Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...) ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST. (shrink)

Language’s intentional nature has been highlighted as a crucial feature distinguishing it from other communication systems. Specifically, language is often thought to depend on highly structured intentional action and mutual mindreading by a communicator and recipient. Whilst similar abilities in animals can shed light on the evolution of intentionality, they remain challenging to detect unambiguously. We revisit animal intentional communication and suggest that progress in identifying analogous capacities has been complicated by (i) the assumption that intentional (that is, voluntary) production (...) of communicative acts requires mental-state attribution, and (ii) variation in approaches investigating communication across sensory modalities. To move forward, we argue that a framework fusing research across modalities and species is required. We structure intentional communication into a series of requirements, each of which can be operationalised, investigated empirically, and must be met for purposive, intentionally communicative acts to be demonstrated. Our unified approach helps elucidate the distribution of animal intentional communication and subsequently serves to clarify what is meant by attributions of intentional communication in animals and humans. (shrink)

Cet ouvrage ne présente pas un système complet et cohérent, méritant le nom d'une philosophie du droit international. Une telle entreprise serait à la fois trop vaste face à une société internationale de haute complexité et aussi un peu anachronique au regard de la perte de foi dans les systèmes trop parfaits et dès lors trop réductifs. C'est plutôt une série de réflexions personnelles sur les points de droit international qui m'ont paru importants au fil des années d'étude de cette (...) matière, que je veux ici présenter. Si ces points ne s'ordonnent pas en un système, ils ne sont néanmoins pas jetés sur le papier au hasard. Ces réflexions ont ceci en commun qu'elles tentent de serrer de plus près les aspects ordonnateurs et structurants du droit international, en un mot, ses chevilles ouvrières aux points charnière ou ses voûtes névralgiques. Ces réflexions s'ordonnent autour de trois axes. Dans une première partie, il s'agit de dégager quelques caractéristiques fondamentales du droit international, qui expliquent et imprègnent ses applications. Après une discussion des types possibles de droit international et de leur réalisation dans l'histoire, il est question des grandes phases d'évolution qu'a connues le droit international depuis le temps de Grotius. Ensuite, les caractéristiques propres des sources du droit international (les sources constituant une espèce de radiographie de tout ordre juridique) sont examinées. Parmi les autres caractéristiques de la règle internationale, ce sont notamment sa tendance à l'individualisation, à l'ouverture vers les circonstances particulières des espèces, ainsi que les incidences de cette tendance, qui font l'objet de considérations. Enfin, il est question de la règle " tout ce qui n'est pas interdit est permis ", renforcée en droit international par la souveraineté. De sa place et de ses rôles exacts dépend la nature et la force de l'ordre juridique en question. Dans une seconde partie, ce sont les relations multiples du droit et de la politique qui font l'objet d'analyses. Si la politique est un facteur essentiel de vie et de réalisation de tout droit (et aussi une menace pour lui), il en est à plus forte raison ainsi en droit international, où les deux branches, droit et politique, sont particulièrement proches. L'analyse ne se borne pas à des relations stéréotypées, mais tente de dégager en catégories d'espèces une multitude de pesées réciproques entre les deux branches, dans leurs vertus centripètes et centrifuges. Enfin, dans une troisième partie importante, c'est une série de notions juridiques cardinales qui forme l'objet des réflexions. Il s'agit du bien commun ; de la justice ; de la sécurité juridique ; de la réciprocité, de l'égalité et de la proportionnalité ; de la liberté ; de la morale et de la morale sociale ; de la volonté dans ses rapports avec la raison ; de la sanction. Il s'agit de voir quelle est la configuration que l'expérience juridique générale a donnée à ces notions et par la suite d'examiner comment elles peuvent s'insérer et agir au sein du droit international au regard des spécificités de la société internationale, avec quelles analogies mais aussi avec quelles altérations ou adaptations. C'est ainsi qu'on peut dégager ce degré d'orientation juridique inhérent au " droit international " dans ses forces et ses faiblesses. (shrink)

IntroductionLittle is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence.ObjectiveTherefore, this study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection.MethodsGerman healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires at baseline (...) and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up.ResultsSeven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden.ConclusionsThis study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates. (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)

Volume 1. A - Cog -- volume 2. Col - Eg -- volume 3. El - Gi -- volume 4. Gl - L -- volume 5. M - Po -- volume 6. Pr - Sp -- volume 7. St - Z, Appendix, Index.

