A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have (...) piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have (...) piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)

The recommendations, during the past 20 years, to improve PhD scientific training and graduate school success, have focused on the significance of mentoring. It is well established that PhD students with mentors have significantly more success in graduate school as demonstrated by publishing papers before they graduate and by making presentations. Have faculty and academic institutions embraced the mentoring role? This study explores the views of 3,500 scientists who have primary responsibilities to educate PhD and MD/PhD students. Faculty members report (...) they are more likely to prefer being viewed as advisors (54 %) than mentors (38 %). Through an examination of perceptions about specific responsibilities of advisors and mentors, faculty members provide a description of their culture and the expectations they have about themselves and others. One would expect that because mentoring requires additional time and involvement that faculty would report differences between advising and mentoring. However, faculty members perceive few differences between advisors and mentors. We examine the implications of these findings. Future scientists need to be confident their education includes the opportunity to acquire the best possible research skills. To develop advisors who have the ability to provide this training, the process begins by defining role expectations and responsibilities and preparing advisors to interact with doctoral students in ways comparable to mentors. We expect faculty members to know how to teach and how to mentor; yet, we rarely discuss how to develop and shape the necessary skills of advisors so, that they more closely resemble those of mentors. (shrink)

Changes being introduced to deregulate the Dutch health care system after decades of extensive state control are to be welcomed, and will in future require consumers to be ‘well‐informed, cost‐conscious and assertive patients, who are aware of their responsibility for their own health.’ R.B. Kool MD, PhD and E.J.J.M. Kimman PhD are attached to the Department of Business Ethics in the Faculty of Economics and Econometrics at The Free University, P.O. Box 7161, 10107 MC Amsterdam.

Changes being introduced to deregulate the Dutch health care system after decades of extensive state control are to be welcomed, and will in future require consumers to be ‘well‐informed, cost‐conscious and assertive patients, who are aware of their responsibility for their own health.’ R.B. Kool MD, PhD and E.J.J.M. Kimman PhD are attached to the Department of Business Ethics in the Faculty of Economics and Econometrics at The Free University, P.O. Box 7161, 10107 MC Amsterdam.

