Across the world, pain is under-treated in emergency departments. We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED is due partly to an epistemic preference for signs over symptoms on the part of some practitioners, and some ED practices that themselves worsen pain (...) by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under-treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem-solve along lines pre-established by modern medical science. We conclude by touching on some potential solutions for ED practice. (shrink)

ABSTRACT In keeping with the pre‐eminent status accorded autonomy within Australia, Europe, and the United States, medical practice requires that patients authorize do‐not‐resuscitate (DNR) orders, intended to countermand the default practice in hospitals of instituting cardiopulmonary‐resuscitation (CPR) on all patients experiencing cardio‐pulmonary arrest. As patients typically do not make these decisions proactively, however, family members are often asked to act as surrogate decision‐makers and decide on the patient's behalf. Although the appropriateness of patients or their families having to decide about (...) the provision of CPR has been challenged, there has been little examination of how patients and their families talk about and negotiate such decisions, particularly in the context of the patient's imminent death. In this article, part of a larger study analysing interviews with 28 patients (13 female) with cancer within weeks of their death, and 20 others (predominantly family) attending, we argue that a common assumption underpinning participants' talk about the DNR decision (i.e. forgoing CPR) is that it requires a choice between life and death. Using illustrative examples, we demonstrate that in making decisions about CPR, patients and their families are implicitly required to make moral judgements about the value of the patient's life, including their relationships with significant others. We identify some implications of these empirical observations for the development of ethically appropriate policies and practices regarding patient autonomy and surrogacy at the end of life. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. (...) Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring “informed choice” about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions and consider the implications if the autonomy of drinking behavior is substantially compromised. Our discussion (...) demonstrates the need for the various ethical issues to be considered and addressed in any decision to mandate cancer warning labels. (shrink)

Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case study (...) approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating. (shrink)

The classical interpretation of mathematical statements can be seen as comprising two separate but related aspects: a domain and a truth-schema. L. E. J. Brouwer’s intuitionistic project lays the groundwork for an alternative conception of the objects in this domain, as well as an accompanying intuitionistic truth-schema. Drawing on the work of Arend Heyting and Michael Dummett, I present two objections to classical mathematical semantics, with the aim of creating an opening for an alternative interpretation. With this accomplished, I then (...) make the case for intuitionism as a suitable candidate to fill this void. (shrink)

Mechanistic models are built using knowledge as the primary information source, with well-established biological and physical laws determining the causal relationships within the model. Once the causal structure of the model is determined, parameters must be defined in order to accurately reproduce relevant data. Determining parameters and their values is particularly challenging in the case of models of pathophysiology, for which data for calibration is sparse. Multiple data sources might be required, and data may not be in a uniform or (...) desirable format. We describe a calibration strategy to address the challenges of scarcity and heterogeneity of calibration data. Our strategy focuses on parameters whose initial values cannot be easily derived from the literature, and our goal is to determine the values of these parameters via calibration with constraints set by relevant data. When combined with a covariance matrix adaptation evolution strategy, this step-by-step approach can be applied to a wide range of biological models. We describe a stepwise, integrative and iterative approach to multiscale mechanistic model calibration, and provide an example of calibrating a pathophysiological lung adenocarcinoma model. Using the approach described here we illustrate the successful calibration of a complex knowledge-based mechanistic model using only the limited heterogeneous datasets publicly available in the literature. (shrink)

Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated ‘inner posture’ as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something (...) new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer’s notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions. (shrink)

¿Qué significa vivir y filosofar bajo una dictadura militar? Tomaré como punto de partida la experiencia que he compartido con mis amigos chilenos, excluidos o marginados de su universidad, y pronto con otros, argentinos y uruguayos, en las postrimerías de los regímenes autoritarios, una aventura que dura cuarenta años. Al hacerlo, me viene a la memoria la frase de George Eliott que da título al excelente libro de Patrick Vauday, Comenzar. Variaciones sobre la idea de comienzo : “Los hombres (...) no pueden hacer nada sin la ficción de un comienzo”. Es el precio de toda historia o narración, pero “hay sin embargo una necesidad, la de dar cuenta de lo nuevo que no se desprende de lo que le precede sin al menos desviar o derivarse de su línea, como aspirado por lo que aspira a nacer”. (shrink)

Ludwig Wittgenstein (1889-1951) was an extraordinarily original thinker, whose influence on twentieth-century thinking far outside the bounds of philosophy alone. In this engaging Introduction, A.C. Grayling makes Wittgenstein's thought accessible to the general reader by explaining the nature and impact of Wittgenstein's views. He describes both his early and later philosophy, the differences and connections between them, and gives a fresh assessment of Wittgenstein's continuing influence on contemporary thought.

