The purpose of medical humanities is to improve the delivery of effective health care through a better understanding of disease in society, and in the individual. The interfaces between the science of medicine and the arts, philosophy, sociology and law interpret causes and effects of disease. The field of medical ethics is the most prominent offspring of this wider debate, yet the context of disease in the life of the individual and of society is profound and far-reaching. The influences of (...) medicine on the humanities and vice versa are all around, yet only recently have they been recognised in the wider world of health care. How can you encapsulate the essence of medical humanities and teach it to health professionals? Medical Humanities is designed to fill the need for a clear, well illustrated text that both provides the principles for the individual reader, and encourages discussion. The issues are explored in four main sections. Based on a highly successful seminar, and with contributions from leading writers, thinkers, and teachers, this book provides a comprehensive and authoritative reference for what is becoming a professional requirement in medicine. It will be invaluable for clinicians and students alike. (shrink)

This text offers a concise explanation of how philosophical concepts underpin much medical activity, and how being aware of this can improve everyday practice. It is not a basic introduction to philosophy, but restricts itself to those aspects that have a direct impact on medical professionals.

In a research proposal recently submitted to one of the research ethics committees in Wales, children suffering from otitis media, or ‘glue ear’ as it is more familiarly known, were to be tested for allergic reactions to a number of substances using skin-prick tests. Small lancets would be used to pierce the skin of the forearm, allowing the penetration of traces of the allergenic reagent. The size of the subsequent inflamed area of skin would be measured. To demonstrate the expected (...) correlation between glue ear and an allergic reaction, it would be necessary to see whether other children who did not suffer from glue ear also had the same reactions. If they did not, of course, then some causal association between the reaction and the disease condition could be inferred and investigated, with the hope of improving the treatment of the disease itself. (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the (...) body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

In this book the author argues that human musical understanding is rooted in the traditions of culture and that experience of music depends crucially on what the individual brings to it.

Many bioethics questions are resistant to journalistic exploration on account of their inherently philosophical dimensions. Such dimensions are ill-suited to what we may term the internal goods (in MacIntyre's sense) of the newspapers and mass media generally, which constrain newspaper coverage to an abbreviated form of narrative that, whilst not in itself objectionable, is nonetheless inimical to the conduct of philosophical reflection. The internal goods of academic bioethics, by contrast, include attention to philosophical questions inherent in bioethical issues and value-enquiry. (...) The danger for bioethics is that its agenda for reflective enquiry will, if dictated by this abbreviated narrative, be distorted in terms of both range and priorities, to the inevitable neglect of questions having a philosophical dimension to them. This danger can be avoided by a constructive partnership between the media and academic bioethics. The success of this partnership relies on four suggested provisos, for the meeting of which both journalists and academics bear responsibility. (shrink)

Using fictionalized case studies this series follows four patients through the medical process, from onset through Diagnosis, Treatment and PrognosisVolume 1: Symptom. Examines the idea of 'symptom' as a route to understanding the structure of clinical practice -- Volume 2: Diagnosis. Explores the meaning of 'diagnosis' as a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. -- Volume 3: Treatment. Considers the concept of treatment as an active process which produces an outcome, be it effective, (...) inappropriate or inadequate. Enlightening reading. -- Volume 4: Prognosis. Contemplates the challenge of the prognosis, attempting to make sense of life and death. Considers, through personal and professional perspectives, the role of the medical profession in guiding patient experience.--. (shrink)

Recruiting patients into clinical research is essential for the advancement of medical knowledge. However, when the physician undertaking the care of the patient is also responsible for recruitment into clinical research, a situation arises of an inter-role breach of confidentiality which is distinguishable from other conflicts of interest. Such discord arises as the physician utilizes confidential information obtained within the therapeutic relationship beyond its primary objective, and safeguards ought to be observed in order to avert this important, and generally overlooked, (...) problem. The moral worth of the pledge of confidentiality is based not on its innate value but on its being a promise on which subsequent interactions and disclosures are founded. Within the patient-doctor interaction, confidentiality is an important facet of the promised fidelity and, as such, a loose interpretation of the notion threatens the essence of the relationship, and any violation thereof requires compelling moral justification. To avoid conflict, patients' confidential information ought not be used for the purpose of recruitment, which needs to be undertaken through general education and non-directed appeals, and a preliminary consent to be approached for research should be obtained from the patient prior to her being identified as a suitable research subject. Securing this prior consent would avoid one source of potential, albeit unintended, coercion. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

