Health systems are integrating medical-legal partnerships (MLPs) into clinical care and increasingly center “complex care” patients. These patients have intersecting medical and social needs and often face systemic inequities that exacerbate their chronic health conditions. This paper describes a role for MLPs in hospital quality initiatives; examines the ethics of MLPs assisting with guardianship and institutionalization of hospital patients including marginalized groups; and advocates for MLP interventions designed to address intersectional and ethical concerns.

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm‐generated information and risk scores motivates clinicians to refuse to treat—or to inappropriately treat—vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal (...) antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act. (shrink)

Testimony is an invaluable source of knowledge. We rely on the reports of those around us for everything from the ingredients in our food and medicine to the identity of our family members. Recent years have seen an explosion of interest in the epistemology of testimony. Despite the multitude of views offered, a single thesis is nearly universally accepted: testimonial knowledge is acquired through the process of transmission from speaker to hearer. In this book, Jennifer Lackey shows that this (...) thesis is false and, hence, that the literature on testimony has been shaped at its core by a view that is fundamentally misguided. She then defends a detailed alternative to this conception of testimony: whereas the views currently dominant focus on the epistemic status of what speakers believe, Lackey advances a theory that instead centers on what speakers say. The upshot is that, strictly speaking, we do not learn from one another's beliefs - we learn from one another's words. Once this shift in focus is in place, Lackey goes on to argue that, though positive reasons are necessary for testimonial knowledge, testimony itself is an irreducible epistemic source. This leads to the development of a theory that gives proper credence to testimony's epistemologically dual nature: both the speaker and the hearer must make a positive epistemic contribution to testimonial knowledge. The resulting view not only reveals that testimony has the capacity to generate knowledge, but it also gives appropriate weight to our nature as both socially indebted and individually rational creatures. The approach found in this book will, then, represent a radical departure from the views currently dominating the epistemology of testimony, and thus is intended to reshape our understanding of the deep and ubiquitous reliance we have on the testimony of those around us. (shrink)

How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old. These new foundations rest on familiar observations of human nature and human needs. (...) Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues-based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today. This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world. (shrink)

Resumen En este trabajo se analizan las pautas de elección entre los cuatro paradigmas gramaticales de segunda persona del español peninsular (los prototípicos, representados por los pronombres tú y vosotros, y los desplazados, por usted y ustedes), cuando se usan para indexar a interlocutores específicos, en un corpus de discurso radiofónico de la ciudad española de Salamanca. Se plantea la hipótesis de que los fundamentos cognitivos de las personas gramaticales se proyectan en su potencial sociopragmático como recursos para la configuración (...) de identidades contextuales. Tras clasificar a los participantes del corpus en cuatro tipos de identidad socioprofesional recurrentes en la comunicación radiofónica (locutores, personajes públicos, políticos y hablantes particulares), se calculan las frecuencias con que cada tipo dirige y recibe cada tratamiento de segunda persona. El análisis cuantitativo constituye un punto de partida para la observación cualitativa de los contextos de uso. Tras este se concluye que la elección entre las cuatro formas de segunda persona combina los parámetros sociopragmáticos de cercanía-distancia (que afecta a la elección entre formas prototípicas y desplazadas) e individualidad-grupalidad (que afecta a la elección entre formas singulares y plurales). Tales parámetros remiten, a su vez, al continuum discursivo-cognitivo entre la subjetividad y la objetividad. (shrink)

The purpose of this article is to analyze Spanish first-person plural subjects as a cognitively grounded grammatical choice serving various discursive functions. Both the expressed and omitted variants of the subject will be considered, even if omission is by far the more frequent choice in Spanish and the more communicatively versatile one. The particularly vague reference of omitted nosotros ‘we’ – always involving an extension of the self towards a wider notional scope – results in a remarkable variety of possible (...) contextual projections. It can be used to signal speaker identities as well as manage interpersonal relationships through the iconic suggestion of viewpoint coincidence. First-person plural clauses are quantitatively and qualitatively investigated across two corpora of contemporary Spanish comprising a variety of spoken and written genres. It is found that, aside from the basic distinction between hearer-exclusive and hearer-inclusive first persons, a third, intermediate variant can be considered, that of empathic hearer-exclusive uses. These are typical of interactions where involvement of the audience is sought even if they are not referentially included in the subject, as is usual in some varieties of spoken mass-media discourse. Each one of the referential variants is used with different frequencies and contextual repercussions, depending on the socio-functional demands and goals of particular textual genres. (shrink)