This is an interview with neurologist Antonio Damasio, MD, PhD, whose work on consciousness has influenced scholars in a variety of fields, including anthropology. Damasio addresses a number of issues, including the neurobiology of altered states, the neurology of flow and other optimal, pleasurable states, and the potential to identify biological markers that are common to the experience of altered states in a variety of cultures. Damasio also discusses the relationship between body and brain, and concludes by discussing the scope (...) of the consciousness problem and contributions to the solution that anthropologists might be well suited to make. Key words: body, consciousness, altered states, interview. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adjusting Laboratory Practices to the Challenges of WartimeOksana Sulaieva, Anna Shcherbakova, and Oleksandr DudinFunding. Oksana Sulaieva, MD, PhD is supported by the Loyola University Chicago–Ukrainian Catholic University Bioethics Fellowship Program, funded by the National Institutes of Health Fogarty International Center (D43TW011506).After 500 days of the unjust war initiated by the Russians, we look back to reflect on the challenges our medical laboratory faced during these early days. On the (...) morning of February 24th, we were awakened by the dreadful roar of sirens, the sound of which filled us with adrenaline and anxiety. Although our team had considered the risks of Russian military aggression and thus updated our emergency plan at the beginning of 2022, the first day of the war revealed that nobody was truly ready for the bombing, air alarms, tanks on the streets of towns and cities, violence and murders of civilians. That morning the city’s transportation system collapsed, and the flow of cars cluttered all the roads as people were trying to leave the city and escape the upcoming atrocities and death. Serious and disquieted people hurried along the streets—some people rushed to shelters, and others went to the military registration and enlistment offices to fight against Russian aggressors for the life, independence, and sovereignty of Ukraine.We hurried to work, committed to performing our duties. Our medical laboratory serves more than 750 hospitals in Ukraine. Despite fear and uncertainty, we walked to the lab, taking our children and alarm case1 with documents and essential things. Months later, people asked us why we went to the laboratory instead of leaving the city or even the country. At that moment, our [End Page 155] professional duties were an anchor linking us to each other against fear and panic. Our responsibility to provide patients and physicians with the results of blood testing, pathology, and molecular reports outweighed our fears of the war. We had to complete the testing of all the samples delivered to the laboratory to provide our customers—who include children, pregnant women, diabetic and cancer patients—with data essential for identifying accurate diagnoses and effective treatments. So we spent the first days of the war in the laboratory. At the same time, we had obligations and responsibilities to our staff as well. We had to consider how to manage our employees’ protection along with continuous laboratory services provided under endless air alarms and bombings. Many healthcare facilities in eastern regions and around Kyiv were affected by missiles or completely destroyed. Of our sixty laboratory offices around Ukraine, ten were damaged or abandoned due to occupation. Several of our fleet cars were also damaged and riddled with bullets. Many employees in the regional offices in Melitopol, Kherson, Mariupol, Chernihiv, and in suburbs of Kyiv such as Bucha and Irpin lost their homes as a result of massive military operations or occupation. Dozens of our employees joined the Ukrainian armed forces to defend civilians and fight against aggressors. Many others became volunteers, involved in blood donation, medical care for the wounded, cooking, and serving the troops. And still, we had to continue our work and protect our staff at the same time. We also helped each other by sharing our goods, medication, homes, cars, warmth, and support. Some pathologists stayed at the workplace for several days moving between pathology stations, microscopes and shelters, and sleeping on the floor but continuing to work.Our main challenge was the regular terroristic attacks on healthcare facilities situated far away from the front line, which in fact, violated international humanitarian law regarding respect for human rights during armed conflicts. During the first weeks of the war, the magnitude of military aggression, massive bombing, and air attacks undermined the healthcare system and endangered laboratory staff and patients. We prioritized protective measures. Some of our laboratory staff and facilities were evacuated from Kyiv to Lviv in western Ukraine. The partial relocation of our laboratory to Lviv was also driven by the displacement of several million Ukrainians to the western part of the country.We were able to arrange relatively safe accommodations for our laboratory employees and their families in Lviv. Under strikes and alarms, our... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychodramatic Psychotherapy for Schizophrenic IndividualsJohn Nolte, MD, PhD (bio)As a long-time student, practitioner, trainer, author and advocate of J. L. Moreno, MD,’s works and specifically the psychodramatic method, I am always appreciative of efforts, like Chapy’s, to commend and advocate for psychodrama. This is especially so because for a time, Moreno and psychodrama were heavily criticized, even maligned in the mental health professions. At the same time, considering how (...) poorly Moreno and his methods have been understood as well as the difficulty of accessing his original material, I feel an obligation to set the record straight when confronted with incomplete, inadequate, or sometimes incompetent expositions of Moreno’s psychodrama.Chapy’s article recommends psychodrama as a treatment method for schizophrenic people by calling upon existentialist and phenomenological concepts. Psychodrama, he proposes, opens up existence by allowing “schizophrenic patients to incorporate the experience of an ‘absolutely other.’”There are major flaws in Chapy’s presentation. His “clinical illustration,” the presentation of a psychodrama with a schizophrenic patient, while it may be considered psychodrama under the broadest definition of the term, hardly fulfills the requirements of a psychotherapeutic psychodrama. We must question the competence of the psychodramatist in Chapy’s example. Chapy’s description of the drama itself falls short of being an adequate account of a psychodrama, failing to convey the emotional intensity and realness which a well directed and reported psychodrama achieves. We do not learn, for example, if Damien’s perception of his father is introduced through role reversal with the father, a standard psychodramatic technique which is done in order to give the auxiliary ego taking that role an understanding how Damien experiences his father. We do not know if role reversals are made throughout the drama so that Damien can experience how he is perceived by father, can feel the force of his confrontation in the role of father, and is required to reply as his father to his confrontation. We are given little information about the psychodramatic techniques employed by the director other than the scene setting of the studio in which the psychodramatic [End Page 227] encounter takes place, and the soliloquy in which Damien expresses his worry and hopes for the outcome of the confrontation. It should be clear in the description of the drama whether the father’s statements in the drama were produced by Damien in role reversal, or by the auxiliary ego playing the role. There is a difference and it is significant. Although we are told that Damien “evokes a systematic relationship between him and his father” during the psychodrama, we do not see how this happens. Every psychodrama is an existential experience and its description should fully communicate its meaning and emotion.A more serious problem, however, is that this drama does not deal with Damien’s psychosis. Although Damien may be diagnosed as schizophrenic, his disorder is obviously in remission or controlled by psychotropic drugs. The drama reveals none of the hallucinations, delusions, or disorder characteristic of schizophrenic disorders. It could be psychodrama of any young man with a complaint about his father.The notion that people with schizophrenia can be successfully treated by psychodrama is not new. Moreno began developing psychodramatic psychotherapy at his Beacon Hill Sanitarium, established in 1936. He and psychodrama gained some fame because of his success in treating schizophrenic patients at a time when schizophrenic individuals were considered incapable of benefitting from psychotherapy. Moreno’s approach to the treatment of schizophrenic patients was much more robust than the psychodrama described by Chapy. During a psychotic attack, the individual’s perception of the world and self are distorted in ways that made action and interaction in the world of conventional