Skolem-Löwenheim theorem for C. We also evaluate the degree of unsolvability for C, by showing that it is exactly 0′. We compare this logic with the logics of Henkin quantifiers, Σ11 logic, and SO. We also shortly discuss properties of the logic C in finite models.

La pensée de la différence de Luisa Muraro - philosophe italienne, membre de la librairie des femmes de Milan - déjà présentée dans un précédent numéro de CLIO (n° 12) mérite ici d’être redécouverte à travers cette oeuvre singulière qu’est L’ordre symbolique de la mère. Traduit de l’italien, cet ouvrage est original d’un double point de vue. Sa structure, tout d’abord. En effet, aux six chapitres répondent six contre-chants par lesquels l’auteure dévoile ses inspirations, précise ses concepts...

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews (...) constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

This compilation will mark a high point of excellence in its genre."--Gregory Vlastos, University of California, Berkeley.

Annette Baier sets the title, the genre, and the task of her book from Hume’s essay "Of Moral Prejudices." Rather than arguing from or towards general principles, these essays call upon a wide range of reading, observation, and experience: we are not only meant to be enlightened, but also invited to adopt the reflective habits of mind they exemplify. Like Hume, Baier analyzes and evaluates our attitudes and customs; like him, she finds that our foibles and our strengths are closely (...) linked; and like him, she is both a proponent and a model of good sense. When she is unfairly prejudiced— as she is against what she sees as the harsh and narrow rigors of Kant—she is, with all the bonnehommie of Hume, more ready to tease than to demolish. (shrink)

The philosopher must inform himself of the relevant empirical investigation to arrive at a definition, and the scientist cannot afford to be naive about the..

The challenge of explaining the emotions has engaged the attention of the best minds in philosophy and science throughout history. Part of the fascination has been that the emotions resist classification. As adequate account therefore requires receptivity to knowledge from a variety of sources. The philosopher must inform himself of the relevant empirical investigation to arrive at a definition, and the scientist cannot afford to be naive about the assumptions built into his conceptual apparatus. The contributors to this volume have (...) approached the problem of characterizing and classifying emotions from the perspectives of neurophysiology, psychology, and social psychology as well as that of philosophical psychology. They discuss the difficulties that arise in classifying the emotions, assessing their appropriateness and rationality, and determining their function in motivating moral action. (shrink)

Courage is dangerous. If it is defined in traditional ways, as a set of dispositions to overcome fear, to oppose obstacles, to perform difficult or dangerous actions, its claim to be a virtue is questionable. Unlike the virtue of justice, or a sense of proportion, traditional courage does not itself determine what is to be done, let alone assure that it is worth doing. If we retain the traditional conception of courage and its military connotations–overcoming and combat–we should be suspicious (...) of it. Instead of automatically classifying it as a virtue, attempting to develop and exercise it, we should become alert to its dangers. And yet and yet. There is an aspect of traditional courage that serves us: we require the capacities and traits that enable us to persist in acting well under stress, to endure hardships when following our judgments about what is best is difficult or dangerous. If courage is checked, redefined as the virtue that enables virtue–the various sets of dispositions, whatever they may be, that make us resolute in worthy, difficult action–then we need not fear the dangers of courage. We need rather to reform it by diversifying it, as a heterogeneous variety of traits that enable us to act well under stress, against the natural movements of self-protection. (shrink)

During the period from Descartes to Rousseau, the mind changed. Its domain was redefined; its activities were redescribed; and its various powers were redistributed. Once a part of cosmic Nous, its various functions delimited by its embodied condition, the individual mind now becomes a field of forces with desires impinging on one another, their forces resolved according to their strengths and directions. Of course since there is no such thing as The Mind Itself, it was not the mind that changed. (...) Conceptions of the mind changed. Yet even to say this is misleading, because it suggests that somewhere out there in nowhere there is Nous, Psyche, Soul or Mind, the true but opaque object of all these conceptions. But of course there is no Mind in the realm of things in themselves, waiting for us to see it truly, like a China of the noumenal world, amused that our various conceptions reveal as much about ourselves as about it. (shrink)

A major contention of our bookHellenism in the Eastwas that the most profitable way for making progress in understanding the Achaemenid and Seleucid empires was to try to evaluate, sensitively, the very disparate types of evidence within their own social and cultural contexts, however difficult this might be in practice. In the case of the Antiochus I cylinder we are confronted by an inscribed object whose significance lies as much in its physical form as in the content of the text (...) it bears. These aspects are inextricably intertwined as part of a tradition specific to Mesopotamian culture—object and text combined are the physical representation of a major, longstanding, sociopolitical institution for which a mass of earlier evidence exists. It is all too understandable that Greco-Roman scholars, who have been the primary students of the hellenistic world, should find it hard to know how to approach such material emanating from an unfamiliar cultural milieu. Yet, for once, this text isnotfragmentary—it is a long, well-preserved document, easy to read and readily accessible in translation which in itself demonstrates an acknowledgment by hellenistic historians of the potential importance of this non-Greek text for understanding Seleucid history. (shrink)

