Illness narratives from patients with colorectal cancer commonly record patterns of change in social relationships that follow the diagnosis and treatment of the condition. We believe that these changes are best explained as a process of facework, which reflects losses of face on the part of the patient, and which assists in the creation of new faces that convey new senses of identity. Facework is familiar in the work by E. Goffman (1955) and has been extensively reworked since his time. (...) There is considerable agreement that face is a pervasive and universal constituent of all social interaction, and that it expresses the subject's view of the way he or she would like to be considered by others in interactions. Ho's concept of multiple faces negotiated dynamically according to social context is particularly useful in understanding the purpose and techniques of facework (D. Y.-F. Ho, 1994). We propose a model of face that uses dignity as the face-expression of personal attributes and acquisitions, and honor as the face-expression of systemic capabilities and attainments. This model can be used to examine individual variations in response and adaptation to colon cancer and its treatment, and it provides a useful means of teaching health care workers about the experience of illness. (shrink)
There is mounting evidence that strong personal relationships and spiritual beliefs contribute to our well-being. In Divine Therapy, Janet Sayers employs a biographical approach to the lives and writings of a range of eminent psychotherapists and psychologists to illuminate the link between physical and mental well-being and the 'at-one-ness' provided by love, religious and mystical experiences.
This classic, with a new introduction by Madeleine L'Engle, is by turns an entrancing mediation on language a piercing commentary on the nature of art and why so much of what we read, hear, and see falls short and a brilliant examination of the fundamental tenets of Christianity. The Mind of the Maker will be relished by those already in love with Dorothy L. Sayers and those who have not yet met her. A mystery writer, a witty and perceptive (...) theologian, culture critic, and playwright, Dorothy Sayers sheds new,unexpected light on a specific set of statements made in the Christian creeds. She examines anew such ideas as the image of God, the Trinity, free will, and evil, and in these pages a wholly revitalized understanding of them emerges. The author finds the key in the parallels between the creation of God and the human creative process. She continually refers to each in a way that illuminates both. (shrink)
Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.
Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)
For Marx, work is the fundamental and central activity in human life and, potentially at least, a ful lling and liberating activity. Although this view is implicit throughout Marx’s work, there is little explicit explanation or defence of it. The fullest treatment is in the account of ‘estranged labour’ [entfremdete Arbeit] in the Economic and Philosophical Manuscripts;1 but, even there, Marx does not set out his philosophical assumptions at length. For an understanding of these, one must turn to Hegel. Marx (...) is quite explicit about his debt to Hegel in this respect. (shrink)
What are economic exchanges? The received view has it that exchanges are mutual transfers of goods motivated by inverse valuations thereof. As a corollary, the standard approach treats exchanges of services as a subspecies of exchanges of goods. We raise two objections against this standard approach. First, it is incomplete, as it fails to take into account, among other things, the offers and acceptances that lie at the core of even the simplest cases of exchanges. Second, it ultimately fails to (...) generalize to exchanges of services, in which neither inverse preferences nor mutual transfers hold true. We propose an alternative definition of exchanges, which treats exchanges of goods as a special case of exchanges of services and which builds in offers and acceptances. According to this theory: (i) The valuations motivating exchanges are propositional and convergent rather than objectual and inverse; (ii) All exchanges of goods involve exchanges of services/actions, but not the reverse; (iii) Offers and acceptances, together with the contractual obligations and claims they bring about, lie at the heart of all cases of exchange. (shrink)
Marx conceives of labor as form-giving activity. This is criticized for presupposing a "productivist" model of labor which regards work that creates a material product — craft or industrial work — as the paradigm for all work (Habermas, Benton, Arendt). Many traditional kinds of work do not seem to fit this picture, and new "immaterial" forms of labor (computer work, service work, etc.) have developed in postindus trial society which, it is argued, necessitate a fundamental revision of Marx's approach (Hardt (...) and Negri). Marx's theory, however, must be understood in the context of Hegel's philosophy. In that light, the view that Marx has a "productivist" model of labor is mistaken. The concept of "immaterial" labor is unsound, and Marx's ideas continue to provide an illuminating framework for understanding work in modern society. (shrink)
Women currently earn 77 cents for every dollar earned by men. Explanations abound for why, exactly, this wage gap exists. One of the more potent justifications attributes this pay differential to the unequal effects of marriage on the sexes: the marital asymmetry hypothesis. However, even when marital status is accounted for, a small but significant residual gap remains. This article argues that this is the result of social factors. Entrenched societal sexism causes all of us to harbor unconscious bias about (...) the capabilities and proper gender roles of women. This bias, in turn, leads us to discount work completed by females, especially in professional environments. Employers are not immune from this effect, and the undervaluation of female ability affects hiring practices, leading to the residual wage gap. (shrink)