reality impossible. Additionally, the psychotic episode makes the psychotic person incapable of being comprehended by anyone else, including the psychiatrist. Moreno’s solution was to make the chaotic, bewildering, sometimes violent and always terrifying inner world visible and tangible in the surplus reality of the psychodramatic stage. In moments of lucidity following the psychotic episode, he asked his schizophrenic patients to reenact their psychotic experiences. The result was that, “In this imaginary reality on the psychodramatic stage, the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rationality, Irrationality, and Depathologizing OCDBrent Kious, MD, PhD (bio)Pablo Hubacher argues that some persons with obsessive-compulsive disorder (OCD) do not, in virtue of OCD itself, exhibit what he calls “epistemic irrationality,” which is a matter of violating rational norms related to belief and inquiry (Hubacher, 2023). The argument is complex and meticulous, but ultimately not persuasive. I outline the argument, show how it is unsound, and articulate its most (...) troubling consequences. I end by inquiring about the goal of projects like this, which, I believe, is to examine the rationality of mental illnesses in order to show that they are or are not illnesses.Hubacher starts by noting that (some) persons with OCD appear “doxastically irrational”: when they exhibit obsessions, they err in how they form beliefs. Specifically, they seem to “jump to conclusions,” inferring that a feared outcome is probable or certain from scant evidence. However, psychological research shows that persons with OCD are not more likely to jump to conclusions than others. Hubacher also observes that jumping to conclusions involves the inference, “possibly P, therefore definitely P.” This inference is irrational but not specific to people with OCD, because many of us do it, and an account of the irrationality of OCD should identify OCD-specific deviations. Hubacher concludes that persons with OCD are not doxastically irrational. He next considers whether they exhibit “zetetic” irrationality, which involves violating epistemic norms of inquiry. This might identify the irrationality of OCD, since compulsions like repeatedly checking the stove are basically ways of getting evidence. But Hubacher introduces the phenomenon of sexually focused OCD, or S-OCD. Persons with S-OCD worry about whether they have sexual desires they regard as inappropriate—for instance, incestuous desires or homosexual desires. Hubacher does not think people with S-OCD are zetetically irrational, however. Their endless doubts are actually reasonable, since it is possible—even common—for people to have repressed sexual desires when those desires are stigmatized. If a person with S-OCD worries about having incestuous desires, the bare fact that he does not feel those desires in the usual way should not be reassuring to him: those desires could simply be repressed. Hubacher adds that [End Page 151] people with OCD have high intolerance of uncertainty, which he takes to mean that they approach inquiries with high standards for confirmation; they are not satisfied with evidence others would see as compelling. He concludes that people with S-OCD are neither zetetically nor doxastically irrational, and so not epistemically irrational.This is a surprising conclusion, but it results from an unsound argument. An initial problem is his assumption that the only way persons with OCD can be doxastically irrational is by jumping to conclusions. This ignores other possible ways of being doxastically irrational. For instance, it would be irrational to retain beliefs that have been disconfirmed by evidence (Hubacher might call this zetetic irrationality, but surely, my beliefs can be disconfirmed without active inquiry). Irrationally retaining disconfirmed beliefs might even capture what happens in OCD: the person with OCD thinks something awful is likely to be true, even though she gets copious disconfirming evidence.A second problem is in Hubacher’s interpretation of the psychological evidence about whether persons with OCD jump to conclusions. He cites two studies involving a very specific psychological test, the bead task, wherein a subject is asked to determine whether a random sequence of colored beads have been drawn from a jar with a preponderance of one color or another. A “jumping to conclusions bias” is taken to be an inclination to guess the jar after no more than two beads are revealed (Huq & Garety et al., 1988). Although a few studies have shown that persons with OCD do not have this jumping to conclusions bias, we cannot conclude that they do not often jump to conclusions in real life. One might imagine, for instance, that people with OCD are still quite likely to jump to conclusions with respect to their obsessions (i.e., things that are highly anxiety-provoking, where the anxiety affects the conclusions drawn). And most people with OCD are not obsessed about the colors of beads.A third... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 261-264 [Access article in PDF] Mind, Meaning, and the Brain Thomas Fuchs, MD, PhD Keywords: Mind, brain, meaning, translation, depression. A Systemic View of the Mind Progress in brain research over the past two decades demonstrates the power of the neurobiological paradigm. However, this progress is connected with a restricted field of vision typical of any scientific paradigm. The psychiatrist should be aware (...) of this restriction, because, unlike the brain scientist, he deals with patients, not with brains. The restricted view may be described by the terms of (1) reductionism, (2) reification, and (3) isolation.Reductionism: Neurobiology tends to regard subjectivity as a mere by-product of the brain's activity as a symbol-manipulating machine or an information processor. Consciousness becomes an epiphenomon of the neuronal machinery that, operating behind our back, creates the illusion of a continuous self and of an autonomous will (Churchland 1995; Roth 1996).Reification: Mental or subjective states seem to be localizable in the brain; thoughts or feelings, it appears, may be observed in the colored illumination of cortical and subcortical structures. This results in the belief that brain images could also show the cause of a mental illness, or even the illness itself, which then manifests, for instance, in a reduced metabolic activity in certain areas of the cortex.Isolation: As a further consequence, this view isolates the individual patient and considers his illness separated from the interconnections with his environment. However, on these interconnections his personal experiences and dispositions are founded, and it is the actual interpersonal situation that has triggered his present illness.Walter Glannon's paper successfully counters these tendencies toward a neurobiological reductionism with an extended view of the mind: "... the mind is not located in any one place but is distributed among the brain, the body, and the environment." Of course, who observes someone's brain will never see his thoughts, his pain, or his anxiety. For consciousness is not a localizable object or state at all but a process of relating to something: a perceiving of, remembering of, wishing for, aiming at, and so on. Thus on the phenomenological level, there is nothing like a "mental event" that could be isolated from the world and from the stream of conscious experiences. The mind exists only embedded in the world and in the temporal process of life.The same applies to the biological level: Consciousness is based on the continuous interaction of the brain with the organism, and of the organism as a whole with the environment. The role of the brain for mental phenomena is thus comparable to the role of the heart in the circulatory system or of the lung in the respiratory system. Of course, the lung is the central organ of breathing, but respiration may not be restricted to the [End Page 261] lung, nor to the organism as a whole. It means constant exchange with the environment, and there is no sense in asking whether the air taken in still belongs to the surroundings or already to the organism. The same systemic unity is found in the circle of perception and action mediated by the brain: When I am writing a letter, there is no place in the unity of action where my "self" ends and the "world" begins, no border that separates inner and outer worlds.There is another argument to be raised against the reification of the mind if we consider the aspect of a historical biology. From birth on, our mind as well as the correlated brain structures are essentially formed by social and cultural influences. The brain is not inserted into the world as a prefabricated apparatus but through its plastic development in and from the world. Thus it adapts epigenetically to its specific natural and social environment like a key to a lock. This complementarity makes it impossible to restrict one's view to the anatomic organ and requires an interdisciplinary approach to brain-environment investigation, as for example, under the heading of a "social cognitive neuroscience" (Ochsner and Lieberman 2001).As Glannon goes on to argue, to overcome... (shrink)

