Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused on (...) one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 185-187 [Access article in PDF] Measuring Moral Identities:Psychopaths and Responsibility Gwen Adshead Doctor Ciocchetti examines the responsibility of psychopaths as a function of psychological capacities operating within relationships. He then argues against the punishment of psychopaths. I have some sympathy with both views, but perhaps argued in different ways, and from different standpoints, based on my clinical experience.Doctor Ciocchetti's offers an unusual (...) account of responsibility as a concept that involves at least two people, and perhaps many more than two; and this I would entirely support. In this sense, responsibility is a transitive and dynamic process that involves not only the personal sense of ownership of an action or thought, but also the attribution of responsibility by others. Moral, when applied to intentions, seems to me to suggest that they are intentions that involve another person and that they are held by an active agent who can make choices about those intentions. Responsibility implies not only causal responsibility, but also that the actor owns his own intentions about his behaviors toward others.Responsibility, either as experienced by the actor or attributed by others, is a type of moral judgment; an exercise in moral reasoning. Following Gilligan (1987), I am persuaded that moral reasoning, or the discourse of ought-and-should is relational in nature and must be seen in the context of relationships. I think much of the early work on moral reasoning in offenders is flawed because it assumes that moral reasoning was a capacity like serum bilirubin: normally distributed out there in the population, and able to be measured by an objective observer, in a process independent of the findings. Unsurprisingly, these studies found either that offenders had immature moral reasoning capacities (which we might have guessed already), or they had normal moral reasoning capacity, which was disturbing and puzzling.What we want to understand is how people come to let themselves do horrible things to others. Cioccchetti argues that psychopaths can do these things because they lack the affective capacities needed to respond to others' distress. Ordinary people care about harm to others (including the physical self/body and sentient animals) and demand explanations for the deliberate infliction of suffering on others. It is not only the lack of participant attitudes in the psychopath that bother us; it is our own responses, expressive of our participant attitudes, that tell us something about what this person is, and what is wrong. In my view, this is what punishment is all about for us, the larger social group [End Page 185] forced to respond to the distressing and disturbing actions of others.As Ciocchetti suggests, it is the perceived guilt of the offender that justifies the punishment; it is also the experienced distress of those affected that drives the need for punishment. The distress is part of the relationship between the victim and the offender; the victim is often just as active as the offender.The issue becomes most clear in relation to capital punishment and its supporters, especially those who wish not only to view executions, but also to broadcast them. In considering this, there are two useful sources of information: first, studies of the reactions of those who witness executions, and second, studies of the impact of murder on those related to the murder victim, so-called secondary victims. In those states that have capital punishment in the United States, it is often the secondary victims who witness the execution. They often have testified to the appalling impact of the offender's crime on them; most states give them a right to be present at the execution, even if they do not exercise it. It is hard not to think that it is the enormity of the feelings caused by the offender's wrongdoing that the death sentence is designed to address; the death of the offender changes the relationship between victim and offender, as much as the death of the original victim changes the relationship with their relatives. One might then wonder about the impact of his or her execution on the relatives... (shrink)

How would you feel about your husband, wife, or partner masturbating using pornography or erotica? For many, this would be a betrayal – a kind of cheating. I explore whether monogamous relationships should forbid solo masturbation using erotica and pornography, considering two possible objections: (1) the objection that such activity is a kind of infidelity; (2) the objection that such activity involves attitudes, usually attitudes towards women that are incompatible with an equal, loving relationship. I argue that the use of (...) erotic material in solo masturbation should not count as cheating. Solo use of pornography differs significantly from interpersonal sexual activity. Thus, unlike causal interpersonal sex, it does not undermine the role of sex within the relationship. Additionally, freedom to explore sexual fantasy through masturbation is an important element of sexual autonomy. Objection (2) holds against some but not all erotic material. Sexual enjoyment of pornography that depicts, or is produced by, suffering or degradation involves a way of seeing others that has implications for the user’s relationships with others, particularly sexual relationships. However, not all erotic material involves objectionable attitudes towards others. Thus partners should allow moderate use of some types of erotica in solo-masturbation. (shrink)

