Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

With a unique blend of clinical compassion and philosophical reflection, Donna M. Orange illuminates the nature and process of psychoanalytic understanding within the intimate and healing human context of treatment. Moving away from objectivist empiricism and its polar opposite, constructivist relativism, her work details a paradigm shift to a perspectival realism that does justice to the concerns of both. Laying the groundwork for a fuller, more encompassing view of psychoanalytic practice, Emotional Understanding is enlightening reading for all mental health (...) professionals interested in psychodynamic theory and treatment. (shrink)

This study examines the impact of a social desirability response bias as a personality characteristic (self-deception and impression management) and as an item characteristic (perceived desirability of the behavior) on self-reported ethical conduct. Findings from a sample of college students revealed that self-reported ethical conduct is associated with both personality and item characteristics, with perceived desirability of behavior having the greatest influence on self-reported conduct. Implications for research in business ethics are drawn, and suggestions are offered for reducing the effects (...) of a socially desirable response bias. (shrink)

In Buddhism the idea of a transcendental or eternal self is denied as non-substantial and impermanent: a non-verifiable metaphysical entity that leads to grasping, craving and suffering. Buddhism posits that things continually change, are continually reducible and recyclable, and that no inherent existence or metaphysical “self” exists but rather a series of aggregates give rise to the experience so that consciousness itself is causally conditioned. As applied to the notion of no- self the one who is reborn and the one (...) who dies and the one who follows the path and the one who realizes enlightenment are neither the same nor different selves. With the Buddhist doctrine of impermanence an analysis of the notion of the “self” breaks down into layers to discover that the self does not exist independently at all. Because of simultaneous arising and falling of each moment the self exists as essentially empty. (shrink)

Jerry Fodor has charged that Fred Dretske's account of content suffers from indeterminacy to the extent that we should reject it in favor of Fodor‘s own account. In this paper, we ask what the problem of indeterminacy really is; we distinguish a relatively minor problem we call ‘looseness of fit’ from a major problem of failing to show how to point to what is not there. We sketch Dretske's account of content and how it is supposed to solve the major (...) problem. After presenting Fodor's challenge as the claim that Dretske has failed to solve the major problem, we articulate a response available to Dretske. Although we do not think the response is ultimately successful, we argue that it is every bit as good as the response Fodor has offered to a similar challenge, in his so-called ‘mixed theory.’ The upshot is this: despite advertisements to the contrary, Fodor's theory, in its mixed version, offers no real advantages over Dretske's regarding the serious problem of indeterminacy. (shrink)

_Thinking for Clinicians_ provides analysts of all orientations with the tools and context for working critically within psychoanalytic theory and practice. It does this through detailed chapters on some of the philosophers whose work is especially relevant for contemporary theory and clinical writing: Emmanuel Levinas, Martin Buber, Ludwig Wittgenstein, Maurice Merleau-Ponty, and Hans-Georg Gadamer. Orange presents the historical background for their ideas, along with clinical vignettes to help contextualize their theories, further grounding them in real-world experience. With a hermeneutic sensibility (...) firmly in mind, _Thinking for Clinicians_ rewards as it challenges and will be a valuable reference for clinicians who seek a better understanding of the philosophical bases of contemporary psychoanalytic theory. (shrink)

The study assesses how a social desirability (SD) bias influences the relationship between several independent and dependent variables commonly investigated in ethics research. The effect of a SD bias was observed when a questionnaire was administered under varying conditions of anonymity and with different measurement techniques for the SD construct. Findings reveal that a SD bias is present in the majority of relationships studied, and it most frequently plays a moderating role. While the measure of SD influences the strength and (...) type of relationship, condition of anonymity has relatively little effect on the level of SD. (shrink)

In _Plato's_ Timaeus _and the Missing Fourth Guest_, Donna M. Altimari Adler offers an original account of Plato's Timaeus from 35a-36d, yielding a new interpretation of the _Timaeus_ scale and cosmic harmony imbedded in the text.