In this paper, I discuss nurses' ongoing difficulty in engaging with politics and address the persistent belief that political positioning is antithetical to quality nursing care. I suggest that nurses are not faced with choosing either caring for their patients or engaging with politics. I base my discussion on the assumption that such dichotomy is meaningless and that engaging with issues of relationships firmly grounds nursing in the realm of politics. I argue that the ethical merit of nursing care relies (...) instead on positioning nurses squarely at the centre of care activities, experiences, and functions. Such positioning makes possible what Foucault called ‘practices of self‐formation’, that is, micro‐level processes that balance out the ubiquitous economic, cultural, legal, and scientific technologies that steadily constitute subjects in this era of modernity. Nurses, then, become not a group that needs to be controlled and governed, but individuals who must care for their self before they may care for anyone else. (shrink)

Since many varieties of self-deception are ineradicable and useful, it would be wise to be ambivalent about at least some of its forms.1 It is open-eyed ambivalence that acknowledges its own dualities rather than ordinary shifty vacillation that we need. To be sure, self-deception remains dangerous: sensible ambivalence should not relax vigilance against pretence and falsity, combating irrationality and obfuscation wherever they occur.

Many have said, and I think some have shown, that it is irrational to fear death. The extinction of what is essential to the self—whether it be biological death or the permanent cessation of consciousness—cannot by definition be experienced by oneself as a loss or as a harm.

There is more akrasia than meets the eye: it can occur in speech and perception, cognitively and emotionally as well as between decision and action. The lures of akrasia are the same as those that are exercised in ordinary psychological and cognitive inferential contexts. But because it is over-determined and because it occurs in opaque intentional contexts, its attribution remains highly fallible.

Comment la bande dessinée rend-elle compte de l’argent ? Comment sont pensés les liens entre argent et lien social ? Ce texte essaie de répondre à ces questions en examinant principalement trois récits grand public dans lesquels utopie de l’absence de monnaie et contre-utopie de l’introduction de la monnaie sont âprement discutées : Obélix et Compagnie , Le Schtroumpf financier et Achille Talon et l’Archipel de Sanzunron . Si les deux premiers décrivent un univers perturbé par l’introduction de la monnaie (...) et les valeurs nouvelles qu’elle véhicule, le troisième dénonce comme utopique l’idée de s’extraire des rapports d’argent. La représentation commune de l’argent que véhicule la bande dessinée apparaît généralement fortement négative.How do comics handle the idea of money? How do they reflect on the relationships between money and social ties? This paper attempts to answer these questions, mainly through an examination of three stories aimed at a general readership and involving a fierce contest between a Utopian absence of money and a aimed at a general readership and involving a fierce contest between a Utopian absence of money and a counter-Utopian advent of money: “Obélix et Compagnie” , “Le Schtroumpf financier” and “Achille Talon et l’Archipel de Sanzunron” . While the first two describe a world disrupted by the introduction of money and the new values it conveys, the third denounces the idea of withdrawing from monetary relationships as Utopian. In general, representations of money conveyed by comics are highly negative. (shrink)

The essays in this volume form a commentary on Descartes' _Meditations_. Following the sequence of the meditational stages, the authors analyze the function of each stage in transforming the reader, to realize his essential nature as a rational inquirer, capable of scientific, demonstrable knowledge of the world. There are essays on the genre of meditational writing, on the implications of the opening cathartic section of the book on Descartes' theory of perception and his use of skeptical arguments; essays on the (...) theory of ideas and their role of Descartes' reconstructive analytic method; essays on the proofs for the existence of God, on the role of the will in the formation and malformation of judgments; and the essays on the foundations of the science of extension and on Descartes' account of the union of mind and body. (shrink)

This article interrogates the extent to which institutional discourses on the governance of religious minorities are useful to think about the complexity of how religion gets negotiated in the quotidian. It takes as its starting point the exploration of the discourse on religious governance in the province of Quebec organized around the notion of request for accommodations. Through an analysis of public policy documents, it examines facets of this discourse of request, including the role it plays in delimiting what we (...) imagine the religious to be and how we imagine it to work. Second, drawing on interviews with self-identified Muslims in Montreal, the article explores how piety gets negotiated in their everyday. These narratives are approached as fertile sites to think differently about the recognition of difference. This two-pronged perspective acts as an invitation to think more broadly about not only what institutional discourses “produce” but also what they “obscure.”. (shrink)