This powerfully iconoclastic book reconsiders the influential nativist position toward the mind. Nativists assert that some concepts, beliefs, or capacities are innate or inborn: "native" to the mind rather than acquired. Fiona Cowie argues that this view is mistaken, demonstrating that nativism is an unstable amalgam of two quite different--and probably inconsistent--theses about the mind. Unlike empiricists, who postulate domain-neutral learning strategies, nativists insist that some learning tasks require special kinds of skills, and that these skills are hard-wired into (...) our brains at birth. This "faculties hypothesis" finds its modern expression in the views of Noam Chomsky. Cowie, marshaling recent empirical evidence from developmental psychology, psycholinguistics, computer science, and linguistics, provides a crisp and timely critique of Chomsky's nativism and defends in its place a moderately nativist approach to language acquisition. Also in contrast to empiricists, who view the mind as simply another natural phenomenon susceptible of scientific explanation, nativists suspect that the mental is inelectably mysterious. Cowie addresses this second strand in nativist thought, taking on the view articulated by Jerry Fodor and other nativists that learning, particularly concept acquisition, is a fundamentally inexplicable process. Cowie challenges this explanatory pessimism, and argues convincingly that concept acquisition is psychologically explicable. What's Within? is a clear and provocative achievement in the study of the human mind. (shrink)

Fiona Woollard presents an original defence of the Doctrine of Doing and Allowing, according to which doing harm seems much harder to justify than merely allowing harm. She argues that the Doctrine is best understood as a principle that protects us from harmful imposition, and offers a moderate account of our obligations to offer aid to others.

Which objects and properties are represented in perceptual experience, and how are we able to determine this? The papers in this collection address these questions together with other fundamental questions about the nature of perceptual content. The book draws together papers by leading international philosophers of mind, including Alex Byrne (MIT), Alva Noë (University of California, Berkeley), Tim Bayne (St Catherine’s College, Oxford), Michael Tye (University of Texas, Austin), Richard Price (All Souls College, Oxford) and Susanna Siegel (Harvard University) Essays (...) address the central questions surrounding the content of perceptual experience Investigates how are we able to determine the admissible contents of experience Published in association with the journal Philosophical Quarterly . (shrink)

This paper explores the meaning of environmental ethics in the small firm domain. A distinction is made between two approaches: conventional ethical discourse based on shallow ecological principles and a new ethical discourse based on deep ecology principles. Using the literature in this multi‐disciplinary field of inquiry a link is made between small firms, ethics and the environment. Empirical research data based on the author’s doctoral work with firms in Leeds is discussed. The research results indicate that small firms from (...) the study are predominantly operating a conventional ethic discourse and are framing their response to the environmental challenge using a shallow ecology ethic. (shrink)

Although the focus of "Globalizing Democracy and Human Rights" is practical, Gould does not shy away from hard theoretical questions, such as the relentless debate over cultural relativism, and the relationship between terrorism and democracy.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 15-18 [Access article in PDF] Through a Glass, Darkly:Commentary on Ward Gwen Adshead Keywords: psychopathy, moral reasoning. Now we see, as through a glass darkly.... (St Paul's first letter to the Corinthians, Chapter 13) JIM DID AN EVIL THING. He deliberately caused another person's suffering in a way that was humiliating, cruel, and persistent. He very nearly killed another man. He knew (...) what he was doing; he knew it was wrong, but somehow, that did not matter to him. After he was caught, he came to a forensic psychiatric facility where he was offered therapy. (What the purpose of therapy is could be the subject of a paper in its own right, although I will say a little more about this at the end of the paper). Several years on, Jim has had many thoughts about his behavior. First, he has no doubt that he was responsible insofar as he chose to do what he did, and he feels guilty on that count. Second, he is also aware that he had consciously carried out such acts many times in his mind before, but had not previously acted out his fantasy; and that therefore the process of crossing the line between fantasy and reality is a crucial one for him to think about further. This metaphor of a line that has to be crossed from one place to another suggests two worlds: one of internal reality and the other of external reality. Jim used the metaphor thus: "I came up to the line, but I drew back." He also said of this moment (when he nearly killed his first victim): "I said to myself... 'This is mad... I can't justify this.'... " I have emphasized these words of Jim's because I want to use his experience to explore some of the arguments raised in David Ward's most interesting paper. I found much to agree with, and some claims that sat less easily. I should say that the context of my response is my work as a psychotherapist with mentally disordered offenders in Broadmoor Hospital, and also a current research project with Jonathan Glover and Christine Brown on moral reasoning in antisocial men. Kant and Won't I have no doubt that most if not all of the men (and women) that I work with do operate according to universalizable principles. As the author suggests, however, these principles are incoherent and contain what Cleckley (1976) called a type of agnosia, or distorted vision. It seems to me that Kant's two forms of principle are really two different levels of intention or choice-making process. Kant's hypothetical level of intention is very much about making choices in the external world: I experience the world as cold, I want to be warm because I need to be warm, I will do what I need to do to make that need happen for me. It is not universalizable because [End Page 15] others may not feel the cold as I do. Notice that this level of intention may be very closely linked to the next level, which Kant calls categorical: I would like the world to be such that everyone who is needy will get their needs met, and I would like to be the sort of person who makes that happen. The categorical level of intention is Kant's take on the Golden Rule: that you should want everyone to be treated as you yourself would wish to be treated. It is an intentional process that is interpersonal, which implies a second order of thinking—thinking about one's thoughts and wishes, and thinking about the sort of person one would wish to be in relation to others.At this point, I think it may be helpful to bring in the other aspect of Kant's vision of moral intentions, which is the injunction to treat others as ends in themselves and not merely as means to ends. Thus every individual is a unique person or self, who claims respect as a person and not... (shrink)