This is an interview with neurologist Antonio Damasio, MD, PhD, whose work on consciousness has influenced scholars in a variety of fields, including anthropology. Damasio addresses a number of issues, including the neurobiology of altered states, the neurology of flow and other optimal, pleasurable states, and the potential to identify biological markers that are common to the experience of altered states in a variety of cultures. Damasio also discusses the relationship between body and brain, and concludes by discussing the scope (...) of the consciousness problem and contributions to the solution that anthropologists might be well suited to make. Key words: body, consciousness, altered states, interview. (shrink)

Little is known about how researchers view ethically salient aspects of human studies. As part of a National Institutes of Mental Health-funded study, the authors performed a confidential written survey to assess the attitudes, views, and experiences of researchers with institutional review board approved protocols at the University of New Mexico. A total of 363 researchers (57% response rate) participated. Investigators overall held favorable views of general ethical aspects of research and ethics-based safeguards, and they identified a positive role of (...) ethics training. Investigators with more experience encountering ethical problems (p < .001), more ethics training (p = .001), and a PhD or MD/PhD (p = .003) held more favorable general ethical perspectives. Women investigators (p < .03), nonphysician investigators (p < .001), those whose training had been helpful in resolving ethical dilemmas (p = .006), and those for whom spirituality is important (p = .008) more strongly endorsed ethical safeguards. Investigators perceive the scientific and ethical aspects of their work as valuable and linked, and they affirm the role of safeguards in human studies. Formal ethics preparation and training initiatives were also viewed positively by investigators. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why We StayVladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, and Lyudmyla PrystupaFunding. Vladyslava Kachkovska, MD, PhD is supported by the Loyola University Chicago– Ukrainian Catholic University Bioethics Fellowship Program, funded by the National Institutes of Health Fogarty International Center (D43TW011506).We are a group of physicians and professors in the Department of internal medicine at Sumy State University in Ukraine, located 20 miles from the border with Russia. We have been (...) working together for ten years and, against the background of the war, have become more than colleagues, more than a hematologist, an allergist, a pulmonologist and a rheumatologist. We are now one organism that works for the benefit of patients, coordinating humanitarian supplies, teaching medical students, and at the same time worrying incredibly about our children, but trying to maintain our psychological homeostasis.Over the past year and a half, we have learned many things. Dividing everything that surrounds us into primary and secondary concerns, we learn how to live without electricity during the winter and how to preserve the water supply. We realize material possessions are not important, as at any moment you may lose everything. After covering the basic needs of our families, we do not try to save money, but rather the opposite: we spend all the rest on drugs and supplies for those who are in need now. Of all that we have learned, one thing we have not learned is indifference, which is not possible during this time of constant loss of acquaintances, colleagues, and friends. We find balance only in our constant work. We have patients with medically complex conditions, and we prioritize them and their needs.Our multidisciplinary teamwork before the war brought us great pleasure: interesting clinical cases and successful work with our patients, frequent training abroad, scientific research, and work with medical students and residents.On February 24, 2022, our priorities changed. In addition, each of us faced a dilemma: whether to take our children to a safe place or stay. Balancing our emotional experiences and work is challenging, but mutual support, daily communication, and a heavy workload help us maintain a sense of normalcy. Still, we are sure this “normal” is adapted to our conditions and will not apply in peacetime. Moreover, since the beginning of the war, we have experienced dissonance between our established moral and bioethical principles, our virtues, and the main goal of medicine—preserving human life and dignity—with the surrounding events caused by the war. Daily deaths of Ukrainian civilians and soldiers, innocent children, domestic animals, abuse, rape of women, children, and older adults, demonstrative torture, the humiliation of human dignity, and criminal behavior of the enemy have altered our worldview. We are challenged by the central ethical and Christian dilemma, which our generation is unlikely to cope with—to accept everything we are going through and forgive.During the last year, we have noticed that the occupation, life in the border area, and daily shelling affect our patients, dividing them into two main groups. The first group includes patients with complex psychological issues who are looking for a physical explanation for their symptoms. This group in particular overloads the healthcare system. Since few mental health specialists are [End Page 158] available for consultations, other physicians often have to act as psychologists to reassure these patients. The second group of patients are those who do not seek medical help because they believe that their health problems are simply caused by the constant stress of war and thus they are indifferent to their health and ignore symptoms such as weakness, weight loss, chronic pain, or enlarged lymph nodes.Every day we work with patients whose lives have been negatively affected by war. Each has stories about the loss of loved ones, the loss of homes, or constant emotional stress related to relatives who are currently fighting in the armed forces. These stories cannot leave us indifferent. We live this experience together with our patients, in reality and not in the abstract, and we feel their emotions. To do otherwise would be impossible in our realities. In addition to qualified medical care, we take on the duties of psychologists because sometimes, this is the... (shrink)

AbeBooks.com: The Technological Society.

Up to the present, there have not been any specific norms regarding medically assisted human reproduction in Romanian legislation. Due to this situation the general legislation regarding medical assistance, the Penal and Civil law and the provisions of the Code of Deontology of the Romanian College of Physicians are applied to the field of medically assisted human reproduction. By analysing the ethical and legal conflicts regarding medically assisted human reproduction in Romania, some characteristics cannot be set apart because they derive (...) from religious, cultural and socio-economic aspects. In this article the authors identify the development stages of medically assisted human reproduction in Romania, beginning from these characteristics and insisting upon the failure of the legal system in this specific field. The authors consider that the law regarding medically assisted human reproduction cannot be effective because it did not take into account the ethical and cultural aspects that might appear. Furthermore, in this framework of the legal process, no public debate involving the representatives of civil society was undertaken although the Council of Europe Oviedo Convention approved by our country according to law no. 17/2001 stipulated exactly this working method. Content Type Journal Article Pages 4-13 Authors Beatrice Ioan, PHD, MD, MA IN BIOETHICS, University of Medicine and Pharmacy, Iasi, Romania Vasile Astarastoae, PHD, MD, JD, University of Medicine and Pharmacy, Iasi, Romania Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 14 Journal Issue Volume 14, Number 2 / 2008. (shrink)

This commentary comprises three different responses to Counted and Zock’s article: “Place Spirituality: An Attachment Perspective.” The first response is from Esther Sternberg, MD, who gives a psychophysiological and neuroscience critique. The second is from Altaf Engineer, PhD, from the perspective of architecture and environmental psychology, and the last response is from Hester Oberman, PhD, who gives a psychology of religion rebuttal.