This is a study of Blondel's philosophy of the supernatural as it appeared only in the dissertation on Action of 1893. First, it reviews how Blondel brought philosophy to focus concretely on human action and what he focuses on in this action as the principle for its dialectical unfolding. Second, it shows how this focus brings him to a radical critique of superstition and any idea of natural religion, since even the latter is viewed as a kind of superstition. Third, (...) it examines how he proceeds to the affirmation of God as the necessary being of action and how this affirmation places the human being in a position of having to choose between saying yes or no to God at the core of his action. Fourth, it shows how Blondel argues from this existential exigency that the thought of the supernatural necessarily arises with regard to the question of human destiny and that such a thought, if it actualized in human action through a gratuitous initiative on the part of God, necessarily entails a revelation, a mediation, and a religious practice on the part of man. In conclusion it reflects on how this science of practice remains a philosophy, as distinct from theology, even though it has to do with religious practice in the most supernatural sense. /// O presente artigo constitui urn estudo sobre o problema do sobrenatural, tal como Blondel comeca por o tratar em sua tese de doutoramento sobre a Ácção, publicada em 1893. Em primeiro lugar, passa-se em revista não só o modo concreto como Blondel fez do problema da acção assunto para a filosofia, mas também se procura discernir aquilo que, segundo ele, na acção mesma constitui o princípio do seu desdobramento dialéctico. Em segundo lugar, mostra-se como a partir deste ponto de focagem Blondel procede a uma critica radical da superstição bem como de toda e qualquer ideia de religião natural, por ele igualmente vista como uma espécie de superstição. Em terceiro lugar, examina-se o modo como Blondel avança em direcção a uma afirmação de Deus como o ser necessário da acção e como esta mesma afirmação coloca o ser humano numa posicjio de, no fulcro do seu agir, ter de optar entre o dizer sim ou não a Deus. Em quarto lugar, mostra-se o modo como Blondel, partindo desta exigência existencial, argumenta no sentido de que o pensamento do sobrenatural necessariamente se dá em conexão com a questão do destino humano e de como tal pensamento, actualizado na acção humana graças a uma iniciativa gratuita da parte de Deus, necessariamente implica a ideia de revelação, mediação, e prática religiosa da parte do homem. Finalmente, em conclusão, reflecte-se sobre o modo como esta ciência da prática permanece filosofia, distinta da teologia, mesmo quando, enquanto tal, ela tern a ver com uma prática religiosa no sentido mais sobrenatural do termo /// Ceci est une étude de la philosophie du surnaturel de Blondel telle qu'elle parut uniquement dans la thèse sur L'Action de 1893. Premièrement, elle revoit comment Blondel a amené la philosophie à réfléchir concrétement sur l'action humaine et ce sur quoi cette réflexion s'appuie comme principe du déploiement dialectique de cette action. Deuxièmement, elle montre comment ce déploiement amène Blondel à une critique radicale de la superstition et de toute idée de religion naturelle, puisque cette dernière est vue comme une sorte de superstition. Troisièmement, elle examine comment Blondel avance vers une affirmation de Dieu comme Fetre necessaire de l'action et comment cette affirmation amène l'être humain à devoir choisir entre dire oui ou non face à Dieu au plus profond de son action. Quatrièmement, elle montre comment Blondel, à partir de cette exigence existentielle, arrive à poser que la pensée du surnaturel surgit nécessairement par rapport à la question du destin de l'être humain et comment une telle pensée, si elle devient réalite dans l'action humaine par une initiative gratuite du côté de Dieu. entraine du côté de l'homme la nécessité d'une révélation, une médiation et une pratique religieuse. En conclusion, l'étude se demande comment cette science de la pratique reste une philosophie, distincte de toute théologie, même si elle traite de la pratique religieuse dans son sens le plus surnaturel. (shrink)