Many philosophers believe that God has been put to rest. Naturalism is the default position, and the naturalist can explain what needs to be explained without recourse to God. This book agrees that we should be naturalists, but it rejects the more prevalent scientific naturalism in favour of an 'expansive' naturalism inspired by David Wiggins and John McDowell. Fiona Ellis draws on a wide range of thinkers from theology and philosophy, and spans the gulf between analytic and continental philosophy. (...) She tackles various philosophical problems including the limits of nature and the status of value; some theological problems surrounding the natural/ supernatural relation, the Incarnation, and the concept of myth; and offers a model to comprehend the relation between philosophy and theology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on“Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”Gwen Adshead (bio)AbstractIn this commentary, I address two points raised by Fields: the origin of other-regarding beliefs, and the management of psychopaths, if they are not criminally responsible (as Fields suggests). I argue that the capacity to form affective bonds is necessary in order to hold other-regarding beliefs, and that a psychological developmental perspective may be helpful in understanding the moral understanding (...) of the psychopath. In response to Fields’s view that psychopaths should receive “treatment,” I suggest that most forensic psychiatrists do not agree.Keywordspersonality disorder, empathy, development, remorse, attachment theoryInsufficient attention has been paid to the problem posed by so-called “psychopaths.” Lloyd Fields’s paper is therefore welcome. Here I shall focus on two issues: the nature and acquisition of other-regarding beliefs, and the implications for managing those who do not have them.Fields argues that there is a subgroup of psychopaths, unable to form “other-regarding beliefs”; that such beliefs provide a motivation for acting in a particular way, and result in a “[disposition] to experience certain emotions and to have certain attitudes.”But it is arguable that the disposition to experience certain emotions and have certain attitudes towards others could be critical to acquiring the capacity to have other-regarding beliefs. If one asks what stops people from hurting others, a common answer is that it makes people feel bad. To quote Mencius (Legge, 1960): “All men have a mind which cannot bear to see the suffering of others.”The question then is, how does anyone acquire a notion of “the other,” such that failing to endorse other-regarding principles/beliefs has an adverse effect on the subject?Mencius’ “mind” implied “reciprocity,” and involved four components:i. The recognition of another’s distressii. Being moved by that distress (empathy)iii. Wishing to reduce that distress (sympathy)iv. Altruism (the sense of obligation to reduce distress, and guilt if one fails).By these criteria, (iv) resembles Fields’s “other-regarding” belief, in that the sense of obligation provides a reason for acting. I would argue that (iv) is a virtue, which requires (i), (ii) and (iii) as capacities—not necessarily separate, but different aspects of a broader “affective” capacity. It is this affective capacity which is arguably lacking in the psychopath.Some of these capacities have already been discussed in the literature of psychopathy. It is the [End Page 279] failure to recognize another’s distress which Cleckley describes in many of his cases (Cleckley 1964), and which he describes as a type of “agnosia.” This term implies some neuropathological deficit, and there is some evidence for such deficits in psychopaths, mainly in the autonomic nervous system. Blair (1995) has also suggested that psychopaths lack a (postulated) violence inhibitory mechanism (VIM).It could be argued, however, that such neuropathological hypotheses lead to circular arguments about psychopathy, as described by Barbara Wootton 1(Wootton 1959). A more fruitful account is offered by theories (such as attachment theory) which offer a developmental account which includes both psychological and neuropathological perspectives. Described and developed by Bowlby (1969), attachment theory draws on experimental work with non-human primates and emphasises the importance of relationships with significant others in infancy for the development of later social relationships (Harlow 1975; Ruppenthal et al 1976). Such attachment relationships are also important for the development of cortical neural networks, and the modulation of stress, which can itself be neurotoxic (Sapolsky 1994).How could attachment theory be relevant to acquiring an affective capacity? The earliest work on attachment behaviors showed that monkeys failing to make early attachments behaved recklessly with other monkeys, and could not make relationships (for example, to mate). Of particular relevance was the finding that such monkeys launched suicidal attacks on monkeys higher in the hierarchy; not dissimilar to those “self-defeating” behaviors which Cleckley described in human psychopaths.So much for possibly psychopathic monkeys; do humans with failed attachments lack affective capacity? There is evidence that substantial proportions of “psychopaths” have histories of failed attachments in childhood. The more severe the failure, the more severe the disturbance in adulthood, which might explain why there... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice and ViciousnessGwen Adshead (bio)Keywordspsychiatric diagnosis, antisocial behaviorI am Grateful to Professor Sadler for such a clear and helpful account of how human misconduct (or vice) has been confounded diagnostically with human disease (as defined by the Diagnostic and Statistical Manual of Mental Disorders [DSM] classificatory system); and even more grateful for the chance to offer comment. Professor Sadler’s paper raises questions about the DSM enterprise as a (...) whole; and this is a field in which I have no particular experience to offer for additional discussion. But his other main point is that psychiatrists are constantly invited to distinguish between vice and disease, and he gives three examples, one of which is a clinical case from my own research. I entirely agree with him that this is a good example, and in this commentary, I will explain why.The argument is about how to distinguish between human behaviors that reflect chosen deviance from prosocial norms and behaviors that reflect a diseased state of mind. Arguments are both legal and political: Aristotle, in the Nichomachean Ethics sets out conditions in which a man should not be blamed for his behaviors, and to some extent these conditions still hold good in the criminal court; ignorance of the meaning of one’s actions, or being forced to act under duress, are good legal defenses. Politically, as