Wandering Arameans: Arameans outside Syria: Textual and Archaeological Perspectives. Edited by Angelika Berlejung, Aren M. Maeir, and Andreas Schüle. Leipziger Altorientalistische Studien, vol. 5. Wiesbaden: Harrassowitz Verlag, 2017. Pp. x + 298, illus. €58.

Our task is the preservation of historic towns. In America as in Europe historic town centers are surrounded by recent additions and suburban sprawl. It is tempting to imagine the task of preservation as protecting our historical heritage from a featureless wave of mediocrity, as the worldwide commercial civilization overwhelms local cultures. This story is familiar from the writings of Kenneth Frampton and others: sprawl, homogenization, loss of distinctive local and regional form. I want to disagree with this story. From (...) what force are we trying to save the historic towns? Might not that force have its own new kinds of order? Might that new order be already at work inside the historic towns? Are its effects only negative? I want to question a presupposition common in many discussion of historic preservation. This is the presupposition that a spatially distinct historic center belongs to a single community that possesses a unified self-consciousness and a unified aesthetic self-image. Local communities less and less correspond to bounded spatial areas, and spatial areas contain less and less homogeneous communities. There is growing a new kind of discontinuous unity, which is the theme of this essay. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Summary Gestalt Theoretical Psychotherapy, in the broader sense of the term, has developed in various forms on both sides of the Atlantic since the 1920s. Gestalt Theoretical Psychotherapy, in the narrower sense of the term, came into being in the second half of the 1970s in German-speaking countries. In Austria, it is a state-approved, independent scientific psychotherapy method since 1995, and an integrative psychotherapeutic approach based on the Gestalt theory of the Berlin School. With reference to this comprehensive, consistent, scientific (...) theory, this article presents the basic concepts of therapeutic practice in the field of Gestalt psychotherapy. Starting from the overarching whole to the parts, the paper first examines the concept of therapeutic relationship and therapeutic attitude, and then describes the basic principles of the practical design of the therapeutic process. (shrink)

The present paper focuses on the Arabic theological work al-Tamhīd fī bayān al-tawḥīd, authored by the Transoxanian scholar, Abū Shakūr al-Sālimī. A jurist and theologian, he belonged to the kalām -school in the succession of Abū Manṣūr al-Māturīdī, and which, based on Ḥanafī tradition, forms the second pillar of the Sunni confession alongside the doctrines of Abū l-Ḥasan al-Ashʿarī and his followers. Despite increasing activities in the field of editions during the last few decades, details of Māturīdī speculative theology still (...) remain insufficiently studied. This deficiency applies, on the one hand, to the utilization of texts, partially or not yet available in text-critical and analytically focused editions. On the other hand, a profound and pressing need for systematic research remains, particularly with regards to the relationship between Māturīdism and Ashʿarism, given that the latter has been studied in much greater detail. Against this background, al-Sālimī is presented in his historical and intellectual milieu. It is shown that his treatise is in the Ḥanafī–Māturīdī tradition, but his doctrines sometimes differ from other Māturīdī teachings. Subsequently, some key topics of the Tamhīd are addressed. A special focus is on the beginning of the dispute between Māturīdī theologians and the Ashʿariyya, where issues of epistemology, prophecy, the doctrine of God’s names and attributes, and the conception of faith that serve as typical examples of Ḥanafī jurisprudence and theology are also treated. Finally, a case study illuminates important issues at the heart of Māturīdī theology, as well as the integration of juridical topics into kalām. Through this approach, this paper intends to introduce the text as a valuable source for the study of Sunni theology in a more comprehensive sense than has previously been considered. (shrink)

Multi-stakeholder initiatives have been praised as vehicles for tackling complex sustainability issues, but their success relies on the reconciliation of stakeholders’ divergent perspectives. We yet lack a thorough understanding of the micro-level mechanisms by which stakeholders can deal with these differences. To develop such understanding, we examine what frames—i.e., mental schemata for making sense of the world—members of MSIs use during their discussions on sustainability questions and how these frames are deliberated through social interactions. Whilst prior framing research has focussed (...) on between-frame conflicts, we offer a different perspective by examining how and under what conditions actors use shared frames to tackle ‘within-frame conflicts’ on views that stand in the way of joint decisions. Observations of a deliberative environmental valuation workshop and interviews in an MSI on the protection of peatlands—ecosystems that contribute to carbon retention on a global scale—demonstrated how the application and deliberation of shared frames during micro-level interactions resulted in increased salience, elaboration, and adjustment of shared frames. We interpret our findings to identify characteristics of deliberation mechanisms in the case of within-frame conflicts where shared frames dominate the discussions, and to delineate conditions for such dominance. Our findings contribute to an understanding of collaborations in MSIs and other organisational settings by demonstrating the utility of shared frames for dealing with conflicting views and suggesting how shared frames can be activated, fostered and strengthened. (shrink)

