Jack Freer, Stephen Wear; Culture Wars in New York State: Ongoing Political Resistance by Religious Groups to the Family Health Care Decisions Act, Christian bi.

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the (...) meaning of “professionalism” itself, thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

In this article I defend an account of beauty labor as a form of resistance that can enable individuals and communities to combat body oppression. Focusing on the “Fuck Flattering!” movement, a social-media-driven movement in which fat people purposefully wear unflattering clothing to resist antifat fashion and oppressive body standards, I first set three criteria necessary for an act of beauty labor to count as one of resistance. I argue that (1) the agent in question must be (...) situated as a less ideal candidate for attributions of beauty, (2) the agent must have some level of knowledge or awareness of the norms (defined in light of dominant groups) and their harms, and (3) that knowledge or awareness of the harms of said norms must inform the agent's act of beauty labor. Based on this account of beauty labor as resistance, I argue that beauty labor can combat larger systems of oppression and incite meaningful change insofar as it enables individuals to claim and reclaim space (both digital and physical) from which fat people have been historically excluded, while affording an opportunity for education and unpacking of oppression and bias, and expanding the fashion industry. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

This books delves into the major tenets of Syrianus' philosophical teachings on the Timaeus and Parmenides based on the testimonia of Proclus, as found in Proclus' commentaries on Plato's Timaeus and Parmenides , and Damascius, as reported in his On First Principles and commentary on Plato's Parmenides.

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has (...) defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

Over the past forty years, the health humanities, previously called the medical humanities, has emerged as one of the most exciting fields for interdisciplinary scholarship, advancing humanistic inquiry into bioethics, human rights, health care, and the uses of technology. It has also helped inspire medical practitioners to engage in deeper reflection about the human elements of their practice. In _Health Humanities Reader_, editors Therese Jones, Delese Wear, and Lester D. Friedman have assembled fifty-four leading scholars, educators, artists, and clinicians (...) to survey the rich body of work that has already emerged from the field—and to imagine fresh approaches to the health humanities in these original essays. The collection’s contributors reflect the extraordinary diversity of the field, including scholars from the disciplines of disability studies, history, literature, nursing, religion, narrative medicine, philosophy, bioethics, medicine, and the social sciences. With warmth and humor, critical acumen and ethical insight, _Health Humanities Reader_ truly humanizes the field of medicine. Its accessible language and broad scope offers something for everyone from the experienced medical professional to a reader interested in health and illness. (shrink)

In this paper, I argue for an account of metaphorical content as what is said when a speaker utters a metaphor. First, I show that two other possibilities—the Gricean account of metaphor as implicature and the strictly semantic account developed by Josef Stern—face several serious problems. In their place, I propose an account that takes metaphorical content to cross-cut the semantic-pragmatic distinction. This requires re-thinking the notion of metaphorical content, as well as the relation between the metaphorical and the literal.

Imaginative and creative capacities seem to be at the heart of both games of make-believe and figurative uses of language. But how exactly might cases of metaphor or idiom involve make-believe? In this paper, I argue against the pretense-based accounts of Walton (1990, 1993), Hills (1997), and Egan (this journal, 2008) that pretense plays no role in the interpretation of metaphor or idiom; instead, more general capacities for manipulating concepts (which are also called on within the use of pretense) do (...) the real explanatory work. This result has consequences for both our understanding of metaphor and idiom as well as for the use of figurative language by fictionalists in ontology. (shrink)

Relevance Theory is a cognitively oriented theory of pragmatics, i.e., a theory of language use. It builds on the seminal work of H.P. Grice1 to develop a pragmatic theory which is at once philosophically sensitive and empirically plausible (in both psychological and evolutionary terms). This entry reviews the central commitments and chief contributions of Relevance Theory, including its Gricean commitment to the centrality of intention-reading and inference in communication; the cognitively grounded notion of relevance which provides the mechanism for explaining (...) pragmatic interpretation as an intention-driven, inferential process; and several key applications of the theory (lexical pragmatics, metaphor and irony, procedural meaning). Relevance Theory is an important contribution to our understanding of the pragmatics of communication. (shrink)

The pattern of impairments exhibited by some individuals on the autism spectrum appears to challenge the relevance-theoretic account of metaphor ( Carston, 1996, 2002 ; Sperber and Wilson, 2002 ; Sperber and Wilson, 2008 ). A subset of people on the autism spectrum have near-normal syntactic, phonological, and semantic abilities while having severe difficulties with the interpretation of metaphor, irony, conversational implicature, and other pragmatic phenomena. However, Relevance Theory treats metaphor as importantly unlike phenomena such as conversational implicature or irony (...) and like instances of ordinary literal speech. In this paper, I show how Relevance Theory can account for the prima facie incongruity between its treatment of metaphor and the case of individuals with autism. (shrink)

