This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative—related to a strand in public choice theory—is to (...) model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)

Valérie Chevassus-Marchionni, Raymond Lemieux et François Nault.

◆ Writing is per se already violence: the rupture there is in each fragment, the break, the splitting, the tearing of the shred—acute singularity, steely point. And yet this combat is, for patience, debate. The name wears away [s'use], the fragment fragments, erodes.There is much talk today but little speech, or rather, little speech that could be received and responded to absent the vows of the unavowable community of its speakers. There is combat but debate is foreclosed by the absence (...) of asignifying absence. To avow that a community is unavowable—when the name wears away—is not to say that it has been disavowed, subjected, though in many cases this is so, for often the name names sovereignly.... (shrink)

The incredible achievements of modern scientific theories lead most of us to embrace scientific realism: the view that our best theories offer us at least roughly accurate descriptions of otherwise inaccessible parts of the world like genes, atoms, and the big bang. In Exceeding Our Grasp, Stanford argues that careful attention to the history of scientific investigation invites a challenge to this view that is not well represented in contemporary debates about the nature of the scientific enterprise. The historical record (...) of scientific inquiry, Stanford suggests, is characterized by what he calls the problem of unconceived alternatives. Past scientists have routinely failed even to conceive of alternatives to their own theories and lines of theoretical investigation, alternatives that were both well-confirmed by the evidence available at the time and sufficiently serious as to be ultimately accepted by later scientific communities. Stanford supports this claim with a detailed investigation of the mid-to-late 19th century theories of inheritance and generation proposed in turn by Charles Darwin, Francis Galton, and August Weismann. He goes on to argue that this historical pattern strongly suggests that there are equally well-confirmed and scientifically serious alternatives to our own best theories that remain currently unconceived. Moreover, this challenge is more serious than those rooted in either the so-called pessimistic induction or the underdetermination of theories by evidence, in part because existing realist responses to these latter challenges offer no relief from the problem of unconceived alternatives itself. Stanford concludes by investigating what positive account of the spectacularly successful edifice of modern theoretical science remains open to us if we accept that our best scientific theories are powerful conceptual tools for accomplishing our practical goals, but abandon the view that the descriptions of the world around us that they offer are therefore even probably or approximately true. (shrink)

The place of the emotions among the passions -- The analytic of the emotions I -- The analytic of the emotions II -- The dialectic of the emotions -- Pride, arrogance, and humility -- Shame, embarrassment, and guilt -- Envy -- Jealousy -- Anger -- Love -- Friendship -- Sympathy and empathy.

Some scientific categories seem to correspond to genuine features of the world and are indispensable for successful science in some domain; in short, they are natural kinds. This book gives a general account of what it is to be a natural kind and puts the account to work illuminating numerous specific examples.

By the time of his death in 2006, Sir Peter Strawson was regarded as one of the world's most distinguished philosophers. Unavailable for many years,_ Scepticism and Naturalism_ is a profound reflection on two classic philosophical problems by a philosopher at the pinnacle of his career. Based on his acclaimed Woodbridge lectures delivered at Columbia University in 1983, Strawson begins with a discussion of scepticism, which he defines as questioning the adequacy of our grounds for holding various beliefs. He then (...) draws deftly on Hume and Wittgenstein to argue that we must distinguish between 'hard', scientific naturalism; or 'soft', humanistic naturalism. In the remaining chapters the author takes up several issues in which sceptical doubts play an important role, in particular the nature of transcendental arguments and including the objectivity of moral philosophy, the mental and the physical, and the existence of abstract entities. _Scepticism and Naturalism_ is essential reading for those seeking an introduction to the work of one of the twentieth century’s most important and original philosophers. This reissue includes a substantial new foreword by Quassim Cassam and a fascinating intellectual autobiography by Strawson, which together form an excellent introduction to his life and work. (shrink)

Two approaches to the study of diagnostic thinking are compared, one mainly propositional, namely that of Patel and Groen (1986), the other mainly semantic, that of Lemieux and Bordage (1986). Patel and Groen analyzed the linear dimension of cardiologists' discourses while solving a case of acute bacterial endocarditis, that is, the before and after propositional rules. A secondary analysis of two of their pothophysiological protocols is done using structural semantic techniques from Lemieux and Bordage where the vertical dimension (...) of the discourses is analyzed, that is, the levels of meaning or semantic axes. Contrary to Patel and Groen's position, making an accurate diagnosis is not explained in terms of pure forward reasoning through networks of causal rules, but by means of networks of semantic qualities abstracted from the symptoms and signs. The semantic qualities operate in the clinician's mind in terms of binary oppositions (e.g., sudden-gradual, unilateral-bilateral) whereby each pair of properties constitutes a semantic axis (e.g., sudden-gradual). The successful diagnosticians are those who use the most diversified and pertinent set of semantic axes and, therefore, have a deeper representation of the problem. (shrink)

