Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and (...) power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs. (shrink)

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, Arvan hopes to demonstrate that we ought to evaluate moral theories in a similar manner to the sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of rightness as fairness meets the scientific evaluative standards better than any of the alternatives. I’m afraid I was unconvinced that we should abandon our preferred moral (...) theories in favor of rightness as fairness. (shrink)

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, hopes to demonstrate that we ought to evaluate moral theories in a similar manner to sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of ‘rightness as fairness’ meets the scientific evaluative standards better than any of the alternatives.

The punchy central claim of Torbjörn Tännsjö's book is that act-utilitarianism best explains our considered intuitions about the moral status of different kinds of killing. An interesting aspect of this book is Tännsjö's revisionary methodology, which he names 'Applied Ethics (Turned Upside Down)'. So, why does Tännsjö choose applied ethics (turned upside down) to argue for act-utilitarianism's role in explaining our considered intuitions about killing and what, exactly, is his innovative method of moral investigation?

Previous research suggests that exposure to nature may reduce delay discounting and thereby facilitate healthier dietary intake. This pre-registered study examined the impact of online exposure to images of natural scenes on delay discounting and food preferences. It was predicted that exposure to images of natural scenes would be associated with: lower delay discounting; higher desirability for fruits and vegetables ; and delay discounting would mediate the effect of nature-image exposure on food desirability. Adult participants were recruited to an online (...) between-subjects experiment in which they viewed a timed sequence of six images either showing natural landscape scenes or urban scenes. They then completed measures of mood, delay discounting and rated their momentary desire to eat four fruits and vegetables, and four energy-dense foods. There was no statistically significant effect of experimental condition on delay discounting or food desirability. Bayes factors supported the null hypothesis for discounting, and energy-dense food desirability, but provided no strong evidence for either hypothesis for F&V desirability. These findings indicate that brief online exposure to images of nature does not affect momentary impulsivity or energy-dense food preference, whereas for preference for less-energy dense foods, the evidence was inconclusive. (shrink)

Transient receptor potential vanilloid 4 (TRPV4), a member of the TRP superfamily, is a broadly expressed, cell surface‐localized cation channel that is activated by a variety of environmental stimuli. Importantly, TRPV4 has been increasingly implicated in the regulation of cellular morphology. Here we propose that TRPV4 and the cytoskeletal remodeling small GTPase RhoA together constitute an environmentally sensitive signaling complex that contributes to pathological cell cytoskeletal alterations during neurological injury and disease. Supporting this hypothesis is our recent work demonstrating direct (...) physical and bidirectional functional interactions of TRPV4 with RhoA, which can lead to activation of RhoA and reorganization of the actin cytoskeleton. Furthermore, a confluence of evidence implicates TRPV4 and/or RhoA in pathological responses triggered by a range of acute neurological insults ranging from stroke to traumatic injury. While initiated by a variety of insults, TRPV4–RhoA signaling may represent a common pathway that disrupts axonal regeneration and blood–brain barrier integrity. These insights also suggest that TRPV4 inhibition may represent a safe, feasible, and precise therapeutic strategy for limiting pathological TRPV4–RhoA activation in a range of neurological diseases. (shrink)

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

The aim of the article is to illustrate concrete problems in the asymmetrical nurse–patient power relationship. It is an ethical demand that the nurse is faced with the challenges that the power in the relation is administered so that the patient's room for action is expanded and trust maintained. It is an essential message in care philosophy, but in clinical practice, success is not always achievable. A hidden and more or less unconscious restriction of the patient's room for action may (...) result in the excesses of care. Three selected aspects: dependence, trust, and power described by the Danish philosopher K.E. Løgstrup and the Norwegian nursing philosopher Kari Martinsen's care philosophy has inspired this empirically based examination of some current barriers in the asymmetrical nurse–patient relationship. On the basis of qualitative interviews with six patients and six nurses, the research thus provides an identifying and problem‐exploratory examination of some current obstacles in which the handling of trust and power reflects the excesses of care. The findings develop three themes. ‘Being a burden’ acknowledges that the balance of power will always tip to the nurse's advantage. The second theme, ‘Doing only what's absolutely necessary’, shows how a fixation with ‘technicalism’ creates a distance between people that may constrain the patient's room for action. The last theme is concerning the nurse's ability to navigate between closeness and distance is essential in avoiding ‘the excesses of care’, paternalism, and overprotectiveness. A situation in which distance takes the upper hand and care turns into paternalism. A different situation would arise if the nurse's emotions became sentimental or intimate with the result that closeness gets the upper hand. To avoid a harmful exercise of power and the excesses of care, the findings have demonstrated that a relationship‐based caring is a demand for situation‐specific sensitive attention skills. (shrink)