In this article I explore the ways in which legal language, discourses, and narratives construct new dominant identities for women who kill their children. These identities are those of the ‘bad’, ‘mad’, or ‘sad’ woman. Drawing upon and critiquing statutes, case law, and sentencing remarks from England and Wales, I explore how singular narrative identities emerge for the female defendants concerned. Using examples from selected cases, I highlight how the judiciary interpret legislation, use evidence, and draw upon gender stereotypes in (...) carefully constructing macro-narratives which produce gendered identities for filicidal women, thus nullifying the challenge these women pose to appropriate femininity and the motherhood mandate. Each of the narrative identities discussed deny the agency of the female defendants that they are attached to, albeit in subtly different ways, by denying their ability to make any degree of choice in relation to their filicidal actions. Although such identity construction and agency denial may not always be damaging to these filicidal women per se, its pervasiveness within legal discourse reinforces and reproduces damaging gender stereotypes surrounding women and femininity. (shrink)

This volume brings together original research that throws new light on how standards of behavior for medical practitioners are articulated in different religious, social, and political contexts.

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what expanded responsibilities and tactics physicians should embrace to protect and enhance such patients' autonomy; and (3) the standards, criteria, and mechanisms (...) by which paternalistic interventions might be justified in cases when the diminishment remains too substantial to merit acceptance of the patients' directives. (shrink)

This dissertation examines how the distinction between what is said and what is implicated should be applied to metaphorical language. I claim that metaphor has been incorrectly held to belong to the domain of pragmatics---what is implicated by an utterance---and I argue that metaphorical interpretations can and should be regarded as constituting what is said. ;The first two chapters develop the case against two implicature accounts of metaphor: Grice's account of metaphor as conversational implicature, and the relevance-theoretic account of metaphor (...) as 'loose talk' developed by Dan Sperber and Deirdre Wilson. Two reasons to dispute these characterizations of metaphor as implicature are developed by examining dissimilarities between alleged metaphorical implicatures and more typical cases of implicature. The third chapter focuses on the notion of what is said in cases of literal language, and explores where and how the line between what is said and what is implicated should be drawn for several controversial cases. I argue for a view of such cases according to which considerable contextual variation is taken to fall within the realm of what is said. With this view of what is said in place, the final two chapters of the dissertation explore how a semantic account of metaphor might go. Two existing semantic accounts are examined, and difficulties with each are discussed. Finally, a characterization of metaphorical content is proposed, and an alternative semantic account is developed. (shrink)

Health professionals faced with refusal of life-saving treatment may wish to override a person's wishes, especially if that person suffers from a mental disorder. Mental illness does not automatically mean a patient is incapable of making decisions of this nature. It is not always clear whether an individual is legally competent to decide whether to undergo treatment or not. This article discusses a clinical example and analyses some of the moral implications.

The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to (...) toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

Consumer culture and neoliberal political economy are often viewed by social psychologists as topics reserved for anthropologists, economists, political scientists and sociologists. This paper takes an alternative view arguing that social psychology needs to better understand these two intertwined institutions as they can both challenge and provide a number of important insights into social psychological theories of self-identity and their related concepts. These include personality traits, self-esteem, social comparisons, self-enhancement, impression management, self-regulation and social identity. To illustrate, we examine how (...) elements of consumer culture and neoliberal political economy intersect with social psychological concepts of self-identity through three main topics: ‘the commodification of self-identity’, ‘social categories, culture and power relations’ and the ‘governing of self-regulating consumers’. In conclusion, we recommend a decommodified approach to research with the aim of producing social psychological knowledge that avoids becoming enmeshed with consumer culture and neoliberalism. (shrink)

Many teachers of bioethics often express concern, in their writings and otherwise, about the theoretical basis (or lack of it) of bioethics and the allied issue of relativism. The companion articles by Tong and Momeyer are in this vein and rightly address such issues within the context of a liberal arts education. This article addresses such issues in a different venue, i.e., bioethics teaching in the clinical sphere of health care institutions. It presumes to suggest that many of these theoretical (...) concerns, as well as the threat of relativism, seldom arise in this sphere. Rather, a broad based, well accepted body of moral truth has been fashioned over the last quarter century and it is this that clinical bioethics regularly keys to and to which most moral dilemmas are referred for resolution. The various forms of this pedagogy, e.g., case consultations or institutional policy statements, are charted out in this regard, as well as the often tactical character of much of this teaching, i.e., not "what should we do?", but "how might we best do it?". The article then goes on to conclude with a reflection on the use and abuse of power in clinical bioethics teaching and consultation. (shrink)