This narrative symposium illuminates the problem of clinician moral distress. NIB editorial staff and narrative symposium editors, Cynda Rushton, PhD, RN, FAAN and Renee Boss, MD, MHS, developed a call for stories, which was sent to several list serves and posted on Narrative Inquiry in Bioethics’ website. The request for personal stories from inter–professional healthcare providers asked them to: identify specific clinical situations that give rise to moral distress; discuss the sources of this distress; reflect on how they experienced moral (...) distress—physically, psychologically, socially, or spiritually; assess how they managed their situations; and offer suggestions for avoiding future problems of a similar nature. Twelve stories are found in the print version of the journal and an additional eight supplemental stories are published online only through Project MUSE. The clinicians describe a wide range of experiences with patients, other clinicians, and their own professional and personal identities. Embedded in each of the narratives are deeply felt emotions that accompany their experiences of moral distress. Katherine Brown-Saltzman (a nurse), Alisa Carse (a philosopher), Zhanna Bagdasarov and Shane Connelly (industrial–organizational psychologists), and Nancy Berlinger (a bioethicist) provided commentaries. (shrink)

This case looks at the question of how to consider obligations of confidentiality by a mental health professional who works for an institution and learns that a student has been using a drug intended for an animal research project. Dr. Paul Appelbaum, MD, a psychiatrist at Columbia University, examines the issue of the limits of confidentiality. Nicholas Steneck, PhD, a scholar in research misconduct at the University of Michigan, explores the obligations to report research misconduct. Walter Limehouse, MD, an ethicist (...) at the Medical University of South Carolina, considers the systems issues raised by this case and offers some suggestions that might change the institutional environment. (shrink)

On Monday, June 25, 2018, H. Tristram Engelhardt, Jr., PhD, MD, co-founder of The Journal of Medicine and Philosophy, was laid to rest in the beautiful Hill Country of Texas near Comal County. Professor Engelhardt co-founded The Journal of Medicine and Philosophy in 1976 with Dr. Edmund Pellegrino. Engelhardt first served as Associate Editor, and then Editor and Senior Editor from 1976 until 2018. The Journal thrived for more than four decades through his energy, vision, and dedication. One of the (...) intellectual founders of the fields that would become known as bioethics and the philosophy of medicine, Engelhardt’s seminal scholarship has framed the philosophical debates surrounding healthcare policy and medical practice throughout the world. The Journal of Medicine and Philosophy mourns his passing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture provided an (...) interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

A penetrating analysis of our technical civilization and of the effect of an increasingly standardized culture on the future of man.