Este artículo se adentra en los temas y tópicos vitales de la obra literaria de Eliacer Cansino, escritor dedicado a la literatura juvenil, e invita a reflexionar sobre cómo su lectura puede desarrollar el pensamiento crítico de los jóvenes lectores del siglo XXI. Para abordar esta investigación, se ha recurrido a una metodología de corte cualitativo, con especial atención a la narrativa biográfica. De esta manera, dado que literatura y realidad constituyen dos caras de una moneda al forjar lectores, se (...) analizó el perimundo literario de Eliacer Cansino. Los resultados justifican que la lectura de la obra de este autor es un referente literario para el desarrollo del pensamiento crítico desde la experiencia lectora de los adolescentes. (shrink)

Jennifer Church presents a new account of perception, which shows how imagining alternative perspectives and possibilities plays a key role in creating and validating experiences of self-evident objectivity. She explores the nature of moral perception and aesthetic perception, and argues that perception can be both literal and substantive.

Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with what (...) is commonly called “decisional capacity”, a central concept in health care law and ethics, and increasingly an independent topic of philosophical inquiry. -/- Decisional capacity can be defined as the ability of subjects to make their own medical decisions. Somewhat similar questions of capacity arise in other contexts, such as capacity to stand trial in a court of law and the ability to make decisions that relate to personal care and finances. However, the history behind the more general legal notions of capacity to stand trial and capacity to manage one’s life is different and operates somewhat differently in law (Roth, Meisel, & Litz 1977; Zapf & Roesch 2005). For the purposes of this discussion the notion of decisional capacity will be limited to medical contexts only; most notably, those where decisions to consent or to refuse treatment or participation in clinical research are concerned. (shrink)

This volume argues that educational problems have their basis in an ideology of binary opposites often referred to as dualism, and that it is partly because mainstream schooling incorporates dualism that it is unable to facilitate the thinking skills, dispositions and understandings necessary for autonomy, democratic citizenship and leading a meaningful life. Bleazby proposes an approach to schooling termed social reconstruction learning, in which students engage in philosophical inquiries with members of their community in order to reconstruct real social problems, (...) arguing that this pedagogy can better facilitate independent thinking, imaginativeness, emotional intelligence, autonomy, and active citizenship. (shrink)

The Perfection of the Universe gives an account of the idea of the universe and its perfection in Aquinas's philosophy, but at the same time it provides an example of how a cosmology can be developed in a teleological framework. Although this is the cosmology of one who was first and foremost a theologian, the book tries to show how it was articulated philosophically and in relation to a particular model of the universe. As a contribution to the history of (...) philosophy, and Thomistic studies in particular, it seeks to draw more attention to Aquinas's view of the world, which has been relatively neglected in favor of emphasis on his theory of knowledge and theory of being, and at the same time to show how it is integral to his very understanding of being. The book thereby brings out a dimension of rationality in Aquinas's philosophy that is often ignored, especially as it concerns creation as a whole and what Aquinas refers to as convenientia in this whole. The systematic nature of Aquinas's conception of the universe is highlighted by the author's attempt to reconstruct the movement of his thought. Thus Oliva Blanchette focuses not just on the universe or on perfection but on the perfection of the universe as a unified idea that recurs frequently in both the philosophy and the theology of Aquinas and that has its own philosophical dynamic both as a logic and as an actuality. In doing so, he endeavors to correct misconceptions about Aquinas's idea of the universe, such as that found in Lovejoy's Great Chain of Being, and to show how the idea stands up philosophically even while being connected with a scientific model of the universe now viewed as obsolete. (shrink)