Professor Sadler makes clear, the arguments were set out first by Foucault and then Szasz; it is possible for the state to use medical discourse to turn what might be a legitimate social grievance into individual pathology—the ultimate ad hominem argument.These arguments have not gone away, despite the best efforts of a materialist wing of neuropsychiatry, aided and abetted by pharmaceutical companies, who have a great interest in reductionist arguments in the biosciences. This is particularly so in relation to antisocial behaviors, especially crime. I want to focus on one particular type of antisocial behaviors, namely, the wish to hurt another person. I focus on this because it is my clinical bread and butter: My work as a forensic psychiatrist and psychotherapist requires me to try and understand how and why people want to hurt others. But I think it also makes sense to focus on this because it is the most problematic wish socially and demands understanding. All three of Professor Sadler’s examples involve hurt and harm to others, and it is noteworthy that neuroreductionist or medicalized explanations are rarely sought for theft or tax evasion. This must be in part because socially we think it is normal to try and profit yourself, even illegally, if you can get away with it. (I actually think that such behavior is not all that normal, but that is an argument for another day).Let us take the clinical example from my own work, cited by Professor Sadler. It is an example of what is called in the DSM “Factitious Disorder by Proxy” (FDP), although it also has an unhelpful eponym of “Munchausen’s Syndrome by Proxy.” As a practicing forensic psychiatrist, it is one of the best examples I know of what has been crudely dichotomized as a “mad or bad?” debate. A [End Page 23] mother quite deliberately makes her child ill, and then presents the child to medical services as in need of hospital treatment. In the case I described with Dr. Bluglass, the mother smothered her baby girl and then presented her as having “breathing difficulties” (which was, of course, quite true in one sense). There are two examples of vice here: deliberately hurting your child and lying to others about it; the lies also have the indirect result of potentially causing more harm to the baby. Harming your child, and then lying about it, in a not-for-profit way, are criteria for FDP.Quite how these actions ever made it into the DSM is puzzling, when they are quite straightforwardly antisocial. If a man in the street were to smother another man to the point of asphyxia, and then lie about it, we might well ask many questions about why he had done it, but we would not say that no offence had occurred. We... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What’s His Story?Gwen Adshead (bio)Keywordsnarrative, violence, identityIn this commentary, I discuss three issues raised by Cartwright: whether and to what extent explanations from the past can adequately explain or excuse present actions, the nature of moral identity, and the notion of the moral community.I have often thought that psychiatrists and psychotherapists working with offenders have to be like writers of detective fiction. To make the story convincing, the (...) writer of detective fiction has to convey to the reader an understanding of the killer's motives. The successful writer enables the reader to appreciate the killer's reasons for killing; and these reasons offer to readers a tantalizing glimpse of what it might actually be like to be a violent and dangerous person; or more particularly, one who acts on their cruel and violent thoughts.Psychiatrists want to understand the reasons for their patient's violence, for several reasons (which probably include the voyeuristic pleasure that all humans seem to have at other people's disasters). However, the main reason is to do with prevention of future harm; if we understand the reasons that this happened, then we can take steps to make sure that it does not happen again. This view has been called the just world theory (Janoff Bulman 1989), which implies a world of predictable causes and reasons, where disasters occur because of an identifiable fault or omission that can be rectified with good result. The payoff of this view is that it gives the believer a sense of control, which after a disaster is important for maintaining confidence and self-esteem.The problem with this theory is that it presupposes that the world of human actions is essentially rational, and that people do things for reasons that make sense to them. However, much human cruelty has an irrational and unreasonable aspect to it; one that literally makes no sense. Cartwright's paper begins with a narrative about real people doing really dreadful things for no reasons that would ever satisfy the average detective story reader. Forensic mental health work is full of histories that are actually much stranger than any detective fiction.But it seems that humans are not happy with stories that do not make sense, even if senselessness is part of the natural world around them. As Cartwright indicates (see p. 150), when we hear about people like Robert Harris, we immediately move the field of inquiry from "Why did he do that?" to "Why is he like that?" With the rise of developmental psychology over the last 150 years, it has become natural to look at people's histories to see if this explains the person's present identity. In this sense, therefore, we seem to be natural Aristotelians, assuming that a man's character is revealed by his current actions: we also seem to be assuming that a man's character is an expression of past actions and events. [End Page 157]His-Story: Explaining the PresentIs this in fact the case? To what extent is it true that our identities are shaped by our past experiences? Even if this were the case, shaping is not the same as determining. There has always been a risk that developmental psychology will take up a similar position to genetics, with regard to explaining behavior; namely, that there are those who will try to argue that the presence of this, that, or the other gene, or this, that, or the other experience, both determines and "explains" the behavior. The moral point here is that when it comes to violent and antisocial behaviors, a person's past history is said to simultaneously explain the behavior, determine the behavior, and excuse it, by implying that the actor had no choice about what he did, given his past. This has been taken to an extreme in the US criminal courts, with what Dershowitz (1994) has called "the abuse excuse" (used most notably in the trial of the Menendez brothers, who killed their parents and claimed at the trial that their parents had abused them).Trials are about evidence, and it is worth considering the evidence about the effect of early childhood adversity... (shrink)

Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.

Scientific and philosophical perspectives on hallucination: essays that draw on empirical evidence from psychology, neuroscience, and cutting-edge philosophical theory.

Szasz argues that the threat of harm to self or others cannot be understood as a symptom of mental illness, and that there is an irresolvable tension between the traditional medical ethical duty to heal, and any notion of a medical duty to protect the public.1 I think these are two distinct arguments which could each be the subject of extended analysis, and this commentary is of necessity limited.Professor Szasz has consistently raised concerns about the political abuse of psychiatry as (...) a way of controlling dissidence. Many of his arguments remain as cogent and unanswered as when they were first put 30 years ago. But as sympathetic as I am to some of his criticisms, it seems to me that many are too sweeping; especially the first claim that there is no such thing as mental illness, but only persons whose expressed intentions involve taking a stance which is contrary to certain social rules.I do not propose here to discuss the so called “hard” problem of consciousness—that is, exactly how brain states give rise to intentional psychological experience, or indeed, the extent to which “brain” and “mental” can be used synonymously. If we accept that mental states give rise to intentions, then different mental states will give rise to different intentions, and there is no reason not to think that there might be abnormal mental states that might give rise to abnormal intentions. The question then is what we mean by the word “abnormal”. Clearly it is possible for abnormal to be defined as “socially inappropriate”, which is Szasz’s concern. In that case, political and social dissidence is then turned into a symptom by the language of medicine, and thus becomes not a social matter, but an individual’s personal problem.But “abnormal” could be defined with reference …. (shrink)

Can the phenomenal character of perceptual experience be altered by the states of one's cognitive system, for example, one's thoughts or beliefs? If one thinks that this can happen then one thinks that there can be cognitive penetration of perceptual experience; otherwise, one thinks that perceptual experience is cognitively impenetrable. I claim that there is one alleged case of cognitive penetration that cannot be explained away by the standard strategies one can typically use to explain away alleged cases. The case (...) is one in which it seems subjects' beliefs about the typical colour of objects affects their colour experience. I propose a two-step mechanism of indirect cognitive penetration that explains how cognitive penetration may occur. I show that there is independent evidence that each step in this process can occur. I suspect that people who are opposed to the idea that perceptual experience is cognitively penetrable will be less opposed to the idea when they come to consider this indirect mechanism and that those who are generally sympathetic to the idea of cognitive penetrability will welcome the elucidation of this plausible mechanism. (shrink)

This book challenges readers to rethink rural health ethics. Traditional approaches to health ethics are often urban-centric, making implicit assumptions about how values and norms apply in health care practice, and as such may fail to take into account the complexity, depth, richness, and diversity of the rural context. There are ethically relevant differences between rural health practice and rural health services delivery and urban practice and delivery that go beyond the stereotypes associated with rural life and rural health services. (...) This book examines key values in the rural context that have not been fully explored or taken into account when we examine health ethics issues, including the values of community and place, and a need to “revalue” relationships. It also advocates for a greater attention to meso and macro level analysis in rural health ethics as being critical to ethical analysis of rural health care. This book is essential reading for those involved in health ethics, rural health policy and governance, and for rural health providers. (shrink)