In recent work, Judith Butler has sought to develop a ‘new bodily ontology’ with a substantive normative upshot: recognition of our shared bodily condition, they argue, can support an ethic of nonviolence and a renewed commitment to egalitarian social conditions. However, the route from Butler’s ontological claims to their ethico-political commitments is not clear: how can the general ontological features of embodiment Butler identifies introduce constraints on behaviour or political arrangements? Ontology, one might think, is neutral on questions of politics. (...) In this paper I reconstruct Butler’s response to this challenge, arguing that there is an interesting and plausible path from ontology to politics. I draw on Heidegger’s ontological/ontic distinction to elucidate the central concepts of Butler’s ontology: vulnerability, precariousness, and interdependency. I argue that one of Butler’s central attempts to derive an ethic of nonviolence from ontology is unpersuasive, resting on a conflation of the ontological and ontic senses of ‘interdependency’. Nonetheless, I contend that Butler is right that genuinely acknowledging our vulnerability is likely to make us more responsive to the claims of others, loosening the grip of ideals of invulnerability and sovereign independence. These ideals and the violence they encourage amount to a disavowal of our ontological condition, while commitment to nonviolence is a way of acknowledgingshrink)

Do continuing education (CE) mandates increase participation in ethics programs and enhance their perceived outcomes? In a study of 5,198 North American psychologists, significant differences were found between mandated and nonmandated psychologists in relation to their participation in ethics programs but not in the perceived outcomes associated with those trainings. Although 64.3% of those psychologists operating under ethics mandates reported completing at least one ethics training within the previous year, only 40.7% of those without such mandates reported doing likewise. Overall, (...) both groups tended to view their ethics training quite favorably in relation to its perceived outcomes, though they differed in relation to their endorsement of CE mandates. Results are discussed in relation to the ongoing development of evidence-based CE and its role in developing critical professional competencies. (shrink)

Although long touted as an ethical and legal requirement, some clinicians still seem to offer less than fully adequate informed consent processes; similarly the counseling of patients and families, particularly about post-intervention scenarios, is often perfunctory at best. Keyed to a narrative of a patient's experience with surgery for a deviated septum, this article reflects on why such less than adequate clinician behaviors tend to occur and what might be done about them. Certain legal misconceptions about informed consent are highlighted (...) in this reflection, as well as why certain clinicians seem to take such a narrow view of their responsibilities to patients. Further reference in this regard is also made to a recently constructed module on informed consent for medical residents. In it, though legal requirements for informed consent are reviewed, the basic perspective taken regards informed consent as a clinical intervention that pursues certain basic goods and values, only one of which lies in determining when legal closure for such processes has occurred. (shrink)

In standard Relevance Theory, hyperbole and metaphor are categorized together as loose uses of language, on a continuum with approximations, category extensions and other cases of loosening/broadening of meaning. Specifically, it is claimed that there are no interesting differences between hyperbolic and metaphorical uses. In recent work, we have set out to provide a more fine-grained articulation of the similarities and differences between hyperbolic and metaphorical uses and their relation to literal uses. We have defended the view that hyperbolic use (...) involves a shift of magnitude along a dimension which is intrinsic to the encoded meaning of the hyperbole vehicle, while metaphor involves a multi-dimensional qualitative shift away from the encoded meaning of the metaphor vehicle. In this article, we present three experiments designed to test the predictions of this analysis, using a variety of tasks (paraph. (shrink)

The idea of a market in human organs has traditionally met with widespread and emphatic rejection from both secular and religious fronts alike. However, as numerous human beings continue to suffer an uncertain fate on transplant waiting lists, voices are beginning to emerge that are willing at least to explore the option of human organ sales. Anyone who argues for such an option must contend, however, with what seem to be largely emotional rejections of the idea. Often it seems that (...) rebuffs offered on a secular ground are rooted in nothing more than vague discomforts. We suspect that these discomforts are often based in religious sentiments that have wound their way into the fabric of secular America. Therefore, in order to contribute further to those voices heard in favor of human organ sales, it is worthwhile to show that from a religious perspective, it is just as possible to affirm the appropriateness of human organ sales as it is from a secular basis. Since Protestantism has historically had a powerful influence in American society it is a proper starting point for such an investigation. (shrink)

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive (...) of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the living human body alone, but on the patientqua person. (shrink)