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumFalsifiability, Causality, and the Importance of AdvocacyArjun Byju, MD (bio) and Phoebe Friesen, PhD (bio)We want to begin by thanking both Kathryn Petrozzo and Paul B. Lieberman for taking the time to read and respond to our article, “Making Up Monsters, Redirecting Blame: An Examination of Excited Delirium,” so thoughtfully. They each offered us an opportunity to consider dimensions of excited delirium that we had not encountered as (...) of yet and encouraged us to think more carefully about them. In our response, we consider each of their commentaries in turn, given that, as a philosopher and a psychiatrist, they each speak to different aspects of our argument.First, we turn to Kathryn Petrozzo’s commentary “Excited Delirium: The Self-Fulfilling Prophecy of Police Brutality.” We are grateful for her generous comments and careful engagement with our arguments. While much of the commentary is supportive of our piece, Petrozzo makes three critical and insightful points that we hope to respond to here.The first point Petrozzo makes is that our assertion that excited delirium is non-falsifiable is not supported. She suggests that those “seeking to exonerate the police/first responders responsible for these deaths, are not accepting this evidence leading them to reject the excited delirium diagnosis, but rather, are crafting an incorrect causal narrative. This is deeply problematic, but it does not necessarily render excited delirium as nonfalsifiable.”Although we are intrigued by this challenge, we would like to hear more about what it would look like to falsify the phenomenon of excited delirium. The way that the causal theories related to it are structured are such that if one causal factor is not present (e.g., drug use), then another causal factor can be located (e.g., mental health), and if that is not found, another may be simply made up (e.g., genetic predisposition), making excited delirium multiply realizable in a seemingly endless fashion. This is precisely what took place in the case of Anthany Dawson, who was initially said to have been experiencing a mental health crisis, but was later said to have died from excited delirium related to a genetic condition never identified before (Hon, 2004; Razack, 2015). [End Page 361]In practice, confirmations of excited delirium are found on the basis of various unrelated factors, such that after a death involving police force, there is almost always the option to reach for excited delirium as an explanation/exoneration. According to proponents, there is no factor that could be present that could rule out the diagnosis of excited delirium as it is currently constructed. Indeed, even in the presence of video evidence showing police officers choking an individual until they stop breathing, these deaths are still attributed to excited delirium. This seems like a clear instance of non-falsifiability.Although Petrozzo might maintain that this is simply “an incorrect causal narrative,” it is a causal narrative that aligns with the current theoretical scaffolding surrounding excited delirium.The second point Petrozzo makes is regarding widespread criticisms of Popper’s demarcation criterion of falsifiability. Indeed, this criterion has been called too inclusive, in that any empirical claim can be called falsifiable in principle—even if it refers to a future apocalypse or a UFO landing. It has also been criticized for being too exclusive, in that it ignores the “remarkable tenacity of scientific theories,” as Lakatos puts it (2009, p. 516). In practice, scientists do not merely abandon a theory if it is not supported by facts; they tend to find other explanations (e.g., the measurement was faulty) rather than accept an instance of falsification.Despite this, we believe it is still worth discussing falsifiability in the context of excited delirium for two reasons. First, while falsifiability may not be successful as a criterion that draws a line between science and pseudoscience, in this case, we argue, it still works well as a signifier of pseudoscience. Recently, many interested in the demarcation question have turned towards pluralism as a way to identify pseudoscientific practices (Pigliucci & Boudry, 2013). And excited delirium offers an excellent example of a phenomenon that bumps up against many of the features that might indicate a pseudoscientific practice... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this particular (...) point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Could Understanding Harm?Iskra Fileva, PhD (bio) and Linda A.W. Brakel, MD (bio)We would like to thank the editors for organizing this symposium and our commentators—Marga Reimer and James Phillips—for the thought-provoking feedback. Although we had thought about the ideas we discuss from many different angles, our commentators raised several interesting issues we had not considered. We are grateful for the opportunity to continue the conversation.Reply to ReimerAs Professor Reimer (...) notes, we advocate an approach to self-constitution that we dub “understanding first.” On this approach, non-moral and non-normative understanding of the origin of maladaptive traits must precede moral evaluation and attempts to free oneself—or as we say “prune”—undesirable traits. Professor Reimer presents several interesting cases meant both to extend and test the limits of our proposal. We appreciate this approach and respond to each case in turn.Genes and AlcoholismSuppose Alejandro, an adult raised by adoptive parents, struggles with alcohol addiction. He learns that his biological parents died of alcoholic liver disease and comes to believe that his alcohol problem is caused by a genetic propensity toward alcohol abuse. One can ask: “Does an understanding first approach have the potential to undermine the sense of agency that is necessary for the effective treatment of maladaptive traits?”Answer: It can be explained to Alejandro that genetic proclivities are just that—proclivities—that can be overridden. In fact, behavior can alter our very genes—although not at the sequence level— changes known as “epigenetic.” And the liver disease of the biological parents can serve as a cautionary tale. If even in light of these considerations, Alejandro’s tendency to see genetic propensities as deterministic persists, it is worth asking why. There is no evidence that “genes are destiny,” so the disposition to see them that way must have a psychological explanation. What is the explanation? A self-destructive desire? Fear of freedom? This exploration can itself be empowering. [End Page 211]Adaptive ForgettingSuppose Beata, who has an eating disorder, was molested by her own father when she was a child. Subsequently, her father shot himself and now she has no recollection of the molestation. However, Beata’s eating disorder is largely a result of those experiences. It is quite possible that if Beata were to recall being molested, that would do more harm than good. In this connection, one can ask together with Reimer: “Does an understanding first approach have the potential to undermine an adaptive ‘forgetting’ of root causes of maladaptive traits?”Answer: Here, understanding the history, instead of forgetting it, might allow Beata to gain insight into and empathize with possible motives that may have led to becoming obese. For example, she might have the phantasy that if she had been obese and unattractive, she could have prevented the molestation—hence, become that way now to prevent it from happening again, and more wishfully reverse it. (In unconscious goings-on time is thought to be in the “unexamined present” (Brakel 2009, p. 63; 2015, p. 131; 2022, p. 4; 2023, p. 404.) One benefit of this is that in gaining this type of recognition, Beata might find it easier to change her behavior that she otherwise would not have; it was never her responsibility to prevent her own molestation, and there is no reason whatsoever for her to now make herself unattractive to her deceased father, and very little reason to remain obese in an attempt to deter current day men.Ego-Syntonic Maladaptive TraitsClaire is a concert pianist and alcoholic. Importantly, Claire does not see her own desire for alcohol as destructive but rather, as something constitutive of her own identity. “I wouldn’t be myself without alcohol,” she says. Reimer asks whether our approach would “work for cases where the agent sees a maladaptive trait as constitutive of their identity?”Answer: Although no approach can guarantee success, our claim is that our approach has a better chance than the main alternative known as the pruning view. Since Claire, by stipulation, is not inclined to see her own drinking as a problem, a... (shrink)

Researches over many years have examined whether levonorgestrel emergency contraception has a postfertilization effect. In a recent article in the Catholic Health Association’s journal Health Progress, Sandra Reznik, MD, asserts that “levonorgestrel acts to prevent pregnancy before, and only before, fertilization occurs.” A companion article by Ron Hamel, PhD, argues for the moral certainty that Plan B is not an abortifacient. Reznik fails to address the principal model supporting a potential postfertil­ization mechanism of action, specifically, that preovulatory administration of levonorgestrel (...) disrupts the delicate ratio of estrogen and progesterone essential to healthy endometrial development and induces the equivalent of luteal phase insufficiency, thereby jeopardizing implantation. Hamel’s argument for moral certitude is similarly inadequate. This article critically reviews both articles and the sources on which they rely. National Catholic Bioethics Quarterly 10.4 : 741–772. (shrink)

Alongside Richard Rorty, Hilary Putnam and Jacques Derrida, Stanley Cavell is arguably one of the best-known philosophers in the world. In this state-of-the-art collection, Alice Crary explores the work of this original and interesting figure who has already been the subject of a number of books, conferences and Phd theses. A philosopher whose work encompasses a broad range of interests, such as Wittgenstein, scepticism in philosophy, the philosophy of art and film, Shakespeare, and philosophy of mind and language, Cavell (...) has also written much about Henry Thoreau and Ralph Waldo Emerson. Including contributions from Hilary Putnam, Cora Diamond, Jim Conant and Stephen Mulhall, this book is a must-have for libraries and students alike. (shrink)

The Political Illusion, examines modern man's passion--political affairs--and the role he plays in them and in the modern state.