In a criminal trial, a judge or jury needs to reason about what happened based on the available evidence, often including statistical evidence. While a probabilistic approach is suitable for analysing the statistical evidence, a judge or jury may be more inclined to use a narrative or argumentative approach when considering the case as a whole. In this paper we propose a combination of two approaches, combining Bayesian networks with scenarios. Whereas a Bayesian network is a popular tool for analysing (...) parts of a case, constructing and understanding a network for an entire case is not straightforward. We propose an explanation method for understanding a Bayesian network in terms of scenarios. This method builds on a previously proposed construction method, which we slightly adapt with the use of scenario schemes for the purpose of explaining. The resulting structure is explained in terms of scenarios, scenario quality and evidential support. A probabilistic interpretation of scenario quality is provided using the concept of scenario schemes. Finally, the method is evaluated by means of a case study. (shrink)

In cases of complicity in one’s own unfreedom and in structural injustice, it initially appears that agents are only vicariously responsible for their complicity because of the roles circumstantial and constitutive luck play in bringing about their complicity. By drawing on work from the phenomenological tradition, this paper rejects this conclusion and argues for a new responsive sense of agency and responsibility in cases of complicity. Highlighting the explanatory role of stubbornness in cases of complicity, it is argued that although (...) agents may only be vicariously responsible for becoming complicit, they can be held more directly responsible for entrenching their complicity. The complicit agent is responsible for their complicity to the extent that they fail to take responsibility for it. (shrink)

In the current paper, our aim is to explore the latent power dynamics surrounding corporate social responsibility in developing countries. To do this, we synthesize an analytic framework that borrows from both cross-cultural management literature as well as feminist considerations of power. We then use the framework to examine three streams of CSR literature. Our analysis uncovers the prevalence of arguments and discussions about indigenous and power-over themes rather than more generative, endogenous, and power-to themes. The paper concludes with the (...) suggestion for more space in the CSR literature for examining the realities and potentialities of local SME CSR expressions to counterbalance the overwhelming focus on MNCs. Such counterbalancing can better lead to the recognition that power and domination are not the only important dynamics to examine in CSR research. Just as important is the need for a more nuanced consideration of the role and contributions of different actors to the continuously unfolding CSR discourse. (shrink)

ABSTRACT Testimony from victims of gendered violence is often wrongly disbelieved. This paper explores a way to address this problem by developing a phenomenological approach to testimony. Guided by the concept of ‘disclosedness’, a tripartite analysis of testimony as an affective, embodied, communicative act is developed. Affect indicates how scepticism may arise through the social moods that often attune agents to victims’ testimony. The embodiment of meaning suggests testimony should not be approached as an assertion, but as a process of (...) ‘articulating an understanding’. This account is deepened in the discussion of testimony as a communicative act. It is argued that testimony must be considered as a relational whole, and thus our aim in receiving victims’ testimony should be to honour the relational conditions under which the truth of testimony can be heard. Approaching testimony as the collaborative process of enabling an understanding to be articulated can enhance our conception of gendered violence, whilst also better serving the victims of gendered violence by helping to overcome the lack of trust and excessive scepticism with which victims’ testimony is often met. (shrink)

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

* INTRODUCTION This book seeks to add dimension to our understanding of Greek Skepticism by concentrating attention on a particular area that is of ...

This book presents a series of informal biographies about major figures in the history of psychology. A unique combination of expertise and human appeal, the volume places the contributions of each pioneer in a new and fascinating perspective. For instance, several of the authors use the novel approach of having the pioneers return to the present day to reflect back on their work as it relates to the here and now. Revisions of speeches given in a popular series of invited (...) addresses at psychological conventions, the chapters offer appealing glimpses into the lives of individuals who made a difference in the early years of psychology as a field of study. Each of the five volumes in this series contains different profiles thereby bringing more than 100 of the pioneers in psychology more vividly to life. (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

Paternalism has attracted new defenders in recent years. Such defenders typically either downplay the normative significance of autonomy or deny that we are sufficiently rational for paternalistic interventions to be objectionable.1 Both of these argumentative strategies constitute challenges to John Stuart Mill’s influential anti-paternalistic ‘harm principle’, which states that coercive interference with the liberty of competent adults is justifiable only if such interference prevents harm to non-consenting third parties (Mill, p. 23).2 In this journal, Wilkinson has provided a novel, provocative (...) defence of paternalism in the medical context—one that (provisionally) accepts rather than challenges Mill’s harm principle.3 Wilkinson’s argument is complex. But he begins with Parfit’s influential account of personal identity.4 According to Parfit, Alice at T1 can be the same person as Alice at T2, but the extent to which Alice at T1 and Alice at T2 are similar depends on the extent to which there are ‘chains’ of strong psychological connections between Alice at T1 and Alice at T2. Strong psychological connections, in turn, are mental states such as intentions or beliefs, or psychological traits. For example, if Alice at T2 remembers very little about herself the day before, and the day before that, all the way to Alice at T1, Alice at T2 has completely different psychological traits than Alice at T1—for example, Alice at T1 was courageous, whereas Alice at T2 is cowardly—then Alice at T1 and Alice at T2 are distinct persons. If the harm principle is correct and Alice is autonomous, it is permissible to interfere with Alice’s liberty only if it prevents harm to some non-consenting third party. But if we accept Parfit’s view on personal identity, then a novel defence of paternalistic intervention emerges: Alice at T2 may well be a distinct person from Alice at T1. So, …. (shrink)

Stem cells may have a special importance in the neoplastic behavior of certain lineages as well as in the normal development of these tissues. The role of oncogenes, and their normal cellular analogues, in stem cell behavior is therefore of special interest. This review describes recent results on the effects of virally‐mediated src‐gene transfer into hemopoietic stem cells in the physiological and developmental properties of these cells.