In this contribution, I critically discuss the thesis, advanced by some recent writers, that nonreductive physicalists can solve the problem of causal exclusion by resorting to the metaphysical notion of grounding. After discussing the many problems confronted by very recent versions of this proposal, I conclude that a version of Nonreductive Physicalism framed in terms of a notion of realization of properties is in a better position than Grounding Physicalism in order to successfully deal with a notoriously complex metaphysical issue (...) such as the causal exclusion problem. (shrink)

Does rationality require imprecise credences? Many hold that it does: imprecise evidence requires correspondingly imprecise credences. I argue that this is false. The imprecise view faces the same arbitrariness worries that were meant to motivate it in the first place. It faces these worries because it incorporates a certain idealization. But doing away with this idealization effectively collapses the imprecise view into a particular kind of precise view. On this alternative, our attitudes should reflect a kind of normative uncertainty: uncertainty (...) about what to believe. This view refutes the claim that precise credences are inappropriately informative or committal. Some argue that indeterminate evidential support requires imprecise credences; but I argue that indeterminate evidential support instead places indeterminate requirements on credences, and is compatible with the claim that rational credences may always be precise. (shrink)

Pt. 1. The journey inward. Breaking into the intellectual scene -- Awakening to the divine light in human action -- The original philosophy of the supernatural -- The vocation to philosophy -- Discourse on method for philosophy of religion -- Crisis of modernity for Catholic apologetics -- The broader social involvement -- The philosopher of Aix -- The philosophical itinerary -- The question of a Catholic philosophy -- Pt. 2. The systematic summation. The question of thought -- The responsibilities of (...) thought -- Ontology of consolidation in being in, through, and of itself -- Action as cooperation with the first cause -- The original philosophy of action revisited -- The expanded philosophy of the supernatural -- Symbiosis of the human and the divine in history -- Christian spirit and historical civilization. (shrink)

The phenomenon of pain presents problems and puzzles for philosophers who want to understand its nature. Though pain might seem simple, there has been disagreement since Aristotle about whether pain is an emotion, sensation, perception, or disturbed state of the body. Despite advances in psychology, neuroscience, and medicine, pain is still poorly understood and multiple theories of pain abound. The Routledge Handbook of Philosophy of Pain is an outstanding reference source to the key topics, problems and debates in this exciting (...) and interdisciplinary subject and is the first collection of its kind. Comprising over thirty chapters by a team of international contributors the Handbook is divided into nine clear parts: Modelling pain in philosophy Modelling pain in neuroscience Modelling pain in psychology Pain in philosophy of mind Pain in epistemology Pain in philosophy of religion Pain in ethics Pain in medicine Pain in law. As well as fundamental topics in the philosophy of pain such as the nature, role, and value of pain, many other important topics are covered including the neurological pathways involved in pain processing, biopsychosocial and cognitive behavioural models of pain; chronic pain; pain and non-human animals; pain and knowledge; controlled substances for pain; pain and placebo effects; and pain and physician assisted suicide. The Routledge Handbook of Philosophy of Pain is essential reading for students and researchers in philosophy of mind, philosophy of psychology and ethics. It will also be very useful to researchers of pain from any field, especially those in psychology, medicine, and health studies. (shrink)

In this paper, we present another case study in the general project of proof mining which means the logical analysis of prima facie non-effective proofs with the aim of extracting new computationally relevant data. We use techniques based on monotone functional interpretation developed in Kohlenbach , Oxford University Press, Oxford, 1996, pp. 225–260) to analyze Cheney's simplification 189) of Jackson's original proof 320) of the uniqueness of the best L1-approximation of continuous functions fC[0,1] by polynomials pPn of degree n. Cheney's (...) proof is non-effective in the sense that it is based on classical logic and on the non-computational principle WKL . The result of our analysis provides the first effective uniform modulus of uniqueness . Moreover, the extracted modulus has the optimal ε-dependency as follows from Kroó 331). The paper also describes how the uniform modulus of uniqueness can be used to compute the best L1-approximations of a fixed fC[0,1] with arbitrary precision. The second author uses this result to give a complexity upper bound on the computation of the best L1-approximation in Oliva 66–77). (shrink)