The concept of normal is so familiar that it can be hard to imagine contemporary life without it. Yet the term entered everyday speech only in the mid-twentieth century. Before that, it was solely a scientific term used primarily in medicine to refer to a general state of health and the orderly function of organs. But beginning in the middle of the twentieth century, normal broke out of scientific usage, becoming less precise and coming to mean a balanced condition to (...) be maintained and an ideal to be achieved. In Normality, Peter Cryle and Elizabeth Stephens offer an intellectual and cultural history of what it means to be normal. They explore the history of how communities settle on any one definition of the norm, along the way analyzing a fascinating series of case studies in fields as remote as anatomy, statistics, criminal anthropology, sociology, and eugenics. Cryle and Stephens argue that since the idea of normality is so central to contemporary disability, gender, race, and sexuality studies, scholars in these fields must first have a better understanding of the context for normality. This pioneering book moves beyond binaries to explore for the first time what it does—and doesn’t—mean to be normal. (shrink)

By the time of his death in 2006, Sir Peter Strawson was regarded as one of the world's most distinguished philosophers. Unavailable for many years,_ Scepticism and Naturalism_ is a profound reflection on two classic philosophical problems by a philosopher at the pinnacle of his career. Based on his acclaimed Woodbridge lectures delivered at Columbia University in 1983, Strawson begins with a discussion of scepticism, which he defines as questioning the adequacy of our grounds for holding various beliefs. He then (...) draws deftly on Hume and Wittgenstein to argue that we must distinguish between 'hard', scientific naturalism; or 'soft', humanistic naturalism. In the remaining chapters the author takes up several issues in which sceptical doubts play an important role, in particular the nature of transcendental arguments and including the objectivity of moral philosophy, the mental and the physical, and the existence of abstract entities. _Scepticism and Naturalism_ is essential reading for those seeking an introduction to the work of one of the twentieth century’s most important and original philosophers. This reissue includes a substantial new foreword by Quassim Cassam and a fascinating intellectual autobiography by Strawson, which together form an excellent introduction to his life and work. (shrink)

: This essay is a collection of my experiences of and reflections on being pregnant and choosing to place the child for open adoption. The piece was started late in the term of my pregnancy and completed about a week before the birth.

Raymond Lemieux | Résumé : Entre le discours du maître et le discours magistériel, la proximité est évidente. Pourtant le magis formant leur élément commun peut aussi bien s’avérer un facteur d’abrutissement, un producteur d’esclave, qu’un porteur d’émancipation. Comment le discours magistériel, qui se veut émancipateur, peut-il gérer cette ambiguïté ? Comment le maître peut-il être un maître de liberté ? L’article interroge tour à tour les pratiques éducatives et les pratiques psychanalytiques qui affrontent le même type d’aporie. Il (...) met de l’avant l’importance de l’interdiction faite à l’éducateur tant qu’à l’analyste de jouir de l’élève ou de l’analysant, c’est-à-dire de faire de leur apparente position de sujet assujetti un profit personnel. Qu’est-ce qu’éduquer à la liberté ? Qu’en est-il du magistère, dont le discours se veut émancipateur ? |: The semantic closeness between the discourse of the master and the magisterial teaching of the Church is obvious. However, the common root magis may be displayed as an enslavement process as well as a liberating one. How can this ambiguousness be removed from the teaching of the Church ? How can this one be an education to liberty ? In order to find some practical way of answering this question, the paper briefly examines contemporary educational and psychoanalytic challenges which confront such a logical and practical deadlock. It stresses the importance of the interdiction, for the educator as well as the psychoanalyst, of taking any personal advantage, pleasure or profit from the apparent position of subject which is that of the other. What does mean to educate with the purpose of liberty ? How the magisterial discourse of the Church can be an emancipatory one ? (shrink)

An Interdisciplinary Approach to Cognitive Modelling presents a new approach to cognition that challenges long-held views. It systematically develops a broad-based framework to model cognition, which is mathematically equivalent to the emerging 'quantum-like modelling' of the human mind. The book argues that a satisfactory physical and philosophical basis of such an approach is missing, a particular issue being the application of quantization to the mind for which there is no empirical evidence as yet. In response to this issue, the book (...) adopts a COM (classical optical modelling) approach, broad-based but mathematically equivalent to quantum-like modelling while avoiding its problematic features. It presents a philosophically informed and empirically motivated mathematical model of cognition, mainly concerning decision making processes. It also deals with applications to different areas of the social sciences. It will be of interest to scholars and research students interested in the mathematical modelling of cognition and decision making, and also interdisciplinary researchers interested in broader issues of cognition. (shrink)