A Decent Proposal: Ethical Review of Clinical Research Donald Evans and Martyn Evans Centre for Philosophy and Health Care University of Wales Swansea, UK The investigation and development of modern medicines and medical technology can create numerous ethical dilemmas both for clinical researchers and research ethics committees. A Decent Proposal: Ethical Review of Clinical Research seeks to facilitate and encourage good clinical research by exploring the concerns, responsibilities, general issues and particular pitfalls associated with ethical aspects of (...) research. It provides practical guidelines for researchers on how to improve the quality of research design, while for those appointed to scrutinise research proposals it offers advice on how to apply consistent, careful and critical reasoning to the process of assessing ethical standards. As such, it will provide invaluable assistance to clinical researchers and ethics committees alike in understanding the moral challenges posed by modern health care. (shrink)

This special issue considers the significance of film to the establishment and development of scientific approaches to the mind. Bonnie Evans explores how the origins of film technologies in 1895 in France encouraged a series of innovative collaborations, influencing both psychological theorisation, and new filming techniques. Jeremy Blatter explains how Harvard psychologist Hugo Münsterberg created early films specifically designed to engage audiences using psychological tactics. Scott Curtis’ article examines how Yale psychologist Arnold Gesell was able to extract scientific data (...) from a film. Felix Rietmann’s article explores a collection of infant observation films from the 1930s and 1960s and how they developed unique narratives of mothers’ engagement with their children that did not necessarily match up with dominant scientific theories. Janet Harbord's article considers how a trilogy of films made at the Maudsley Hospital in the 1950s engaged with innovative film-making techniques that captured behaviour as discrete units. Seth Watter further examines how William S. Condon's use of the unique technology of the Bell and Howell 173BD projector in the 1960s created new understandings of human behaviour that could not have been predicted in advance, and which were highly influenced by the technology itself. Finally, Des O’Rawe explores how radical approaches in both anti-psychiatry, and documentary film-making in the 1960s created new opportunities for audiences to engage with different psychological states. All of these developments in film and psychology continue to influence understandings in both these fields to the present day. (shrink)

Gareth Evans’ account of Identifi cation-freedom (IF), which he devel- ops in Chapters 6 and 7 of The Varieties of Reference (henceforth VR) is almost universally misunderstood.1 Howell is guilty of this same mis- understanding, and as a result claims to have mounted a criticism of Evans, when in fact he has not. I will take the occasion of Howell’s oth- erwise insightful article to clarify Evans’ position. Note that the bulk of Howell’s analysis (...) is targeted at the phenomenon known as immunity to error through misidentifi cation (IEM), which is related to but not (necessarily) identical to IF. Therefore, the accuracy of Howell’s treat- ment of Evans in particular is tangential to the main thrust of his article. My exegesis of Evans’ account — like any non-trivial exegesis — goes somewhat beyond anything Evans overtly says. That Evans did not ex- plicitly put the pieces together in the way I suggest they fi t no doubt contributes to the widespread misunderstanding of his views. But I am. (shrink)

This reply to Martyn Evans's support for a cardiac-centered concept of death attempts to meet some objections to the brainstem definition of death. Evans's appeal to Wittgenstein's philosophy is also criticised.

I joined Trevelyan College (Trevs), Durham University in 2011 as a mature student under former professor and principle of the college Martyn Evans. It was to be the beginning of a transformative journey culminating in my doctoral thesis: Balanced Wonder: A Philosophical Inquiry into the Role of Wonder in Human Flourishing. -/- In 2020 Trevs kindly asked me to contribute to the Alumni Magazine Hippocampus and in particular to the ‘Where Are They Now’ section. -/- “You Haven’t Done (...) Anything” is my contribution and it highlights in a humorous fashion some of the things I have achieved since I left Trevs. -/- Sections: -/- Standing still is rarely a good strategy in life -/- If One Lives Wisely Sometimes Less is More and Infinately More Valuable. (shrink)

The target article tackles an important and complicated issue of the underlying links between curiosity and creativity. Although thought-provoking, the target article overlooks contemporary theories and research on these constructs. Consequently, the proposed model is inconsistent with prior research in the developmental and educational fields and would benefit from better specification and clarity around key constructs and processes.