At a time when many professional philosophers in the English speaking world have all but given up the attempt to think critically and in large scale terms about the modern world, MacIntyre's work is defiantly untimely, and greatly welcome for that. It is remarkably wide ranging, comprehensive and thought provoking. He has been described as a `revolutionary Aristotelian', but this indicates only part of the picture. His work draws on ideas not only from Marx and Aristotle, but also from analytical (...) philosophy, philosophy of science and Thomist sources; and it combines these all together to construct a critical response to the modern condition. It has generated important debates among thinkers in all these areas. (shrink)
This paper discusses Marx’s concept of alienated (or estranged) labour, focusing mainly on his account in the Economic and Philosophical Manuscripts of 1844. This concept is frequently taken to be a moral notion based on a concept of universal human nature. This view is criticized and it is argued that the concept of alienation should rather be interpreted in the light of Hegelian historical ideas. In Hegel, alienation is not a purely negative phenomenon; it is a necessary stage of human (...) development. Marx’s account of alienated labour should be understood in similar terms. It is not a merely subjective discontent with work; it is an objective and historically specific condition, a stage in the process of historical development. Marx usually regards it as specific to capitalism. The criticism of capitalism implied in the concept of alienation, it is argued, does not appeal to universal moral standards; it is historical and relative. Overcoming alienation must also be understood in historical terms, not as the realization of a universal ideal, but as the dialectical supersession of capitalist conditions of labour. Marx’s account of communism as the overcoming of alienation is explained in these terms. (shrink)
Why work? Most people say that they work only as a means to earn a living. This is also implied by the hedonist account of human nature which underlies utilitarianism and classical economics. It is argued in this paper that Marx’s concept of alienation involves a more satisfactory theory of human nature which is rooted in Hegel’s philosophy. According to this, we are productive beings and work is potentially a fulfilling activity. The fact that it is not experienced as such (...) is shown to be at the basis of Marx’s critique of capitalist society. (shrink)
Discussion of Marxism in the Western world since the nineteen-sixties has been dominated by a reaction against Hegelian ideas.1 This agenda has been shared equally by the analytical Marxism which has predominated in the English speaking world and by the structuralist Marxism which has been the major influence in the continental tradition. The main purpose of my own work has been to reassess these attitudes.
The concept of alienation: Hegelian themes in modern social thought -- Creative activity and alienation in Hegel and Marx -- The concept of labour -- The individual and society -- Freedom and the "realm of necessity" -- Alienation as a critical concept -- Private property and communism -- The division of labour and its overcoming -- Marx's concept of communism.
The concepts of identity and community have recently been the subject of a good deal of debate in social philosophy, much of it focused on the ideas of writers like MacIntyre, Taylor, Walzer. These philosophers are often referred to as `communitarians', though they do not constitute a united school and none of them identifies himself as such. Nevertheless, there are good reasons 1 for grouping them together, for they share some important elements of common ground. In their different ways, each (...) develops a critique of liberal and individualist social theory and formulates a philosophy which recognises the reality and value of community. (shrink)
The fundamental principles of modern dialectical philosophy derive from Hegel. He sums them up as follows. ‘Everything is inherently contradictory ... Contradiction is the root of all movement and vitality, it is only in so far as something has a contradiction within it that it moves, has an urge and activity' (Hegel 1969, 439). In Hegel's philosophy these ideas form part of an all−embracing idealist system which portrays all phenomena ×− both natural and social ×− as subject to dialectic. Marx (...) inherits and transforms these ideas; but how precisely he does so has been a topic of much dispute within western Marxism. Marx himself describes his relation to Hegel with the aid of a couple of graphic but vague metaphors. He says that he turns Hegel's dialectic ‘right side up' in order to ‘discover the rational kernel within the mystical shell' (Marx 1961, 20). But how can this be done? Is there a ‘rational kernel' to Hegel's dialectic? If so, how can it be extracted? (shrink)
Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors’ decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed (...) ought to make such decisions, and whether the relatives’ preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors’ decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious , because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death. (shrink)
The concept of alienation is one of the most important and fruitful legacies of Hegel's social philosophy. It is strange therefore that Hegel's own account is widely rejected, not least by writers in those traditions which have taken up and developed the concept in the most influential ways: Marxism and existentialism.