Psychoanalysis engages with the difficult subjects in life, but it has been slow to address climate change. Climate Crisis, Psychoanalysis, and Radical Ethics draws on the latest scientific evidence to set out the likely effects of climate change on politics, economics and society more generally, including impacts on psychoanalysts. Despite a tendency to avoid the warnings, times of crisis summon clinicians to emerge from comfortable consulting rooms. Daily engaged with human suffering, they now face the inextricably bound together crises of (...) global warming and massive social injustices. After considering historical and emotional causes of climate unconsciousness and of compulsive consumerism, this book argues that only a radical ethics of responsibility to be "my other s keeper" will truly wake us up to climate change and bring psychoanalysts to actively take on responsibilities, such as demanding change from governments, living more simply, flying less, and caring for the earth and its inhabitants everywhere. Linking climate justice to radical ethics by way of psychoanalysis, Donna Orange explores many relevant aspects of psychoanalytic expertise, referring to work on trauma, mourning, and the transformation of trouble into purpose. Orange makes practical suggestions for action in the psychoanalytic and psychotherapeutic communities: reducing air travel, consolidating organizations and conferences, better use of internet communication and education. This book includes both philosophical considerations of egoism as problematic, together with work on shame and envy as motivating compulsive and conspicuous consumption. The interweaving of climate emergency and massive social injustice presents psychoanalysts and organized psychoanalysis with a radical ethical demand and an extraordinary opportunity for leadership. Climate Crisis, Psychoanalysis, and Radical Ethics will provide accessible and thought-provoking reading for psychoanalysts and psychotherapists, as well as philosophers, environmental studies scholars and students studying across these fields. ". (shrink)

That Wittgenstein in the Tractatus likens logic to geometry has been noticed; however, the extent and force of the analogy he develops between logical form and a broadly Kantian account of geometry has not been sufficiently appreciated. In this paper, I trace Wittgenstein's analogy in detail by looking closely at the relevant texts. I then suggest that we regard the fact that Wittgenstein develops his account of logical form by analogy with a Kantian account of geometry as evidence for the (...) bold thesis that Wittgenstein belongs within a Kantian epistemological tradition. Finally, I supply two small pieces of the interpretive puzzle needed to support the larger thesis: first, evidence that Wittgenstein's concern with logical form involves a crucial epistemological component; second, a sketch of how Wittgenstein's account of logical and mathematical knowledge can be viewed as continuing a Kantian tradition. (shrink)

In October 1993, a survey of health care agency administrators was undertaken shortly after they had experienced two sudden reductions in public funding. The purpose of this investigation was to gain insight into the role of ethics in health administrator decision making. A mail questionnaire was designed for this purpose. Descriptive statistics and content analysis were used to summarize the data. Staff reductions and bed closures were the two most frequently reported mechanisms for addressing the funding reductions. Most administrators did (...) not believe that these changes would have a negative public impact. In contrast, the majority indicated that future changes in reaction to additional funding reductions would have a negative public impact. Approximately one-third of the administrators reported ethics to be an element of recent administrative decision making, and one-half could foresee that ethics would be important in the future if reductions continued. These findings are discussed in relation to ethics. Issues for additional research are outlined. (shrink)

For every uncountable regular cardinalκ and any cardinalλ≧κ,P κ λ denotes the set $\left\{ {x \subseteqq \lambda :\left| x \right|< \kappa } \right\}$ . Furthermore, < denotes the binary operation defined inP κ λ byx (...) + denotes the setP κ λ−I, andI * the filter dual toI.An idealI overP κ λ is said to benormal iff every functionf:P κ λ→λ with the property that {x∈P κ λ:f(x)∈x}∈I + is constant on a set inI +.I is said to bestrongly normal iff every functionf:P κ λ→P κ λ with the property that {x∈P κ λ:x∩xκ≠Ø∧f(x)shrink)

Nourishing the Inner Life of Clinicians and Humanitarians: The Ethical Turn in Psychoanalysis, demonstrates the demanding, clinical and humanitarian work that psychotherapists often undertake with fragile and devastated people, those degraded by violence and discrimination. In spite of this, Donna M. Orange argues that there is more to human nature than a relentlessly negative view. Drawing on psychoanalytic and philosophical resources, as well as stories from history and literature, she explores ethical narratives that ground hope in human goodness and (...) shows how these voices, personal to each analyst, can become sources of courage, warning and support, of prophetic challenge and humility which can inform and guide their work. Over the course of a lifetime, the sources change, with new ones emerging into importance, others receding into the background. Donna Orange uses examples from ancient Rome, from twentieth century Europe, from South Africa, and from nineteenth century Russia. She shows how not only can their words and examples, like those of our personal mentors, inspire and warn us; but they also show us the daily discipline of spiritual self-care, although these examples rely heavily on the discipline of spiritual reading, other practitioners will find inspiration in music, visual arts, or elsewhere and replenish the resources regularly. Nourishing the Inner Life of Clinicians and Humanitarians will help psychoanalysts to develop a language with which to converse about ethics and the responsibility of the therapist/analyst. This is an exceptional contribution highly suitable for practitioners and students of psychoanalysis and psychotherapy. Donna M. Orange teaches, consults, and offers study groups for psychoanalysts and gestalt therapists. She seeks to integrate contemporary psychoanalysis with radically relational ethics. Recent books are _Thinking for Clinicians: Philosophical Resources for Contemporary Psychoanalysis and the Humanistic Psychotherapies _, and _The Suffering Stranger: Hermeneutics for Everyday Clinical Practice_, both from Routledge. (shrink)