To Will & To Do presents one of the most significant theological contributions of the dynamic twentieth-century thinker Jacques Ellul. Benefiting from recent scholarship on Ellul and a discovery of a lost manuscript, this new edition renders the full text available in English for the first time, combining a fresh translation of Volume I with a first English translation of Volume II. Together, the two volumes constitute the introductory first part of Ellul's planned four-part treatment of Christian ethics. Volume (...) I examines the origin of the problem of Good and Evil, outlines the contemporary morality of Western society, and provocatively sketches the paradox of an impossible and yet necessary Christian ethics. Volume II carries this discussion forward, outlining the characteristics and conditions of Christian ethics. It then treats the relationship between ethics and the legal texts of the Bible, the relationship between ethics and dogmatic theology, and concludes by reimagining the theological use of the ""analogy of faith"" for scriptural interpretation. In constant dialogue with Karl Barth, Dietrich Bonhoeffer, Paul Ricoeur, and many other theologians and philosophers, To Will & To Do constitutes a major intervention in twentieth-century theological ethics. (shrink)

To Will & To Do presents one of the most significant theological contributions of the dynamic twentieth-century thinker Jacques Ellul. Benefiting from recent scholarship on Ellul and a discovery of a lost manuscript, this new edition renders the full text available in English for the first time, combining a fresh translation of Volume I with a first English translation of Volume II. Together, the two volumes constitute the introductory first part of Ellul's planned four-part treatment of Christian ethics. Volume (...) I examines the origin of the problem of Good and Evil, outlines the contemporary morality of Western society, and provocatively sketches the paradox of an impossible and yet necessary Christian ethics. Volume II carries this discussion forward, outlining the characteristics and conditions of Christian ethics. It then treats the relationship between ethics and the legal texts of the Bible, the relationship between ethics and dogmatic theology, and concludes by reimagining the theological use of the "analogy of faith" for scriptural interpretation. In constant dialogue with Karl Barth, Dietrich Bonhoeffer, Paul Ricoeur, and many other theologians and philosophers, To Will & To Do constitutes a major intervention in twentieth-century theological ethics. -- back cover. (shrink)

It is widely held that assertions are partially governed by an epistemic norm. But what is the epistemic condition set out in the norm? Is it knowledge, truth, belief, or something else? In this paper, I defend a view similar to that of Stanley (2008), according to which the relevant epistemic condition is epistemic certainty, where epistemic certainty (but not knowledge) is context-sensitive. I start by distinguishing epistemic certainty, subjective certainty, and knowledge. Then, I explain why it's much more plausible (...) to think that "certain", rather than "know", is context-sensitive. After that, I respond to an important worry raised by Pritchard, according to which the proposed view is too strong to accommodate our current practice of assertion. I then show that the main linguistic and conversational data advanced in the recent literature in favour of the knowledge condition are best explained by the certainty view. Finally, I offer two principled considerations: the certainty view is the only one compatible with three independently plausible claims and it fits very well with the common thought that knowledge does not entail certainty. (shrink)