The dialectical method, Marx Insisted, was at the basis of his account of society. In 1858, in a letter to Engels, he wrote: In the method of treatment the fact that by mere accident I again glanced through Hegel's Logic has been of great service to me... If there should ever be the time for such work again, I would greatly like to make accessible to the ordinary human intelligence, in two or three printer's sheets, what is rational in the (...) method which Hegel discovered.1 But he never did find the time for this work. As a result, Marx's dialectical method and the ways in which it draws on Hegel's philosophy remain among the most controversial and least well understood aspects of Marx's work. My purpose in this paper is to explain some of the basic presuppositions of this method and to bring out their significance for Marx's theories. I shall do so by focusing critically on G.A. Cohen 's account of Marxism in Karl Marx's Theory of History: A Defence. In this important and influential work, Cohen contrives to give an account of 2 Marxism in entirely non-dialectical – indeed, in anti-dialectical – terms. By criticising Cohen 's views I will seek to show that the dialectical method is the necessary basis for an adequate theory of history and an indispensable part of Marx's thought. The major purpose of Cohen 's book is to develop and defend a particular interpretation of historical materialism, the Marxist theory of historical development. Cohen claims that his account is an `old-fashioned' and a `traditional' one ; and, indeed, in certain respects it is. For, in contrast to the tendency of much recent Marxist writing, Cohen strongly emphasises the materialistic and deterministic character of Marx's theory of history. He insists that the development of the productive forces is the primary motive force for historical change, and portrays Marxism as a form of technological determinism. However, there are various different forms of materialism, not all of them Marx's. (shrink)
The paper by Szasz is about mental illness and its meaning, and like Procrustes, who altered hapless travellers to fit his bed, Szasz changes the meanings of words and concepts to suit his themes.1 Refuting the existence of “mental illness”, he suggests that the term functions in an apotropaic sense. He submits that in this sense it is used to avert danger, protect society, and hence justify preventive detention of “dangerous” people.But his arguments misrepresent the precise meaning of the term (...) “apotropaic”, which is an adjective, defined in Webster’s, Chambers and the New Shorter Oxford dictionaries as averting or turning aside evil. It is possible that amulets and incantations ward off evil, in the same way as garlic repels vampires, but evil and danger are different concepts. Yet Szasz talks of using phrases like ‘“dangerousness to self and others’ as apotropaics to ward off dangers we fear”, and the word “evil” does not appear in his paper.I will argue that “dangerousness to self and others” and “psychiatric treatment” have a prosaic rather than an apotropaic function.The word “danger” is familiar rather than arcane, and includes many risks. A predatory paedophile is usually both dangerous and evil, but many dangerous people are not evil. For example, a child who plays with a box of matches is dangerous, as is a demented person who drives a car, or a schizophrenic who, acting on delusional beliefs, arms herself with a knife and roams the streets believing she is an avenging angel.Suppose …. (shrink)
Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.Setting—A large district general hospital in the United Kingdom.Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision (...) making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.Results—Twenty-four were inadequately informed of their illness.Forty-six said they would want to know were something serious to be found. Twenty-eight wanted to make their own decision if requiring risky treatment and 11 wanted family members involved. Thirty-one wanted to make a cardiopulmonary resuscitation decision and five of these decisions differed from those made by the doctors. Twenty-five preferred the doctors to decide. Eleven of the patients had heard of living wills but only one had executed such a will. Seven of the patients wished to provide advance directives. Three did not find the history taking helpful but none were discomforted.Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences. (shrink)
`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)
The concept of authenticity -- the idea of `being oneself' or being `true to oneself' -- is central to modern moral thought. Yet it is a puzzling notion. This article discusses two accounts of it. Essentialism holds that each individual has a `true' nature or self. Feelings and actions are authentic when they correspond to this nature. This approach is contrasted with views of the self as a complex entity in which all parts are essential, and in which authenticity involves (...) the harmonious functioning of all parts together. This approach is illustrated from Freud and Plato, and defended against the charge of conservatism (Marcuse) and the postmodernist rejection of the very idea of an integral self (Rorty). (shrink)
The realm of freedom actually begins only where labour which is determined by necessity and mundane considerations ceases; thus in the very nature of things it lies beyond the sphere of actual material production. Just as the savage must wrestle with Nature to satisfy his wants, to maintain and reproduce life, so must civilized man, and he must do so in all social formations and under all possible modes of production. With his development this realm of physical necessity expands as (...) a result of his wants; but, at the same time, the forces of production which satisfy these wants also increase. Freedom in this field can only consist in socialized man, the associated producers, rationally regulating their interchange with Nature, bringing it under their common control, instead of being ruled by it as by the blind forces of Nature; and achieving this with the least expenditure of energy and under conditions most favourable to, and worthy of, their human nature. But it nonetheless still remains a realm of necessity. Beyond it begins that development of human energy which is an end in itself, the true realm of freedom, which, however, can blossom forth only with the realm of necessity as its basis. The shortening of the working day is its basic prerequisite. (Marx 1971, 820). (shrink)
Since 2007, capitalism has been going through its greatest crisis since the 1930s or before. In 2008, the banking system was saved from meltdown (at least for the time being) only by extensive government intervention in the USA, Britain, and a number of other countries. Stock markets all over the world plummeted. Then the crisis spread to the ‘real’ economy. A long and deep recession followed. Only now are we perhaps beginning to see what may – or may not – (...) be fragile signs of recovery. Capitalism, it is sometimes said, has been on the verge of collapse. (shrink)
Marx's concepts of individual and society have their roots in Hegel's philosophy. Like recent communitarian philosophers, both Marx and Hegel reject the idea that the individual is an atomic entity, an idea that runs through liberal social philosophy and classical economics. Human productive activity is essentially social. However, Marx shows that the liberal concepts of individuality and society are not simply philosophical errors; they are products and expressions of the social alienation of free market conditions. Marx's theory develops from Hegel's (...) account of "civil society," and uses a framework of historical development similar to Hegel's. However, Marx uses the concept of alienation to criticize the liberal, communitarian and Hegelian conceptions of modern society and to envisage a form of individuality and community that lies beyond them. (shrink)
Wherever there is movement, wherever there is life, wherever anything is carried into effect in the actual world, there dialectic is at work. It is also the soul of all knowledge which is truly scientific. (Hegel, Enc. Logic, sec. 81Z, p. 148).