Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. (...) In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

Recently, concerns have been raised about the phenomenon of 'overdiagnosis', the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises questions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue that (...) "disease" should be considered a vague concept with a nonclassical structure. On this view, overdiagnosed cases are 'borderline' cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a précising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...) the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)

Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence (...) itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims. (shrink)

The \\)-Robertson–Walker spacetime is under investigation. With the derived Hamilton operator, we are solving the Wheeler–De Witt Equation and its Schrödinger-like extension, for physically important forms of the effective potential. The closed form solutions, expressed in terms of Heun’s functions, allow us to comment on the occurrence of Universe from highly probable quantum states.

Marina McCoy explores Plato's treatment of the rhetoric of philosophers and sophists through a thematic treatment of six different Platonic dialogues, including Apology, Protagoras, Gorgias, Republic, Sophist, and Phaedras. She argues that Plato presents the philosopher and the sophist as difficult to distinguish, insofar as both use rhetoric as part of their arguments. Plato does not present philosophy as rhetoric-free, but rather shows that rhetoric is an integral part of philosophy. However, the philosopher and the sophist are distinguished by (...) the philosopher's love of the forms as the ultimate objects of desire. It is this love of the forms that informs the philosopher's rhetoric, which he uses to lead his partner to better understand his deepest desires. McCoy's work is of interest to philosophers, classicists, and communications specialists alike in its careful yet comprehensive treatment of philosophy, sophistry, and rhetoric as portrayed through the drama of the dialogues. (shrink)

Philosophers continue to debate both the actual and the ideal roles of values in science. Recently, Eric Winsberg has offered a novel, model-based challenge to those who argue that the internal workings of science can and should be kept free from the influence of social values. He contends that model-based assignments of probability to hypotheses about future climate change are unavoidably influenced by social values. I raise two objections to Winsberg’s argument, neither of which can wholly undermine its conclusion but (...) each of which suggests that his argument exaggerates the influence of social values on estimates of uncertainty in climate prediction. I then show how a more traditional challenge to the value-free ideal seems tailor-made for the climate context. (shrink)

T. G. Masaryk’s thought is famous for his concept of the Czech nation as well as his ideals of humanity. As a philosopher, sociologist, and politician, he was confronted with Czech anti-Semitism, and after Czechoslovakia was founded, with issues of the Jewish national minority. He tried to solve all the questions with respect to his ethical conviction and the ideals of democracy and equality. The most difficult personal situation for Masaryk emerged with the ‘Hilsner affair’, when his brave stance against (...) anti-Semitism caused animosity and even hatred from the public. As a consequence of that Masaryk had to abandon his public activities including lecturing at university for some time. The philosopher Jan Patočka analysed Masaryk’s involvement in this case and the following events in his study Masaryk’s struggle against anti-Semitism. Patočka pointed out that there is an interconnection between Masaryk’s involvement in this affair and his engagement in the question of Czech nationality, as Masaryk intended to improve the ethical level of the nation by disposing of bias and namely the ritual murder myth. The second part of the present contribution is focused on Masaryk’s views on Zionism and the assimilation movement and his ambiguity in relation to the issue. It seems that Masaryk’s concept of the Czech nation, formed for the struggle against the Habsburg monarchy, became inadequate in the new republic, as it was not inclusive of the many minorities, the Jewish one included. On the other hand, Masaryk’s ideals of humanity provide a certain solution on the level of ethics. (shrink)

This paper critically examines Weisberg’s weighted feature matching account of model-world similarity. A number of concerns are raised, including that Weisberg provides an account of what underlies scientific judgments of relative similarity, when what is desired is an account of the sorts of model-target similarities that are necessary or sufficient for achieving particular types of modeling goal. Other concerns relate to the details of the account, in particular to the content of feature sets, the nature of shared features and the (...) assumed independence of feature weightings. (shrink)

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)

A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the (...) implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared. (shrink)

This article examines colonialism, the regime of whiteness, and feminism; it sketches possible genealogies of theories and practices in order to design an aesthetic of radicality or a radical aesthetic that is insurgent and defiant, based on histories and knowledge. We know that aesthetics is a colonial formation that historically and currently privileges the white European bourgeois who could speculate on the beautiful and the good, while genocidal practices and slave trade were carried out from European soil in other parts (...) of the world. Similarly, the Shoah, the still unthinkable genocide that happened on European soil in the twentieth century and shaped the European present, is still, at its base, covered by rhetorically empty constructions of aesthetic perception, practices, and theories. A radical aesthetics must realign all these categories, not only with a cynical gesture of inversion but to situate them categorically and ethically elsewhere. (shrink)

In evolutionary psychology predictions, women’s mate preferences shift between fertile and nonfertile times of the month to reflect ancestral fitness benefits. Our meta-analytic test involving 58 independent reports (13 unpublished, 45 published) was largely nonsupportive. Specifically, fertile women did not especially desire sex in short-term relationships with men purported to be of high genetic quality (i.e., high testosterone, masculinity, dominance, symmetry). The few significant preference shifts appeared to be research artifacts. The effects declined over time in published work, were limited (...) to studies that used broader, less precise definitions of the fertile phase, and were found only in published research. (shrink)

The literature on brain activity in depression and anxiety is reviewed with an on highlighting discrepancies and inconsistencies. In particular, and posterior asymmetries have been reported for both depression anxiety, but the magnitude and direction of these asymmetries has been We propose that by identifying subtypes of depression and anxiety of these inconsistencies can be explained. In addition, we review suggesting that issues of comorbidity are important to consider in to account for regional brain activity in depression and anxiety.