Most theories of affective influences on judgement and choice take a valence-based approach, contrasting the effects of positive versus negative feeling states. These approaches have not specified if and when distinct emotions of the same valence have different effects on judgement. In this article, we propose a model of emotion-specific influences on judgement and choice. We posit that each emotion is defined by a tendency to perceive new events and objects in ways that are consistent with the original cognitive-appraisal dimensions (...) of the emotion. To pit the valence and appraisal-tendency approaches against one another, we present a study that addresses whether two emotions of the same valence but differing appraisals—anger and fear—relate in different ways to risk perception. Consistent with the appraisal-tendency hypothesis, fearful people made pessimistic judgements of future events whereas angry people made optimistic judgements. In the Discussion we expand the proposed model and review evidence supporting two social moderators of appraisal-tendency processes. (shrink)

Ethical codes have been hailed as an explicit vehicle for achieving more sustainable and defensible organizational practice. Nonetheless, when legal compliance and corporate governance codes are conflated, codes can be used to define organizational interests ostentatiously by stipulating norms for employee ethics. Such codes have a largely cosmetic and insurance function, acting subtly and strategically to control organizational risk management and protection. In this paper, we conduct a genealogical discourse analysis of a representative code of ethics from an international corporation (...) to understand how management frames expectations of compliance. Our contribution is to articulate the problems inherent in codes of ethics, and we make some recommendations to address these to benefit both an organization and its employees. In this way, we show how a code of ethics can provide a foundation for ethical sustainability, while addressing management intentions and employees’ ethical satisfaction. (shrink)

It is a remarkable thing to find oneself suddenly surprised by an author after having spent years analysing, interpreting, and teaching their works. And yet, that is precisely the experience of many Kant specialists in recent times, as greater attention than ever has been placed on Kant’s discussions of gender and race. Part of the disorientation for Kantians surely comes from the way in which these investigations—oriented as they are by questions of empire as opposed to say, metaphysics—are able to (...) make a body of work that has been long-familiar seem strange and new. It is in this vein that I want to use my discussion here as an opportunity to reconsider one of Kant’s most familiar texts, the Groundwork of the Metaphysics of Morals, in order to focus on the case of moral failure presented by the person who has chosen an easy path in life: one who has ‘seine Talente verrosten ließ’ (4:423; let their talents rust, 75), to use Kant’s phrase.1 With this in focus, I will identify four subsequent counter examples offered up by Kant, each meant to offer specific cases of non-Europeans in a manner that can provide further moral instruction on this point. What this approach should reveal is not only Kant’s unsurprising consistency regarding the need for self-improvement, but also the compatibility he evidently saw between engaging his readers in moral guidance, on the one hand, and identifying non-European others as counterexamples of a morally worthless existence, on the other. (shrink)

A dramatic shift in British and French ideas about empire unfolded in the sixty years straddling the turn of the nineteenth century. As Jennifer Pitts shows in A Turn to Empire, Adam Smith, Edmund Burke, and Jeremy Bentham were among many at the start of this period to criticize European empires as unjust as well as politically and economically disastrous for the conquering nations. By the mid-nineteenth century, however, the most prominent British and French liberal thinkers, including John Stuart (...) Mill and Alexis de Tocqueville, vigorously supported the conquest of non-European peoples. Pitts explains that this reflected a rise in civilizational self-confidence, as theories of human progress became more triumphalist, less nuanced, and less tolerant of cultural difference. At the same time, imperial expansion abroad came to be seen as a political project that might assist the emergence of stable liberal democracies within Europe. Pitts shows that liberal thinkers usually celebrated for respecting not only human equality and liberty but also pluralism supported an inegalitarian and decidedly nonhumanitarian international politics. Yet such moments represent not a necessary feature of liberal thought but a striking departure from views shared by precisely those late-eighteenth-century thinkers whom Mill and Tocqueville saw as their forebears. Fluently written, A Turn to Empire offers a novel assessment of modern political thought and international justice, and an illuminating perspective on continuing debates over empire, intervention, and liberal political commitments. (shrink)

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the needed groundwork for improved (...) models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science. (shrink)