Freely given informed consent to participation is the ethical cornerstone of research in health care. However, in mental health settings, there are many patients who lack the capacity to give such consent to participate in research. There is an abundance of guidance now available on how researchers might think about this issue and the Royal College of Psychiatrists has also recently reviewed its guidance to members about the ethics of research. In this piece, I will discuss some of the issues (...) that were raised during the revision process, and add some reflections of my own. (shrink)

I initiate the concept of ‘making-remote’ to capture various strategies for representing the human in late Palaeolithic cave art. Drawing out the role of remoteness within phenomenological accounts of perception (Husserl and Merleau-Ponty), as well as offering an analysis of a wide range of archaeological evidence, I argue that realism does not capture the specificity of these human representations. In contrast to naturalistic animal representations, humans are consistently represented with a high degree of abstraction e.g., schematisation and abbreviation. I also (...) argue for a site-specific distinction between deep caves and rock-shelters. Following Bourdier (2010) and Pinçon (2012), art at sites such as Roc-aux-Sorciers is best understood as stylised ‘public art’. Meanwhile, the highly expressive and realist art of La Marche is domestic in contrast to the exclusively symbolic art of deep caves. In conclusion I argue that ‘making-remote’ in cave art’s human representations exhibits complex relations to self and others. (shrink)

: This paper responds to the sense of "crisis" or "trouble" that dominates contemporary feminist debate about the categories of sex and gender. It argues that this perception of crisis has emerged from a fundamental confusion of theoretical and political issues concerning the implications of the sex/gender debate for political representation and agency. It explores the sense in which this confusion is manifest in a debate between Seyla Benhabib and Judith Butler.

This paper responds to the sense of “crisis” or “trouble” that dominates contemporary feminist debate about the categories of sex and gender. It argues that this perception of crisis has emerged from a fundamental confusion of theoretical and political issues concerning the implications of the sex/gender debate for political representation and agency. It explores the sense in which this confusion is manifest in a debate between Seyla Benhabib and Judith Butler.

Drawing on resources from both the Analytical and Continental traditions, Form and World argues that a comprehension of Kant's aesthetics is necessary for grasping the scope and force of his epistemology. Fiona Hughes draws on phenomenological and aesthetic resources to bring out the continuing relevance of Kant's project. One of the difficulties faced in reading the Critique of Pure Reason is finding a way of reading the text as one continuous discussion. This book offers a reading at each stage (...) of Kant's epistemological argument, showing how various elements of Kant's argument, often thought of as extraneous or indefensible, can be integrated. This incisive study, arguing for the centrality of aesthetics in philosophy, and within experience in general, challenges a blind spot in the Anglo-American tradition of philosophy and will contribute to a growing interest in the general significance of aesthetic culture. (shrink)

Research ethicists have recently declared a new ethical imperative: that researchers should communicate the results of research to participants. For some analysts, the obligation is restricted to the communication of the general findings or conclusions of the study. However, other analysts extend the obligation to the disclosure of individual research results, especially where these results are perceived to have clinical relevance. Several scholars have advanced cogent critiques of the putative obligation to disclose individual research results. They question whether ethical goals (...) are served by disclosure or violated by non-disclosure, and whether the communication of research results respects ethically salient differences between research practices and clinical care. Empirical data on these questions are limited. Available evidence suggests, on the one hand, growing support for disclosure, and on the other, the potential for significant harm. (shrink)

In this paper I offer a reading of one of Plato's later works, the Sophist, that reveals it to be informed by principles comparable on the face of it with those that have emerged recently in the field of critical thinking. As a development of the famous Socratic method of his teacher, I argue, Plato deployed his own pedagogical method, a ‘mid‐wifely’ or ‘maieutic’ method, in the Sophist. In contrast to the Socratic method, the sole aim of this method is (...) not to disabuse the reader or learner of her false opinions. Rather, its purpose is to supply her with the skills and dispositions as well as the claims and counter‐claims she needs to critically evaluate a view, and so facilitate knowledge acquisition, for herself. But the text does not merely teach critical thinking in this indirect manner. One of the strategies its author employed was to encourage the reader/learner to consider under what conditions a claim or idea would be false. To the extent that it achieves this, the Sophist provides both a model and an application of that particular kind of critical thinking in the learning environment that Jonathan Baron has described as ‘active open‐mindedness’. (shrink)