Feminists have always been concerned with how the clothes women wear can reinforce and reproduce gender hierarchy. However, they have strongly disagreed about what to do in response: some have suggested that the key to feminist liberation is to stop caring about how one dresses; others have replied that the solution is to give women increased choices. In this paper, we argue that neither of these dominant approaches is satisfactory and that, ultimately, they have led to an impasse that pervades (...) the contemporary feminist debate. The problem is that both sides of the debate understand women’s complicity in patriarchal subordination as a matter of what women wear and do. Instead, we propose a phenomenological analysis that understands complicity as based in our relations to our clothes. Starting from this phenomenological perspective, we sketch a new relational feminist ethics of dressing. This alternative ethical paradigm cannot yield a simple recipe for how to dress or tell us what garments are off-limits. But it can offer a way to make critical feminist judgements about clothes without veering into a stifling new prescriptivism. (shrink)

The article examines the construction of “Big Data” in media discourse. Rather than asking what Big Data really is or is not, it deals with the discursive work that goes into making Big Data a socially relevant phenomenon and problem in the first place. It starts from the idea that in modern societies the public understanding of technology is largely driven by a media-based discourse, which is a key arena for circulating collectively shared meanings. This largely ignored dimension invites us (...) to appreciate what matters to journalists and the wider public when discussing the collection and use of data. To this end, our study looks at how Big Data is framed in terms of the governmental use of large datasets as a contentious area of data application. It reconstructs the perspectives surrounding the so-called “Handygate” affair in Germany based on broadcast news and social media conversations. In this incident, state authorities collected and analyzed mobile phone data through a radio cell query during events to commemorate the Dresden bombing in February 2011. We employ a qualitative discourse analysis that allows us to reconstruct the conceptualizations of Big Data as a proper instrument for criminal prosecution or an unjustified infringement of constitutional rights. (shrink)

In the field of placebo studies residual disagreement about the terminology ‘placebo’ and ‘placebo effect’ still persists. We differentiate between the conceptualization of placebos in clinical trials; and placebo effects understood as a psychobiological phenomenon. With respect to the latter, we argue that a scientific ‘placebo paradigm’ has emerged, indicating that—at least among placebo scientists—there exists relatively stable consensus about how to conceive of placebo effects. We claim that existence of a placebo paradigm does not protect concepts from revision; nonetheless, (...) we argue that scientific progress is dependent on, and guided by relative conceptual stability. Therefore, to mount persuasive arguments for conceptual revision in respect of ‘placebo effects’ we argue, critics either need to defend the claim that a placebo paradigm is not underway, or that there are major scientific failings in respect of it. With these considerations in mind we examine three alternative proposals for conceptual reform: Grünbaum/Howick’s relativity models of placebo concepts; Moerman/Brody’s meaning response; and Nunn/Turner’s proposal for conceptual eliminativism. We derive two conclusions from this evaluation. First, we conclude that no convincing arguments have so far been presented for conceptual overhaul of ‘placebo effects.’ Notwithstanding this analysis, we conclude that refinement of this concept is likely. Second, we agree with Turner and Nunn that the term ‘placebo’ in the context of randomized controlled trials remains a source of confusion for many researchers, risking the design and scientific integrity of clinical findings. Therefore, in these contexts, replacing the term ‘placebo’ with ‘control’ is justified. (shrink)

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians. However, even in countries that have implemented (...) the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

This chapter offers a reinterpretation of Heidegger’s conception of the social world in order to overcome the tension between its conflicting positive and negative characterisations in Being and Time. Rejecting a purely positive or a purely negative reading of das Man, the chapter follows Stephen Mulhall in carving out a middle ground between the two. The chapter takes seriously Heidegger’s claim that it is possible for das Man to undergo an authentic transformation, exploring how best to conceive of this idea. (...) It is argued that the authentic transformation of das Man and the everyday way of being it engenders, is most productively understood with reference to Dasein’s relation to das Man and the way Dasein grasps the world as meaningful. Through this reading it is shown how both an authentic and an inauthentic mode of everydayness can be accommodated. The chapter concludes with an examination of the consequences of this interpretation, arguing for the critical and political potential of authenticity as an attentive and engaged mode of being-in-the-world. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

In a criminal trial, evidence is used to draw conclusions about what happened concerning a supposed crime. Traditionally, the three main approaches to modeling reasoning with evidence are argumentative, narrative and probabilistic approaches. Integrating these three approaches could arguably enhance the communication between an expert and a judge or jury. In previous work, techniques were proposed to represent narratives in a Bayesian network and to use narratives as a basis for systematizing the construction of a Bayesian network for a legal (...) case. In this paper, these techniques are combined to form a design method for constructing a Bayesian network based on narratives. This design method is evaluated by means of an extensive case study concerning the notorious Dutch case of the Anjum murders. (shrink)