A purely metaphysical formulation of physicalism is surprisingly elusive. One popular slogan is, 'There is nothing over and above the physical'. Problems with this arise on two fronts. First, it is difficult to explain what makes a property 'physical' without appealing to the methodology of physics or to particular ways in which properties are known. This obviously introduces epistemic features into the core of a metaphysical issue. Second, it is difficult to cash out 'over-and-aboveness' in a way that is rigorous, (...) metaphysically pure and extensionally apt for the purposes of the debate. In this paper I will touch on the first problem, but I wish to focus on the second. In particular, I will focus on the claim that supervenience theses cannot define physicalism because they allow classical emergentist dualism through the physicalist door [Horgan 1993; Kim 1998; Wilson 2005]. I will argue that when the relevant supervenience thesis is metaphysical, emergentism is excluded. Against recent arguments to the contrary, I maintain that this is the case even given necessitarianism about natural laws [Wilson 2005]. I will argue that a necessitarian with emergentist sympathies will be forced either into a type of quasi-panpsychism, where our basic physical properties contain the illicit seeds of mentality at their core, or she will be forced to admit that emergence laws are not necessary after all. Either way, the combination of necessitarianism and emergentism does not provide a counterexample to supervenience physicalism. (shrink)

Self-Knowledge and Self-Reference is a defense and reconciliation of the two apparently conflicting theses that the self is peculiarly elusive and that our basic, cogito-judgments are certain. On the one hand, Descartes seems to be correct that nothing is more certain than basic statements of self-knowledge, such as "I am thinking." On the other hand, there is the compelling Humean observation that when we introspect, nothing is found except for various "impressions." The problem, then, is that the Humean and Cartesian (...) insights are both initially appealing, yet they appear to be in tension with one another. In this paper I attempt to satisfy both intuitions by developing a roughly descriptivist account of self-reference according to which our certainty in basic beliefs stems precisely from our needing to know so little in order to have them. (shrink)

Aims: The experience of a compromised sense of ‘self’, termed ego-dissolution, is a key feature of the psychedelic experience and acute psychosis. This study aimed to validate the Ego-Dissolution Inventory (EDI), a new 8-item self-report scale designed to measure ego-dissolution. Additionally, we aimed to investigate the specificity of the relationship between psychedelics and ego-dissolution. Method: Sixteen items relating to altered ego-consciousness were included in an internet questionnaire; 8 relating to the experience of ego-dissolution (comprising the EDI), and 8 relating to (...) the antithetical experience of increased self-assuredness. Items were rated using a visual analogue scale. Participants answered the questionnaire for experiences with classical psychedelic drugs, cocaine or alcohol. They also answered the 7 questions from the Mystical Experiences Questionnaire (MEQ) relating to the experience of unity with one’s surroundings. Results: 691 participants completed the questionnaire, providing data for 1828 drug experiences (1043 psychedelics. 377 cocaine. 408 alcohol). Exploratory factor analysis demonstrated that the 8 EDI items loaded exclusively onto a single common factor, which was orthogonal to a second factor comprised of the items relating to increased self-assuredness (rho= -.110), demonstrating discriminant validity. The EDI correlated strongly with our measure of unitive experience (rho =.735), demonstrating convergent validity. EDI internal consistency was excellent (Cronbach’s alpha 0.93). Three analyses confirmed the specificity of ego-dissolution for experiences occasioned by psychedelic drugs. Firstly, EDI score correlated with drug-dose for psychedelic drugs (rho=.371), but not for cocaine (rho=.115) or alcohol (rho=-0.055). Secondly, the linear regression line relating the subjective intensity of the experience to EDI was significantly steeper for psychedelics (unstandardized B coefficient= 0.701) compared with cocaine (0.135) or alcohol (0.144). Finally, a binary support vector machine classifier identified experiences occasioned by psychedelic drugs vs. cocaine or alcohol with over 85% accuracy using ratings of ego-dissolution and ego-inflation alone. Conclusions: Our results demonstrate the psychometric structure, internal consistency and construct validity of the EDI. Moreover, we demonstrate the close relationship between ego-dissolution and the psychedelic experience. The EDI will facilitate the study of the neuronal correlates of ego-dissolution, which is relevant for psychedelic-assisted psychotherapy and our understanding of psychosis. (shrink)

Recent years have seen a burgeoning in phenomenological research on sport, physical cultures and exercise. As editors and reviewers, however, we frequently and consistently see social science articles that claim to be ‘phenomenological’ or to use phenomenology, but the reasons for such claims are not always evident. Indeed, on closer reading, many such claims can often turn out to be highly problematic. At this point, we should clarify that our ‘terrain de sport’ constitutes what has been termed ‘empirical phenomenology’ (Martínková (...) & Parry, 2011) and more specifically from our own ‘home’ discipline, a phenomenologically inspired form of sociology. This latter tradition was developed in North America by Alfred Schütz (1972). By this, we do not mean philosophical phenomenology in all its rich and varied strands, the modern form of which was inspired by Edmund Husserl’s (1913/2002) descriptive and/or transcendental phenomenology. The term itself is derived from the Greek phainomenon, from the root phôs, meaning ‘light’, thus referring to something that is placed in the light, made apparent or shown. Phenomenology is therefore the study of phenomena, things as they present themselves to, and are perceived in consciousness. Importantly, it is not just another form of qualitative research; a point which we discuss later. (shrink)