This paper explores the potential for an international political theory of care as an alternative to liberalism in the context of contemporary global politics. It argues that relationality and interdependence, and the responsibilities for and practices of care that arise therewith, are fundamental aspects of moral life and sites of political contestation that have been systematically denied and obfuscated under liberalism. A political theory of care brings into view the responsibilities and practices of care that sustain not just ‘bare life’ (...) but all social life, from nuclear and extended families to local, national and transnational communities. It disrupts and challenges the individualism of liberalism, and the associated valorization of ‘freedom’, ‘autonomy’, and ‘toleration’. Instead, it emphasizes an ontology of relationality and interdependence that accepts the existence of vulnerability without reifying particular individuals, groups or states as ‘victims’ or ‘guardians’. Furthermore, by demonstrating the gendered and raced nature of caring in the contemporary world—from the household to the transnational level—an international political theory of care challenges our received assumptions about ‘dependence’ in world politics, and opens up space to interrogate politically not only gender but race and other aspects of inequality in the global political economy. (shrink)

Ethical perspectives on regional, rural, and remote healthcare often, understandably and importantly, focus on inequities in access to services. In this commentary, we take the opportunity to examine the implications of normalizing metrocentric views, values, knowledge, and orientations, evidenced by the recent (2022) New South Wales inquiry into health outcomes and access to hospital and health services in regional, rural and remote New South Wales, for contemporary rural governance and justice debates. To do this, we draw on the feminist inspired (...) approach to rural health ethics involving analysis of power relationships developed by Simpson and McDonald and related ideas from critical health sociology. In presenting this analysis, we extend contemporary thought about spatial health inequities and structural violence. (shrink)

It is a philosophy of patient care, and is therefore open to critique and evaluation.Using the Oxford Textbook of Palliative Medicine Third Edition as their ...

What does it mean to understand the world religiously? How is such understanding to be distinguished from scientific understanding? What does it have to do with religious practice, transfiguring love, and spiritual well-being? New Models of Religious Understanding investigates these questions to set a new and exciting agenda for philosophy of religion. Featuring contributions from leading scholars in the field, the volume cuts across the supposed divide between analytic and continental approaches to the subject and engages the interest of a (...) broad range of philosophical and theological readers. (shrink)

In this paper I offer a reading of one of Plato’s later works, the Sophist, that reveals it to be informed by principles comparable on the face of it with those that have emerged recently in the field of critical thinking. As a development of the famous Socratic method of his teacher, I argue, Plato deployed his own pedagogical method, a ‘mid-wifely’ or ‘maieutic’ method, in the Sophist. In contrast to the Socratic method, the sole aim of this method is (...) not to disabuse the reader or learner of her false opinions. Rather, its purpose is to supply her with the skills and dispositions as well as the claims and counter-claims she needs to critically evaluate a view, and so facilitate knowledge acquisition, for herself. But the text does not merely teach critical thinking in this indirect manner. One of the strategies its author employed was to encourage the reader/learner to consider under what conditions a claim or idea would be false. To the extent that it achieves this, the Sophist provides both a model and an application of that particular kind of critical thinking in the learning environment that Jonathan Baron has described as ‘active open-mindedness’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.1 (2001) 33-37 [Access article in PDF] "Impossible Things before Breakfast":A Commentary on Burman and Richmond Gwen Adshead "Why sometimes, I've believed as many as six impossible things before breakfast." --Lewis Carroll, Through the Looking GlassBoth Burman and Richmond discuss how a feminist critique or take on a body of theory helps to illuminate or confuse further theoretical development. Burman applies such a critique (...) to False Memory Syndrome (FMS); Richmond to psychoanalytic accounts of eating disorders. In this commentary, I want to discuss the application of a feminist critique to two vital concepts for psychiatry: the recording and measurement of data, and truthful accounts of experience. These concepts are of course related, and I want to explore their connections, not only with each other, but with specific areas of mental health practice, namely, mental health research, psychodynamic psychotherapy, and expert psychiatric testimony. The Recording Angel: Subjectivity and Objectivity, Measurement and Truth Most feminist critiques of measurement begin with an attack on the traditional theoretical distinction between objective and subjective worlds (for example, Fox Keller 1985). Classical accounts of Western scientific practice have assumed that it is possible to divide external physical experience in this way, and this assumption generates two further beliefs: first, that it is possible for an observer to, as it were, stand apart or outside the events observed, and second, that objective accounts of events are somehow real-er or true-er than subjective accounts. This account contains some very old ideas about natural experience: first, that a fixed reality exists that is external to those who have experienced an event, and second, that this reality is observable by others, that is, there is a space between the observer and the observed. This notion of objectivity has been thought to be crucial to valid measurement.In contrast, a feminist critique counterargues that every observer is influenced and influences what he is studying; that he is himself "positioned" in the subject of his interest, in Rom Harré's term. Further, feminist theory argues that because the objective-subjective split is artificial, subjective accounts of experience may be just as "true" as objective accounts. Overarching is the notion that all social behavior is socially constructed and affected by social context, including "science" in all its forms.Such doubts about the exact nature of science have been fueled by two sets of theory within [End Page 33] "science"--the claims of quantum theory in the 1920s and Thomas Kuhn's account of shifting scientific paradigms in the 1960s--and both of these theories have been important for feminism and feminist critique of scientific practice. Despite many odd features, quantum theory has produced research with considerable explanatory power (Hawking 1988, Barrow 1991, Smollin 1997), and some of its claims provide indirect support for the feminist position described above. For example, one claim of quantum theory is that, at the micro-level of events, what is being observed is influenced by the position of the observer. If true, then the notion of an easy divide between internal and external space, in which observer and observed are separately located, is undermined; rather, every position taken by the observer influences the observed in a dynamic relationship. There is no objectivity but rather a developing matrix of positions that are not externally fixed, but changing and uncertain. Similarly, in relation to social construction of theory, Kuhn's description of the changing nature of scientific paradigms also emphasizes the importance of social and community influences on scientific theories and how "true" accounts of events can change. Internal and External Worlds: Implications for Mental Health Research and Psychotherapy Practice Arguably, feminist claims about the social positioning of science are now unremarkable; no one involved in research (especially mental health research) could dispute that what is studied, what is funded, and what is published is hugely influenced by many social and political processes. Even if only to a limited extent, quantum theory and Kuhn do support the doubt thrown on classic notions of objectivity by feminist theory; if only by suggesting that reality... (shrink)