Saul Kripke recently has published an interpretation of the later Wittgenstein's rule-following problem as a "sceptical paradox," the conclusion of which is that language is impossible. In this dissertation, I document the history of the rule-following problem in Wittgenstein's writings, thereby providing a historical perspective not provided by Kripke. In chapters I and II, I develop a broadly Kantian interpretation of the epistemology of the Tractatus. My interpretation conflicts both with interpretations according to which the Tractatus implicitly embodies an empiricist (...) epistemology or no epistemology at all and with idealist readings. In chapter III, I extend the comparison between Wittgenstein and Kant, arguing that there is an important sense in which the notion of thought is fundamental in the Tractatus. My interpretation conflicts with interpretations according to which the Tractarian theory of meaning requires a mental act of "dubbing" which correlates signs and objects as well as with interpretations according to which nothing mental is presupposed. On one hand, chapters I-III can be read independently of chapters IV and V as an interpretation of some aspects of the Tractatus. On the other hand, these chapters lay the groundwork for my argument in chapter IV that the rule-following problem in the Philosophical Investigations is a general and forceful restatement of the problem of an infinite regress of interpretations to which the Tractarian theory of meaning was supposed to provide a solution. For various reasons, which I recount, Wittgenstein became dissatisfied with his early answer, and the problem reappears in his later work. Finally, in chapter V, I present and evaluate Kripke's interpretation of the rule-following problem from the historical perspective developed in the preceding chapters. I suggest that Kripke fails to see that it is a carry-over of a problem with which Wittgenstein wrestled in the Tractatus. In addition, although he recognizes that the later Wittgenstein believes that no fact or process could account for our ability to represent the world, he does not show clearly why Wittgenstein believes that this is so. (shrink)

Previous studies have shown that misperceptions and illusory experiences can occur if sensory stimulation is withdrawn or becomes invariant even for short periods of time. Using a perceptual deprivation paradigm, we created a monotonous audiovisual environment and asked participants to verbally report any auditory, visual or body-related phenomena they experienced. The data (analysed using a variant of interpretative phenomenological analysis) revealed two main themes: (1) reported sensory phenomena have different spatial characteristics ranging from simple percepts to the feeling of immersion (...) in a complex multisensory environment and (2) the active contribution of the perceiver where participants report engaging in exploratory processes even when there is nothing to find. Detailed analysis of the qualitative data further showed that participants who reported more perceptual phenomena were more likely to report internal bodily sensations, move more during the experiment and score higher on the Revised Hallucination Scale than those reporting fewer percepts explicitly linking perceptual deprivation to somatic phenomena. The results demonstrate how the variety of sensory experiences induced by perceptual deprivation can give further insight into the factors mediating conscious awareness and may suggest ways in which the brain imposes meaning on the environment under invariant sensory conditions. (shrink)

This textbook offers a unique and accessible approach to ethical decision-making for practicing pharmacists and student pharmacists. Unlike other texts, it gives clear guidance based on the fundamental principles of moral philosophy, explaining them in simple language and illustrating them with abundant clinical examples and case studies. The strength of this text is in its emphasis on normative ethics and critical thinking, and that there is truly a best answer in the vast majority of cases, no matter how complex. The (...) authors place high trust in a pharmacist’s moral judgment. This teaches the reader how to think, based on ethical principles, not necessarily what to think. This means navigating between the two extremes of overly theoretical and excessively prescriptive. The cogent framework given in this text uses the language of competing duties, identifying the moral principles at stake that create duties for the pharmacist. This is the balancing act of normative ethics, and of deciding which duties should prevail in a given clinical situation. This work presents a clear-cut pathway for resolving ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Presents a clear-cut pathway for resolving the ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Jon E. Sprague, RPh, PhD, Director of Science and Research for the Ohio Attorney General. (shrink)

