In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

This article is intended to revive, through a critical reinterpretation, the bio-psychosocial model of George Engel. Engel’s first description in 1977, was very broad, encompassing too many aspects of medicine. In his later work, he focused his model as an epistemology for clinical medicine. However, what medicine mostly retained were minor aspects of the 1977 article, namely a multi-factorial approach to the etiology of diseases and a call to complement biomedicine with a psychosocial concern in order to re-humanize medicine. We (...) suggest that, properly understood as a clinical epistemology, Engel’s model retains its transformative potential for contemporary medicine.Our discussion begins with a.. (shrink)

Corporate entrepreneurs -- described in the academic literature as those managers or employees who do not follow the status quo of their co-workers -- are depicted as visionaries who dream of taking the company in new directions. As a result, though, in overcoming internal obstacles to reaching their professional goals they can often walk a fine line between clever resourcefulness and outright rule breaking. A framework is presented as a guideline for middle managers and organizations seeking to impede unethical behaviors (...) in the pursuit of entrepreneurial activity. This paper examines the barriers middle managers face in trying to be entrepreneurial in less supportive environments, the ethical consequences that can result, and a suggested assessment and training program for averting such dilemmas. We advise companies that embrace corporate entrepreneurship: (1) establish the needed flexibility, innovation, and employee initiative and risk-taking; (2) remove the barriers that the entrepreneurial middle manager may face to more closely align personal and organizational initiatives and reduce the need to behave unethically; and (3) include an ethical component to corporate training which will provide guidelines for instituting compliance and values components into the state-of-the-art corporate entrepreneurship programs. (shrink)

The combination of genuine ethical concerns and fear of learning to use germ-line therapy for human disease must now be confronted. Until now, no established techniques were available to perform this treatment on a human. Through an integration of several fields of science and medicine, we have developed a nine step protocol at the germ-line level for the curative treatment of a genetic disease. Our purpose in this paper is to provide the first method to apply germ-line therapy to treat (...) those not yet born, who are destined to have a life threatening, or a severely debilitating genetic disease. We hope this proposal will initiate the process of a thorough analysis from both the scientific and ethical communities. As such, this proposal can be useful for official groups studying the advantages and disadvantages of germ-line therapy. (shrink)

In this paper we provide an account of the structural underpinnings of self-awareness. We offer both an abstract, logical account.

The thesis that rationality consists in the straight-forward maximization of utility has not lacked critics. Typically, however, detractors reject the Humean picture of rationality upon which it seems based; they seek to emancipate reason from the tyranny of the passions. It is, then, noteworthy when an attack on this thesis comes from ‘within the ranks.’David Gauthier's paper ‘Reason and Maximization’ is just such an attack; and for this reason, among others, it is interesting. It is not successful, though. In defense (...) of this conclusion, we shall begin by relating the essentials of Gauthier's argument. Then we shall examine in some detail Gauthier's claim that the principle of straighforward max-imization fails to be self-supporting. We shall argue that Gauthier's defense of this claim is at best incomplete. Finally, we shall show that the fact that a normative principle is self-subverting or non-self-supporting does not entail that the principle is defective. (shrink)

This article briefly reviews concerns related to the “cultural colonialism” of applying Western biomedical models of research ethics to non-Western groups. The feasibility of alternate ethical models is discussed and found wanting. In practical terms, many academic researchers in the United States are funded by federal agencies and are required to adhere to Title 45, Part 46 of the Code of Federal Regulations , legislation that is clearly grounded in the Western biomedical research tradition. Consequently, the question is not whether (...) this system of ethics should be applied but rather how it can be applied most sensitively, appropriately, and wisely. The remainder of this article discusses of how the authors have attempted to do so in each stage of their own research with Hispanic immigrants to the United States. (shrink)

A well-known relativistic action at a distance interaction of two unequal masses is altered so as to yield purely Newtonian radial forces with fixed particle rest masses in the system center-of-momentum inertial frame. Although particle masses experience no kinematic mass increase in this frame, speeds are naturally restricted to less than the speed of light. We derive a relation between the center-of-momentum frame total Newtonian energy and the composite rest mass. In a new proper time quantum formalism, we obtain an (...) L2(R4 ⊗ R4, C) Hilbert space by varying individual particle rest masses. We propose the use of density operators, recognizing that the auxiliary proper time parameter is not an observable. The quantum formalism is applied to our altered version of the relativistic harmonic oscillator. Our generalized coherent states yield four-dimensional wave packets which follow the correct classical world lines. Appendices contain reviews of classical Hamiltonian reparametrization (incorporating our notion of manifest covariance), and a comparison of this work with the literature. (shrink)

Delivered only months before his death, the Gifford Lectures allowed Donald MacKay to clarify and to emphasize his views on many important issues. MacKay stressed the primacy of personal experience and the differences between persons, brains, and machines. These positions are reviewed here, as are some of the reasons why MacKay may remain relatively unknown among American psychologists, philosophers, and neuroscientists.

BackgroundPrevious empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice ‘on its own terms’ by turning to the experience of patients.MethodsPhenomenological analysis of in-depth individual interviews with 8 patients.ResultsWe describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point provided by an (...) engaged physician. We draw on Heidegger’s notion of solicitude to show that patients are actively ascertaining the physician’s engagement in their care.ConclusionsThese findings lead us to question the classical “dual discourse” of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician’s solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient. (shrink)

BackgroundPrevious empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice ‘on its own terms’ by turning to the experience of patients.MethodsPhenomenological analysis of in-depth individual interviews with 8 patients.ResultsWe describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point provided by an (...) engaged physician. We draw on Heidegger’s notion of solicitude to show that patients are actively ascertaining the physician’s engagement in their care.ConclusionsThese findings lead us to question the classical “dual discourse” of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician’s solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient. (shrink)

We adjudicate a recent dispute concerning the desire theory of well-being. Stock counterexamples to the desire theory include “quirky” desires that seem irrelevant to well-being, such as the desire to count blades of grass. Bruckner claims that such desires are relevant to well-being, provided that the desirer can characterize the object in such a way that makes it clear to others what attracts the desirer to it. Lin claims that merely being attracted to the object of one’s desire should be (...) sufficient for it to be relevant to one’s well-being. The capacity to characterize the desire as Bruckner requires does no work in the explanation of the welfare-relevance of the desire, Lin claims, especially since Lin’s account and Bruckner’s account are extensionally equivalent. In response, we provide a conceptual analysis of desire based on conceptual role semantics. Our analysis shows the plausibility of and motivation for Bruckner’s account. As well, it shows that the extensional equivalence of the accounts is no accident, but due to what it is to have a desire. Lin has not succeeded in providing an alternative to Bruckner’s account, but merely reformulated it, though in an illuminating way that supports Bruckner’s original case. (shrink)