The early modern period (roughly, 1600–1800 ce) in Europe brought tremendous changes in intellectual, political, and cultural life. It was a period in which philosophical debates were inevitably bound up with questions about the nature and sources of religious truth. A chronological examination of some of the period’s major thinkers highlights two issues that were central to the development of philosophy of religion in the period. The first concerns the relations between God, the soul, and the body; the other concerns (...) the relationship between human reason and divine revelation. (shrink)

A critique of Strawson's distinction between descriptive and revisionary metaphysics.

This squib begins with an argument emphasizing that the grammar of English makes a distinction between constituents that are focused and those that are merely new, hence not given. If the distinction is made via features, we need two features: one indicating focus and one indicating either given or new information. Which one of the two? Semantically, the choice doesn’t matter: whatever information is given is not new and the other way round. For the phonology, there is a difference, however. (...) If the prosody of all-new constituents is default prosody, but the prosody of given constituents is special, we would want to indicate givenness, rather than newness. (shrink)

To what extent are artists and sitters (or researchers and “objects” of investigation) implicated in their representations of others? How implicated are we when we identify with the way different cultures or perspectives represent ourselves? Understanding how specific forms of representation reveal differently authored perceptions of the individual is a critical concern. My overarching concern, as an artist, is to start mapping contemporary practices of identity formation and expression through the investigation of specific non- Western and subcultural modes that prioritise (...) different codes and social processes of cultural production – modes that do not privilege the gaze. Crucially, the case studies operate a strategic reversal of the classical artistic and scientific approaches: both sides in this dialogue of interpretation and representation involving the artist/researcher and the cultural actor are equally subject and object. The resulting artworks present distinct cultural practices as new possibilities for portrayal, and acts of selection, interpretation and definition as forms of cultural production. (shrink)

Postcolonial pedagogy invites academic teaching staff to create situations, in which hegemonic modes of knowledge production can be critically reflected and one’s own entanglement as disciplinary s...

Theoretical models and correlational research suggest that anger and disgust play different roles in moral judgment. Anger is theorized to underlie reactions to crimes against persons, such as battery and unfairness, and disgust is theorized to underlie reactions to crimes against nature, such as sexual transgressions and cannibalism. To date, however, it has not been shown that induction of these two emotions has divergent effects. In this experiment we show divergent effects of anger and disgust. We use sounds to elicit (...) anger and disgust, and participants are then asked to consider moral vignettes. As compared to disgust and control condition, anger increases severity of judgments about crimes against persons, and disgust increases severity of judgments about crimes against nature, but not conversely. (shrink)

Written by two of the leading figures in the field, this is a lucid and systematic introduction to semantics as applied to transformational grammars of the ...

FEX A, FLENSNER G, EK A‐C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336–347 Living with an adult family member using advanced medical technology at homeAn increased number of chronically ill adults perform self‐care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self‐care at home, either using (...) long‐term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent‐care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent‐care and transition, which may have an influence on the self‐care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. (shrink)