John Beloff is one of our foremost authorities in parapsychology. He is credited with an instrumental role in the acceptance of parapsychology into academia. On April 21 and 22, 2000, a two-day international conference was held by the Koestler Parapsychology Unit of the Psychology Department at the University of Edinburgh to celebrate Beloff's eightieth birthday. Most of the essays in this work were presented at this conference honoring John Beloff. All of the contributors have published a number of articles in (...) mainstream philosophy and their essays promote Beloff's greatest interest--a philosophical interaction with parapsychology. The book is divided into three sections and each section has three papers. The papers in the first section, "Parapsychology, Philosophy and the Mind," explore "the mind-brain problem," parapsychology and the principle of closure, and a cross-cultural perspective on dualism and the self. The second section, "Parapsychology, Self and Survival," looks at parapsychological phenomena and the sense of self, chrysalid therapy, and the problem of super psi. The third section, "Parapsychology, Religion and Spirituality," features papers that discuss parapsychology and how it relates to Hume's view of miracles, to religion, and to the origin of the Copernican hypothesis. (shrink)

What happens when science hits the headlines - for all the wrong reasons? Do you remember the 'Climategate' email leak? Or the 'Frankenscience'-style headlines about the perils of GM foods? What about the time the government sacked its own science advisor for challenging drug laws? The truth behind the attention-grabbing headlines was complex, nuanced - sometimes even mundane. Yet that's not how it was reported or remembered. We rely on the media to help us make sense of complicated scientific developments (...) that could transform our world. Yet all too often, science coverage in the British press has been less fact than fiction. And equally scientists have too often either avoided engaging with the press or have been actively prevented from doing so. The result? Media hype, political spin, and misinformation from those with vested interests. In Beyond the Hype, Fiona Fox - founding director of the Science Media Centre, set up by scientists to encourage openness and accuracy in science communication - takes us behind the scenes of some of the most contentious stories in science over the past two decades. From animal research and genetically modified foods to hybrid embryos and climate change, she reveals the highs and lows of each controversy and shows us how transparency can radically transform the way science is reported, and what a difference that makes to public understanding. (shrink)

In this paper we trace the historical exclusion of women from the legal profession in Canada. We examine women’s efforts to gain entry to law practice and their progress through the last century. The battle to gain entry to this exclusive profession took place on many fronts: in the courts, government legislature, public debate and media, and behind the closed doors of the law societies. After formal barriers to entry were dismantled, women continued to confront formidable barriers through overt and (...) subtler forms of discrimination and exclusion. Today’s legal profession in Canada is a contested one. Women have succeeded with large enrolments in law schools and growing representation in the profession. However, women remain on the margins of power and privilege in law practice. Our analysis of contemporary official data on the Canadian legal profession demonstrates that women are under-represented in private practice, have reduced chances for promotion, and are excluded from higher echelons of authority, remuneration, and status in the profession. Yet, the contemporary picture of the legal profession also reveals that women are having an important impact on the profession of law in Canada by introducing policy reforms aimed at creating a more humane legal profession. (shrink)