The harvest and the pigeons. A note on the summit course of the pillar of Prusias at Delphi The remains of the pillar of Prusias, next to the temple of Apollon at Delphi, have generated much comment. Indeed, the course that supported the equestrian statue of the king of Bithynia presents 112 mortises, above and beyond the attachment holes of the statue itself. Until the present, it has been thought that these cavities served to attach vegetal elements, ears of corn (...) reaped by a laborer or, after the identification of the base as belonging to the pillar of Prusias, a field of corn signifying the beneficence of the king. A trail of textual and archaeological indications prompts a different interpretation for this enigmatic arrangement. The mortises would have served the insertion of bronze points (obeloi or meniskoi) forming a system of protection against defacement by birds, as is occasionally the case in sculpture and in temple architecture. (shrink)

L’étude du portique de Delphes attribué initialement aux Étoliens a été entreprise par A. Perrier en 2007 et les campagnes de relevés de terrain, commencées à la fin de l’année 2010 avec J.‑J. Malmary (architecte) et L. Fadin (topographe), se sont achevées en 2013 par des vérifications sur le monument, les derniers relevés ayant été mis au net en 2014. Un mémoire sur l’histoire, l’architecture et la topographie du portique et de sa terrasse a été déposé à l’Académie des inscriptions (...) et belles... (shrink)

While we primarily love individual persons, we also love our work, our homes, our activities and causes. To love is to be engaged in an active concern for the objective well-being—the thriving—of whom and what we love. True love mandates discovering in what that well-being consists and to be engaged in the details of promoting it. Since our loves are diverse, we are often conflicted about the priorities among the obligations they bring. Loving requires constant contextual improvisatory adjustment of priorities (...) among our commitments. Besides delighting in—and being enhanced by—the presence and existence of another person, love requires extended reflection and work. (shrink)

Flow describes a state of intense experiential involvement in an activity that is defined in terms of nine dimensions. Despite increased interest in understanding the flow experience of musicians in recent years, knowledge of how characteristics of the musician and of the music performance context affect the flow experience at the dimension level is lacking. In this study, we aimed to investigate how musicians’ general music performance anxiety level and the presence of an audience influence the nine flow dimensions. The (...) participants were 121 university music students who performed solo a music piece once by themselves and once in front of an audience. Their general MPA level was measured with an adapted version of the STAI and ranged from 27 to 76. The level of the nine flow dimensions was assessed with the Flow State Scale-2 after each performance. The levels of “concentration on task at hand,” “sense of control,” and “autotelic experience” decreased significantly with increasing general MPA level. The levels of “unambiguous feedback” and “loss of self-consciousness” decreased significantly with increasing general MPA level during the public performance only. The level of “sense of control” was significantly lower during the public performance than the private performance across participants. The level of “unambiguous feedback” was significantly lower during the public performance than the private performance for participants with a general MPA level higher than 47. The level of “loss of self-consciousness” was significantly lower during the public performance than the private performance for participants with a general MPA level higher than 32. In contrast, the general MPA level and the audience did not significantly affect the levels of “challenge-skill balance,” “clear goals,” and “action-awareness merging.” These results show that the effects of general MPA level and audience vary greatly across flow state dimensions. We conclude that musicians’ flow state should be analyzed at the dimension level rather than as a global score. We discuss how our findings could inform the development and implementation of interventions. (shrink)

In this volume, thirteen philosophers contribute new essays analyzing the criteria for personal identity and their import on ethics and the theory of action: it ...

We are all ambivalent at every turn. “Should I skip class on this gorgeous spring day?” “Do I really want to marry Eric?” Despite being uncomfortable and unsettling, there are some forms of ambivalence that are appropriate and responsible. Even when they seem trivial and superficial, they reveal some of our deepest values, the self-images we would like to project. In this paper, I analyze collaborative ambivalence, the kind of ambivalence that arises from our identity-forming close relationships. The sources and (...) resolutions of collaborative ambivalence reveal how much of our thinking—and so also of our motivational structure—emerges from the details of our collaborative and dialogical engagements. The imaginative skills and strategies exercised in remaining justifiably of two minds—of preserving appropriate ambivalence—are central to practical reasoning. Because these skills provide models for addressing conflicts in the public sphere, because they prompt shared deliberation, they are among the civic virtues. (shrink)