The paper focuses on parents and parental involvement in Germany as well as the challenges which became visible during the COVID-19 pandemic. As has been the case in many other countries, the notion of parents as partners, is the focus of normative discussion about how to engage with parents. However, looking at the role actually played by parents in school settings, and the way school institutions interact with them, it can be seen that there is a difference. This paper describes: (...) first, how the different roles that parents played were understood, prior to the pandemic; secondly, the part played by parents while schools were closed as a result of the pandemic; and thirdly, the strengthening of home-school partnerships in Germany, contrasting this with the roles parents take within them. The results are critically assessed under the broader perspective of de-familialism versus familialism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Post-Traumatic Hermeneutics: Melancholia in the Wake of TraumaAngelika Rauch (bio)1Classical Analysis: Problems for Trauma TherapyAccording to the Journal of the American Psychoanalytical Association, American ego psychology has taken a leading role in debunking what it considers antiquated Freudian approaches to the study of trauma. As neutral observers and students of the facts, ego psychologists have purportedly reclaimed the study of trauma as the search for an objectifiable traumatic event (...) in the past, one that can be accessed as recovered memory, as a specimen of pathogenic development, or as cognitive and behavioral effects that point to an inaccessible implied memory buried in the psyche. Central to this revision of psychoanalytical trauma therapy is the dismissal of Nachträglichkeit as an antiquated and irrelevant concept. Harold P. Blum, for instance, writes in a recent article of JAPA that “‘deferred action’ is an ambiguous concept, a dubious, antiquated, theoretical legacy.” According to Blum, “deferred action overlooks the immediate and potentially powerful effects of preoedipal trauma and is dissociated from considerations of cumulative trauma and developmental disturbance.” [1155]. With respect to Freud’s case of the Wolf-Man, Blum states that “[d]eferred action emphasized traumatic events and memory rather than cumulative developmental effects of shock and strain trauma, and pathogenic object relationships.” Key to Blum’s view, then, is the assertion that “the concept of deferred action deterred consideration of real infantile experience and the complex overdetermination of pathogenesis through development” [1156]. Blum apparently takes the side of those who like to argue that trauma is more real than imagined. Whereas oedipal trauma is an imaginary or illusory trauma, preoedipal trauma is comprehensible as real shock and, as such, is empirically true. This is an idea that is very compatible with “recovered memory” therapy, a subject that has become controversial in recent debates about child abuse and recovered memory syndrome.In contrast, Arnold H. Modell in Other Times, Other Realities points out that “[t]he concept of Nachträglichkeit is virtually unknown among American psychoanalysts. This may be due in part to Strachey’s faulty translation; but this idea is also inconsistent with the belief in an orderly hierarchical psychic development such as that envisioned by ego psychologists.” [3]. In other words, Freudian Nachträglichkeit violates the principles of space and time assumed by empirical scientists whose conceptions are founded on the causality of such principles as stimulus/response. It is here, of course, that ego psychology’s treatment of trauma would come into conflict not only with Freudian analysis, including its French Freudian variants, but with the kind of trauma studies being conducted by the contributors to Cathy Caruth’s Trauma: Explorations in Memory. They include Bessel [End Page 111] van der Kolk, Onno van der Hart, Shoshana Felman, Dori Laub, Robert Lifton, and, of course, Cathy Caruth herself.Emphasis on the reality of traumatic shock (as abuse, stress, accident, and so on), however important it may be, loses sight of a hermeneutical dimension of psychoanalytic therapy that Caruth and her contributors emphasize: the question of how meanings are associated or bound to the understanding of life’s events. My own clinical approach to psychoanalysis favors the introduction of an even stronger hermeneutical perspective that is sensitive to the kinds of issues raised by philosophers like Dilthey, Heidegger, Benjamin, and Gadamer, for whom the question of experience is not reducible to restricted understandings of stimulus/response, nor—as in the case of Caruth (for example, in Unclaimed Experience)—to the privileging of language as a formal (that is, literary) construct. Rather, I am interested in emphasizing a hermeneutics of the therapeutic encounter within which questions of language, culture, history, and behavior are situated. With respect to trauma therapy, I will introduce a number of well-known analytical contributions even as I take the following statement of Arnold Modell’s as my point of departure:The analyst or therapist becomes an unwitting collaborator in the recreation of the past, while still retaining a proximity to present time. The therapist becomes the person with whom one can reexperience trauma within a new context or experience for the first time what has been absent in the past. Affects belonging to... (shrink)

This book argues that tradition is not dissociable from processes of self-consciousness involving our capacity to situate ourselves in a world that includes a rich legacy of predecessors and precedents. It explores how language, the body, experience, imagination, desire, and affect are not dissociable from tradition as transference in the Freudian sense. This argument draws support from several major thinkers and offers new interpretations of them.

The Bhagavadgita is one of the most renowned texts of Hinduism because it contains discussions of important issues such as liberation and the nature of action as well as the revelation of the Krishna as the highest god and creator of the universe. It is included in the ancient Indian Mahabharata epic at one of its most dramatic moments, that is, when the final battle is about to begin. In contrast to many other studies, this book deals with the relationship (...) between the Bhagavadgita and its epic contexts. On the basis of a thorough analysis of the text Angelika Malinar argues that its theology delineates not only new philosophical concepts and religious practices but also addresses the problem of righteous kingship and appropriate use of power. Malinar concludes by considering the Bhagavadgita's historical and cultural contexts and those features of the text that became paradigmatic in later Hindu religious traditions. (shrink)