continent. 2.1 (2012): 56–58 Nechvatal, Joseph, Immersion Into Noise , Open Humanities Press, 2011, 267 pp, $23.99 (pbk), ISBN 1-60785-241-1. As someone who’s knowledge of “art” mostly began with the domestic (Western) and Japanese punk and noise scenes of the late 80’s and early 90’s, practices and theories of noise fall rather close to my heart. It is peeking into the esoteric enclaves of weird music and noise that helped me understand what I think I might like art to be: (...) A way of learning about the world through perturbation—exploration by incitement and speculation of possible conditions. What I have always loved about artistic investigations influenced by noisy aesthetics or sensibilities is that they can be simultaneously transcendent and absurd, amusing and revelatory, singular and pluralistic, mindless and intensely penetrating. The provocative friction that noise brings to bear on aesthetic experience, artistic practice, and “the” Art World acts as a kind of impulse response, proposing new energies while revealing underlying structure; noise signals are a simultaneous synthesis and analysis of spaces, subjects and relations. About two weeks prior to Christmas 2011, Joseph Nechvatal was generous enough to spend some time with me at 39 Quai des Grands Augustins, Paris . We each had one glass of red wine, briefly discussed common acquaintances, shared points of interest, and his published writings. We also, I recall, disagreed lightheartedly about how much contemporary relevance the ideas of telematic-artist Roy Ascott have for today’s art-and-technology practitioner (Joseph > Jamie). After the encounter, I read through a PDF version of Immersion Into Noise Joseph was kind enough to send me ( the HTML version is here ). A number of points of entry into cultures of “noise” are available these days. There are the acoustic-spatial approaches of thinkers like Douglas Kahn, Brandon LaBelle and Salome Voegelin; the techno-cultural musicologies of Jonathan Sterne and David Toop; the political writings of Jacques Attali, former adviser to President François Mitterrand, in his Noise: The Political Economy of Music (spoiler alert: It’s not really about music). Enter the new writings of one Joseph Nechvatal, with his invitation of an Immersion Into Noise . Nechvatal has been active for over 20 years in on- and off-line discussions of art, technology, virtuality, as well as his own set of art-theoretical departures and terminologies. A practicing artist, and instructor at the School of Visual Arts in New York City, Immersion Into Noise , is Nechvatal’s third published volume. His writings, broadly, address a concern with the possibilities of a synthesis between the biological and the virtual, and the contemporary artistic resonances that these possibilities suggest. Nechvatal’s project is to try to name contemporary currents of artistic practice within our technologized culture. He comes at this through art history, post-modern philosophy, anthropology and consciousness studies. Portions of Immersion Into Noise have appeared in his PhD dissertation, as well as online art publications like Zing Magazine . An open-access publication, and part of the impressive and heartening activities of the Open Humanities Press, Nechvatal’s book is a somewhat unexpected addition to the Critical Climate Change series edited by Tom Cohen of SUNY University and Claire Colebrook of Penn State. Other titles in the series have address themes of post-globalism and cultures of threat. Joseph Nachvetal’s title is the first to focus entirely on art history, art practice and aesthetics. It is awkward to too easily fit Nechvatal’s writings in with the aforementioned burgeoning canon of cultural and artistic practice in, and writings on, noise (Russolo, Schaeffer, Cage and Yves Klein through to Kahn, LaBelle, Voegelin, et. al). Immersion Into Noise is not primarily an examination of sound-noise or phenomenologies of sound, and the relativist, non-objectivist possibilities arising therefrom in social, public, and exhibition art practices. Although Nechvatal makes mention of sonic practice and experience (his own encounter in 1968 with the technological complex was set in motion at a Jimi Hendrix concert at the Chicago Coliseum), he does so only by way of introducing a broader concept of “art-noise.” The noise-scape can envelope various kinds of involvement in all kinds of art, by artists, audiences, and distributed amalgams of all of these. Midway through the book, we are offered characteristics of an “immersive noise vision theory.” This theory, leading to an even more syncretic thinking about the art experience, is sketched out through further reference to the author’s personal observation, as well as his art-historical research and notes. Personal examples take on the reflex of a kind of art-noise-travel-writing, as Nechvatal visits Ryoji Ikeda’s Datamatics [ver 2.0] installation at the Centre Pompidou, Paris), hears Cecil Taylor at Alice Tully Hall in New York, spends time with the cave paintings of Lascaux, France, and explores the Wagner-inspired Venus Grotto of Linderhof, Bavaria, to name a few. These site-events, to varying degrees, are renderings of noise-art’s potential to “place us back into a ritual position by dragging art down into the felt 360° noise-perspective of the enthusiastic and participatory.” (p.103) The arc of the ideas proposed here position immersiveness, saturation and “scopic all-over tension” as most productively foundational to noise art, or art-noise. An itinerary from the most ancient of artistic expressions (cave drawings) to the most digital of presentations is charted (Ikeda’s minimal/maximal bitwise works for synchronized audio and visual projection). The harsh sonic onslaught of Masami Akita (a.k.a. Merzbow), is, under this analysis, not so far from colossal denseness of the churches of the High Baroque (Nechvatal visits the Rosario Chapel in Santo Domingo Church, Puebla, Mexico). And there is much more here, eaten up by noise: A rethinking of the work of Duchamp, Jackson Pollock, Nicolas Schöffler (whom Nechvatal names the true “the Father of Cybernetic Art”) and the Happenings of Alan Kaprow, all as art-noise in their own right. Each of these artists and moments demonstrate techniques of destabilization, immersiveness, frame-breaking and “all-over fullness and fervor.” Here is writing on art and art history that is as ambitious as it is promising: “wildly visionary,” Nechvatal states as in conclusion. Self-admittedly far-reaching to the point of verging on totalization, we are asked to consider that the moments, spaces, arts and artists Nechvatal appreciates in the book all derive from an increasingly prevalent “noise consciousness.” Along the way we gain an appreciation of noise as a productive and proactive tension in art, rather than an unwanted signal or unwelcome intrusion. Most promising here for me are Nechvatal’s revealing descriptions of the potential for noise to make manifest the material-perceptual framework of individual and collective art experience. How might we allow what we have been repeatedly taught is our contemporary condition of “information overload” to transform itself into a calm, warm, sympathetic kind of inundation. Treatment of experience in this way, dissolves boundaries between the bodily, informational, material and technical complexes that make up our world, and is the promise of a radical, if momentary, Immersion Into Noise. (shrink)

When postgraduate researchers’ interests lie outside the body of knowledge with which their supervisors are familiar, different supervisory approaches are called for. In such situations, questions concerning the appropriateness of traditional models arise, which almost invariably involve a budding candidate’s relationship with a knowing-established researcher/supervisor. Supervisory relationships involving creative practice-led research in particular confront significant challenges by new and emerging themes, questions, processes and practices. My lack of disciplinary knowledge regarding two PhD candidates’ projects led me some years ago to (...) question the effects of this lack and to search for effective ways of dealing with it. A subsequent commitment to different modes of candidate/supervisor collaborations was based on three assumptions: One, a supervisor is not, in the first instance, a conveyor or purveyor of knowledge. Two, postgraduate researchers already have substantial and refined pockets of relevant knowledge to draw on. Three, and very importantly, they are able to activate networks of distributed knowledge, often outside of the University. The argument presented in this article draws theoretically on Jacques Rancière and Hannah Arendt’s ideas of pedagogy and public space, as well as notions of cosmopolitics, mode 2 knowledge and not-knowing in Art & Design. Reflections on my experiences of supervising PhD and Master of Art & Design candidates, together with ideas offered by contributors to a book I have recently edited, will locate moments of choice and the emergence of the unforeseeable, of vigilance towards singular events as much as collective understanding. (shrink)

Is knowledge the epistemic norm of action and assertion? Gettier and justified-false-belief cases have been raised as counterexamples to the necessity direction of that claim. Most knowledge normers reply by distinguishing permissibility from excusability. An important objection to this move, however, is that it requires a still lacking view of epistemic excuses sufficiently general to cover all the cases, correctly relating the supposed excuse to the subject's cognitive life, and not collapsing into an account of the fundamental normative standard (see (...) Gerken 2017). In this paper, I rely on independent work in epistemology and cognitive science to suggest a novel account of epistemic excuses in terms of epistemic feelings. In contrast to other existing accounts, this account is immune from the above objection and can thus be used to rescue the knowledge norm. (shrink)