In this short paper I propose that the sensorimotor approach to perception is a tree yielding two distinct theoretical fruits. One fruit is sensorimotor reductionism. The other is sensorimotor integrationism. In this paper I try to explain what makes these fruits different.

As is well known, some paradoxes arise through inadequate analysis of the meanings of terms in a language, an adequate analysis showing that the paradoxes arise through a lack of separation of an object theory and a metatheory. Under such an adequate analysis in which parts of the metatheory are modelled in the object theory, the paradoxes give way to remarkable theorems establishing limitations of the object theory.Such a modelling is often accomplished by a Gödel numbering. Here we shall use (...) a somewhat different technique in axiomatic set theory, from which we shall reap a few results having the effect of comparing the strength of various axiom schema of comprehension for sets and classes. Similar results were obtained by A. Mostowski [7] using Gödel numbering. (shrink)

In this note is proved the following:Theorem.Iƒ A × B is universal and one oƒ A, B is r.e. then one of A, B is universal.Letα, τbe 1-argument recursive functions such thatxgoes to, τ) is a map of the natural numbers onto all ordered pairs of natural numbers. A set A of natural numbers is calleduniversalif every r.e. set is reducible to A; A × B is calleduniversalif the set.

The dictionary shows philosophers at their best (and their worst), at their most perverse and their most elegant. Organised by philosopher, and indexed by thought, concept and phrase, it enables readers to discover who said what, and what was said by whom. Over 300 philosophers are represented, from Aristotle to Zeno, including Einstein, Aquinas, Sartre and De Beauvoir, and the quotations range from short cryptic phrases to longer statements. This Dictionary of Philosophical Quotations d will not change your life. It (...) will change your mind. (shrink)

This is the first-ever critical history of sociology in Britain, written by one of the world's leading scholars in the field. A. H. Halsey presents a vivid and authoritative picture of the neglect, expansion, fragmentation, and explosion of the discipline during the past century. The book examines the literary and scientific contributions to the origin of the discipline, and the challenges faced by the discipline at the dawn of a new century.

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A constant comparative analysis of the (...) transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the health care workers’ conflict between their professional role and their moral role, which they perceived as unclear. (shrink)

AC Grayling is Britain’s leading popular philosopher. A professor at Birkbeck College, University of London, he has written over 20 books, ranging from academic monographs such as Truth, Meaning and Realism to more accessible works such as What is Good? and The Mystery of Things. His most recent books are Towards The Light and The Choice of Hercules.

Consolation is needed when a human being suffers (i.e. feels alienated from him-or herself, from other people, from the world or from his or her ultimate source of meaning). The aim of this study was to illuminate the meaning of consolation. Tape-recorded narrative interviews were carried out with 18 professionals from various spheres. The transcribed interviews were interpreted hermeneutically. A model of consolation is outlined in a drawing. It states that the mediator and the receiver of consolation must become ready (...) for consolation before it can take place. To be ready means to be present and available. Availability means expressing suffering and listening respectively, and thereby opening up for communion and consoling dialogue. Communion brings about contact with the sacred dimension that human beings share and thus with goodness, light, joy, beauty and life. Consolation involves a shift of perspective and an experience of meaning in spite of suffering. (shrink)

Articles on the life and works of Āraja Ālī Mātubbara, 1901-1986, Muslim philosopher and author from Bangladesh.

Commentary on the Brahmasūtra of Bādarāyaṇa, aphoristic work on Vedanta philosophy.

t. 1. Noosferizm : vvedenie v noosferizm, Noosferizm: dvizhenie, ideologii︠a︡ ili novai︠a︡ nauchno-mirovozzrecheskai︠a︡ sistema? -- t. 2. Noosferizm : Kapitalokratii︠a︡ mify liberizma ... -- t. 3. Noosferizm : Rossii︠a︡ v XXI veke v kontekste ... -- t. 4, kn. 1. Noosferizm : Noosfernoe ili neklassicheskoe chelovekovedeni; kn. 2. Noosfernoe ili neklassicheskoe chelovekovedenie: poisk osnovaniĭ -- t. 5, kn. 1. Noosfernoe ili neklassicheskoe chelovekovedenie: poisk osnovaniĭ; kn. 12. Noosfernoe ili neklassicheskoe chelovekovedenie: poisk osnovaniĭ -- t. 6. kn. 1. Obrazovanie--vysshiĭ imperativ noosfernogo (...) ili ustoĭchivogo razvitii︢a︡ Rossii v XXI veke; kn. 2 Obrazovanie--vysshiĭ imperativ noosfernogo ili ustoĭchivogo razvitii︢a︡ Rossii v XXI veke -- t. 7. Sistemologii︠a︡ obrazovanii︠a︡ i obrazovanievedenie. (shrink)