I defend the conception of musical works as indicated temporally initiated types against Julian Dodd's recent argument that all types are eternal and uncreated. In doing so, I develop a new account of both cultural and natural types. While types are in a certain sense determined by the properties that underlie them, not all properties determine types; and properties such as being indicated by Beethoven exist only once the temporally initiated entities that those properties essentially involve exist. A cultural type (...) such as Beethoven's Fifth Symphony is a sound pattern that has the essential property of being used in the way specified by Beethoven's singling out of that pattern. (Natural types, such as bird songs or biological species, are patterns having places in actual causal chains in nature.) Given this framework, the Fifth Symphony is an indicated type that was, in a straightforward literal sense, created by Beethoven in 1804–1808. (shrink)

The literature on mathematical explanation contains numerous examples of explanatory, and not so explanatory proofs. In this paper we report results of an empirical study aimed at investigating mathematicians’ notion of explanatoriness, and its relationship to accounts of mathematical explanation. Using a Comparative Judgement approach, we asked 38 mathematicians to assess the explanatory value of several proofs of the same proposition. We found an extremely high level of agreement among mathematicians, and some inconsistencies between their assessments and claims in the (...) literature regarding the explanatoriness of certain types of proofs. (shrink)

Over two decades ago, Davids et al. (1994) and Handford et al. (1997) raised theoretical concerns associated with traditional, reductionist, mechanistic perspectives of movement coordination and skill acquisition for sport scientists interested in practical applications for training designs. These seminal papers advocated an emerging consciousness grounded in an ecological approach, signalling the need for sports practitioners to appreciate the constraints-led, deeply entangled and non-linear reciprocity between the organism (performer), task and environment subsystems. Over two decades later, the areas of skill (...) acquisition, practice and training design, performance analysis and preparation, and talent development in sport science have never been so vibrant in terms of theoretical modelling, knowledge generation and innovation, and technological deployment. Viewed at an ecological level of analysis, the work of sports practitioners has progressively transitioned toward the facilitation of an evolving relationship between an organism (athlete, team) and its environment (sports competition). This commentary sets out to explore how these original ideas from Davids et al. (1994) and Handford et al. (1997) have been advanced through the theoretical lens of Ecological Dynamics. Concurrently, we provide case study exemplars, from applied practice in high-performance sports organisations, to illustrate how these contemporary perspectives are shaping the work of sports practitioners (sport ecology designers) in practice and performance preparation. (shrink)

BackgroundIn the Netherlands, patients have the legal right to make a request for euthanasia to their physician. However, it is not clear what it means in a moral sense for a physician to receive a request for euthanasia. The aim of this study is to explore the moral values of physicians regarding requests for euthanasia. MethodsSemi-structured interviews were conducted with nine primary healthcare physicians involved in decision-making about euthanasia. The data were inductively analyzed which lead to the emergence of themes, (...) one of which was about values regarding end-of-life decisions.ResultsFour clusters of values related to euthanasia requests are described: values related to 1) the patient; 2) the family; 3) the physician; and 4) life and death. The data show that the participants value patient autonomy as a necessary but not sufficient condition for meeting a euthanasia request. A good relationship with the patient and the family are important. For the physician, the values physician autonomy, responsibility, understanding the patient and relief of suffering play a role. Life as an intrinsic good and a peaceful death are also important values.ConclusionThis study shows that next to patient autonomy and the relationship with the patient and the family, it is important for the participants to act in accordance with their professional values and to do justice to values related to life and death. The awareness of going against the intrinsic value of life is crucial, even if performing euthanasia may result in a feeling of relief or gratitude afterwards. (shrink)

In two experiments we tested the hypothesis that the mechanisms that produce belief bias generalise across reasoning tasks. In formal reasoning (i.e., syllogisms) judgements of validity are influenced by actual validity, believability of the conclusions, and an interaction between the two. Although apparently analogous effects of belief and argument strength have been observed in informal reasoning, the design of those studies does not permit an analysis of the interaction effect. In the present studies we redesigned two informal reasoning tasks: the (...) Argument Evaluation Task (AET) and a Law of Large Numbers (LLN) task in order to test the similarity of the phenomena concerned. Our findings provide little support for the idea that belief bias on formal and informal reasoning is a unitary phenomenon. First, there was no correlation across individuals in the extent of belief bias shown on the three tasks. Second, evidence for belief by strength interaction was observed only on AET and under conditions not required for the comparable finding on syllogistic reasoning. Finally, we found that while conclusion believability strongly influenced assessments of arguments strength, it had a relatively weak influence on the verbal justifications offered on the two informal reasoning tasks. (shrink)