This book addresses fundamental issues in linguistic theory, including the relation between formal and cognitive approaches, the autonomy of syntax, the content of universal grammar, and the value of generative and functional approaches to grammar. It focuses on the grammar of case relations, signalled by morphological case, prepositions, and word order. Part I offers a critical history of modern grammars of case, focussing on the last four decades and setting this in the context of earlier, including ancient, developments. The subjects (...) considered include the evolution of ideas concerning deep structure and semantic and grammatical relations, and arguments for the maintenance of the traditional central position of case in the grammar. In parts II and III Professor Anderson examines the category of case and central unresolved issues in the grammar of case. The latter include questions relating to the idea of an ontologically-based grammar, particularly the degree to which syntactic categories and relationships are grounded in meaning, and the notion of linguistic creativity. This involves a consideration of the way in which cases may be identified and whether their distribution is determined through semantics. The book sheds new light on the interactions between meaning and grammar and on the structure and development of lexical and grammatical systems. The argument and its far-reaching consequences will be of wide interest to linguists, philosophers and others seeking to understand the workings of language. (shrink)

This book is the first systematic account of the syntax and semantics of names. Drawing on work in onomastics, philosophy, and linguistics John Anderson examines the distribution and subcategorization of names within a framework of syntactic categories, and considers how the morphosyntactic behaviour of names connects to their semantic roles. He argues that names occur in two basic circumstances: one involving vocatives and their use in naming predications, where they are not definite; the other their use as arguments of (...) predicators, where they are definite. This division is discussed in relation to English, French, Greek, and Seri, and a range of other languages. Professor Anderson reveals that the semantic status of names, including prototypicality, is crucial to understanding their morphosyntax and role in derivational relationships. He shows that semantically coherent subsets of names, such as those referring to people and places, are characterized by morphosyntactic properties which may vary from language to language. His original and important investigation will appeal to scholars and advanced students of linguistics and philosophy. (shrink)

What is hermeneutics? -- The suffering stranger and the hermeneutics of trust -- Sandor Ferenczi : the analyst of last resort and the hermeneutics of trauma -- Frieda Fromm-Reichmann : incommunicable loneliness -- D.W. Winnicott : humanitarian without sentimentality -- Heinz Kohut : glimpsing the hidden suffering -- Bernard Brandchaft : liberating the incarcerated spirit.

It is generally agreed that Parmenides’ fragment B3 posits some type of relation between “thinking” and “Being.” I critically examine the modern interpretations of this relation. Beginning with the ancient sources and proceeding into modern times, I try to show that the modern rationalist reading of fragment B3 conflicts with its grammatical syntax and the context of the poem as a whole. In my critique, I suggest that rather than a statement about epistemological relations, it is, as it was originally (...) understood, a religious assertion of metaphysical identity. (shrink)

Psychoanalysis, History, and Radical Ethics: Learning to Hear explores the importance of listening, being able to speak, and those who are silenced, from a psychoanalytic perspective. In particular, it focuses on those voices silenced either collectively or individually by trauma, culture, discrimination and persecution, and even by the history of psychoanalysis. Drawing on lessons from philosophy and history as well as clinical vignettes, this book provides a comprehensive guide to understanding the role of trauma in creating silence, and the importance (...) for psychoanalysts of learning to hear those silenced voices. (shrink)

This essay makes two points: (a) Dualities between implicit and explicit?like the older ones between body and mind, primary and secondary process, nonverbal and symbolic, inner and outer, unconscious and conscious, emotion and cognition, and so on?can be understood as poles on a complex continuum of experience or as aspects of complex experiential systems; and (b) metaphor in dialogue can create a process of understanding between people and aspects of their experience that seem, on the face of it, to be (...) very far apart or even beyond comprehension. (shrink)

In March 1994, a health care conference was held in Edmonton, Alberta, at which the values of conference participants towards health care were systematically recorded and analysed. This exploration is significant because the values that underpin the structure of the current publicly-funded and administered Canadian health care system rarely enter current discussions regarding health care system reform. Rather, economic and other sociopolitical forces now seem to be having a major impact on plans and actual changes within the health care system. (...) Thus, the underlying attitudes and beliefs of Canadians towards health care have not been articulated or given due credence. The conference par ticipants identified three dominant values: (1) the dignity of the human person as an indi vidual and social being; (2) respect for pluralism and difference; and (3) accountability These values were found to be robust, in that they sustain a focus on the 'common good'. The common good is the core of the Canadian health care system, and is enshrined in the 1984 Canada Health Act. Conceptually, these values could also lead to significant changes in health care, in keeping with the common good, particularly those changes focusing on the current deficiencies of the Canadian health care system. (shrink)