Panentheism has become a familiar term in contemporary Christian systematic theology and philosophy, for it is widely believed to be an appropriate way to overcome the alleged dualism found in the classical God-world relationship. But what is meant by the term panentheism, and how does it work so as to avoid becoming still another form of pantheism or cosmic monism? In 2004 Philip Clayton and the late Arthur Peacocke published a set of papers on the topic of panentheism that came (...) from a conference in England on that topic in 2001.1 Yet, while there were certain broad affinities in approach and content among many of the papers, none of them used precisely the same conceptual model for analysis of the concept. As.. (shrink)

Description from a book review by J. G. Beebe-Center: "Mr. Allen's book develops in detail the view that pleasure and unpleasure are essentially manifestations of the progression and thwarting of impulses. Part one is a brief summary of the principal theories of feeling. Part two is devoted to "sensory" or "bodily" pleasure and unpleasure. These forms of feeling, it is argued, 'depend on an analogue of conation existing in the organism, a nisus to maintain, or to carry out to the (...) full extent, the functioning proper to the bodily system.' Part three -- the piece de resistance (about half the book) -- deals with the relation of pleasure and unpleasure to the main instincts. Parts four, five and six take up a number of classical problems: the relation of pleasure and unpleasure to sensation, their relation to desire, the relativity of feelings, the qualitative variety of feelings, and the psychology of values. The author shows throughout a rare combination of historicophilosophical sophistication and of first-hand familiarity with the modern experimental literature.". (shrink)

The basic (negative and positive) methodological maxims of three currents of philosophy of science (logical empiricism, falsificationism, and postpositivism) are formulated. Many of these maxims (stratagems) are controversial, e.g., the stance about the nonsense of metaphysics, and that of its indispensability. The restricted validity of these maxims allows for their unification. Within the framework of most of them there may be a relationship of (synchronic, or diachronic) subordination of the contradicting desiderata. In this vein ten stratagems are formulated.

Context: The theory of radical constructivism offers a tool for the evaluation of knowledge in general: especially with regard to its epistemic and ontological character. This applies in particular to knowledge that is non-cognitive, such as, e.g., ethical convictions. Problem: What impact can radical constructivism have on the topic of ethics? Specifically, how can ethical issues be resolved within a radical-constructivist epistemic approach? Method: I extend the theory of radical constructivism to include also items of non-cognitive knowledge. This makes it (...) possible to discuss ethical issues, which are non-cognitive, in a constructivist epistemic and ontological perspective. Some arguments against this conception of “strictly personal ethics” are discussed. Results: Radical constructivism is neutral on ethical issues, and thus cannot be invoked to endorse any particular ethical position. However, this causes no problem for the theory: the individual knower will construct her own ethical values and convictions, as part of her store of non-cognitive knowledge, in interaction with her environment (including other individuals. Hence ethical values cannot be argued in cognitive terms; and this elevates the knower into a position of personal responsibility with respect to ethical issues. Constructivist content: I focus on the role played by radical constructivism in the approach to cognitive vs. non-cognitive knowledge. The construction of knowledge (of any kind) emerges as a strictly personal enterprise. For instance, in the context addressed here, constructed non-cognitive knowledge forms a basis for the individual knower’s ethical position. (shrink)

We derive the schemes of from certain weak forms of the same.

This paper studies, by way of an example, the intuitionistic propositional connective * defined in the language of second order propositional logic by * ≡ ∃Q. In full topological models * is not generally definable but over Cantor-space and the reals it can be classically shown that *↔ ⅂⅂P; on the other hand, this is false constructively, i.e. a contradiction with Church's thesis is obtained. This is comparable with some well-known results on the completeness of intuitionistic first-order predicate logic. Over (...) [0, 1], the operator * is undefinable. We show how to recast this argument in terms of intuitive intuitionistic validity in some parameter. The undefinability argument essentially uses the connectedness of [0, 1]; most of the work of recasting consists in the choice of a suitable intuitionistically meaningful parameter, so as to imitate the effect of connectedness. Parameters of the required kind can be obtained as so-called projections of lawless sequences. (shrink)