This study concerns the ideas of one particular philosopher, Henri Bergson, whose views of time, intuition, and creativity have had a significant impact on art, literature, and the humanities, both in his time and in our own. Although it is generally recognized that Bergson's ideas have significantly impacted the arts and the humanities, it has not been recognized how they have also had a creative influence on the sciences as well. Nor has it been realized that this was one of (...) his most basic contentions. Bergson's conception of intuition--his fundamental insight into reality--was not limited to fugitive insights into human existence. By realizing previously unsuspected possibilities for research and discovery, his endeavors were also meant to make possible new advances in the sciences. If it enabled his cousin by marriage, Marcel Proust, to explore human memory in depth, it also inspired psychologists like Daniel Schachter to use Bergson's ideas to make real contributions to contemporary memory science. If his notion of creative evolution brought many thinkers to a belief in human creative freedom, it brought others (notably Alexis Carrel and Pierre Lecomte de Noüy) to a scientific study of biological time. Among his successful speculations was the theory of the Big Bang cosmology. 'Getting Bergson Straight' shows many points at which Bergson's ideas anticipated future developments in the sciences. This was seen clearly by the Nobel Prize-winning physicist Luis de Broglie who viewed Bergson's physics as presaging quantum physics. Thus, the text is well situated for arts, humanities, social science, and natural science classrooms studying creative thinking and/or intellectual history. (shrink)

Une sourde appréhension hante aujourd’hui les consciences : « Le christianisme survivra-t-il à la modernité ? ». S’il a été un facteur historique de civilisation, sa pertinence est-elle caduque quand cette civilisation se transforme, comme cela est le cas dans le monde contemporain ? De quelles quêtes, de quelles souffrances, les regards portés sur lui, de l’intérieur comme de l’extérieur, sont-ils symptômes ? Quels en sont les dynamismes fondamentaux ? À quelles conversions l’expérience chrétienne est-elle appelée ?Pour baliser des pistes (...) de réponses à ces questions, nous questionnerons ici l’institution culturelle du christianisme, c’est-à-dire les modes selon lesquels, dans son histoire, il a soutenu du sens et se trouve, aujourd’hui, confronté à une conjoncture inédite. Cette institution culturelle comprend davantage que la vie interne et l’action des Églises qui à la fois la débordent et en dépendent. Des actes de foi l’animent, certes, sans s’y confiner non plus. Par christianisme, nous entendons donc saisir les modes variés par lesquels se sont inscrites, historiquement, « des nappes de produit relatives à des systèmes de production » en transactions constantes avec le « monde ». A vague apprehension haunts many minds today: “Will Christianity outlive modernity?” Although Christianity was a historical factor in the development of civilisation, will its pertinence be bypassed when this civilisation is transformed, as seems to be the case in the contemporary world? What is the re-examination applied to it from inside and out symptomatic of – of what searching and what suffering? What are the fundamental dynamics underlying this? What sorts of conversion is the Christian experience called upon to undertake?In order to outline some approached to responding to these questions, we shall examine the cultural institution of Christianity, that is, the ways in which it underwrote meaning and today stands at a new crossroads in its history. This cultural institution comprises more than its internal life and the action of the Churches, which both go beyond it and depend upon it. Acts of faith are vital to this process, obviously, but also reach beyond it. By “Christianity”, we mean discerning the various modes through which “the layers of products related to systems of production” in constant interplay with the “world” are inscribed in a historical process. (shrink)

Sous le thème de la « méthode », l’auteur se propose de formuler une éthique de la lecture à partir de Gilles Deleuze. L’analyse est fondée sur un dédoublement de la lecture : d’abord la lecture qu’a fait De-leuze de David Hume tel qu’exprimé dans Empirisme et subjectivité (1953) et celle de Henri Bergson dans Le bergsonisme (1966), ensuite par la lecture que l’auteur fait de ces deux livres de Deleuze. Par l’entremise de l’empirisme (Hume) et de l’intuition (Bergson), l’auteur (...) conclut que la lecture que Deleuze a faite est performative en ce sens qu’elle fait ce qu’elle énonce. Une éthique de la lecture correspondante se voudra donc, de même, performative : elle dépassera le donné à tra-vers le délire, s’ouvrira à l’inhumain et au surhumain à travers le vir-tuel. (shrink)

Sous le thème de la « méthode », l’auteur se propose de formuler une éthique de la lecture à partir de Gilles Deleuze. L’analyse est fondée sur un dédoublement de la lecture : d’abord la lecture qu’a fait De-leuze de David Hume tel qu’exprimé dans Empirisme et subjectivité (1953) et celle de Henri Bergson dans Le bergsonisme (1966), ensuite par la lecture que l’auteur fait de ces deux livres de Deleuze. Par l’entremise de l’empirisme (Hume) et de l’intuition (Bergson), l’auteur (...) conclut que la lecture que Deleuze a faite est performative en ce sens qu’elle fait ce qu’elle énonce. Une éthique de la lecture correspondante se voudra donc, de même, performative : elle dépassera le donné à tra-vers le délire, s’ouvrira à l’inhumain et au surhumain à travers le vir-tuel. (shrink)

Un État idéal pourrait intervenir efficacement pour articuler l’interface entre les médias classiques et les médias sociaux. L’État réel, par contre, ne dispose pas de l’information nécessaire et ses acteurs ne sont pas soumis aux incitations requises. De plus, il n’existe pas d’intérêt public dont l’État puisse se réclamer. Il faut se demander si découlerait du laissez-faire une situation meilleure que celle que produit la coercition des processus politiques et bureaucratiques.