Current conceptions of human language include a gestural component in the communicative event. However, determining how the linguistic and gestural signals are distinguished, how each is structured, and how they interact still poses a challenge for the construction of a comprehensive model of language. This study attempts to advance our understanding of these issues with evidence from sign language. The study adopts McNeill's criteria for distinguishing gestures from the linguistically organized signal, and provides a brief description of the linguistic organization (...) of sign languages. Focusing on the subcategory of iconic gestures, the paper shows that signers create iconic gestures with the mouth, an articulator that acts symbiotically with the hands to complement the linguistic description of objects and events. A new distinction between the mimetic replica and the iconic symbol accounts for the nature and distribution of iconic mouth gestures and distinguishes them from mimetic uses of the mouth. Symbiotic symbolization by hand and mouth is a salient feature of human language, regardless of whether the primary linguistic modality is oral or manual. Speakers gesture with their hands, and signers gesture with their mouths. (shrink)

The increased competition for a share of the market of insured patients, which arose in the wake of failed comprehensive health care reform, has provoked questions about what, if any, standards will govern new “competitive” health care organizations. Managed care arrangements, which typically shift to providers and patients some or all of the financial risk for patient care, are of special concern because they can create incentives to withhold beneficial care from patients. Of course, fee-for-service medical practice creates incentives to (...) provide unnecessary services, and managed care can avoid that type of harm. Still, as Edmund Pellegrino has noted, “managed care, by its nature, places the good of the patient into conflict with … the good of all the other patients served by the plan; the good of the plan and the organization, themselves…; and the self-interest of the physician. (shrink)

In this paper we explore the nature of the emerging purpose ecosystem and its role in transforming and supporting business to help address the UN Sustainable Development Goals. We argue that interactions among its ‘private actors’, who share efforts and belief in changing and redefining the purpose and nature of business by advocating broader non-financial performance outcomes, have the potential to contribute to a wider sustainability-oriented transformation of the business sector. Through interview data collected in the UK and Australia, we (...) identify six main roles that characterise the activities and interactions among its actors and their stakeholders. Our research contributes to expanding knowledge on the emerging phenomenon of the purpose ecosystem and how its actors support the achievement of the UN SDGs by seeking to change the purpose of business and integrating the goals into their operations and engagements with stakeholders. (shrink)

Offering a format that is significantly different than that offered by other books, Ethical Health Care beings by asking what is meant by health and how it is achieved. The book then proceeds to explore with care and context the nature of the relationship between patients and clinicians, health care providers and the societies in which they inhabit, and finally the relationship between the health care enterprise and the international community. By emphasizing the ethical issues that arise in the broad (...) quest to foster human health, and appreciating that health is not primarily a function of medical interventions, Ethical Health Care introduces students to problems such as the international distribution of pharmaceuticals and the dangers of reemerging infections. To a far greater extent than is done traditionally, Ethical Health Care provides an interdisciplinary perspective to bioethics, relying heavily upon the teachings of economics, law, and public health. (shrink)

En la España de los siglos XVI y XVII se desarrolla la Escolástica española. Un tiempo en el que las Universidades no contaban con programas oficiales de estudios y, por tanto, la enseñanza del Derecho era distinta en cada una de ellas. Asimismo, imperan dos corrientes doctrinales distintas: el humanismo jurídico y el mos italicus tardío. El estado de la ciencia jurídica de ese momento provoca que proliferen tratados didácticos para la enseñanza de Leyes. Uno de ellos, muy desatendido por (...) la historiografía jurídica, es Nueva Filosofía de la natvraleza del hombre, no conocida ni alcançada de los grandes filosofos antiguos, que analizamos en este trabajo en aras a contribuir con el estudio del Derecho de la Edad Moderna, pues su autor, Miguel Sabuco, se caracteriza por exponer el estado de la ciencia jurídica en ese momento y formular propuestas de mejora. (shrink)

According to Nicomachean Ethics I.7 1098a16–18, eudaimonia consists in activity of soul “according to the best and most final” virtue. Ongoing debate between inclusivist and exclusivist readers of this passage has focused on the referent of “the best and most final” virtue. I argue that even if one accepts the exclusivist's answer to this reference question, one still needs an account of what it means for activity of soul to accord with the best and most final virtue. I examine the (...) nature of this accordance relation and defend a novel inclusivist reading of the whole passage. (shrink)

Citation: Christodoulou, Marina. “‘To be dead is an unthinkable anomaly’ Reversed Necropolitics and the Death Imaginary.” Lo Sguardo - rivista di filosofia N. 23, 2017 (I) - Reinventare il reale. Jean Baudrillard (2007-2017) a cura di Eleonora de Conciliis, Enrico Schirò, Daniela Angelucci, pp. 127-137. Articolo sottoposto a peer review. Ricevuto il 14/10/2016. Accettato il 12/01/2017. ISSN: 2036-6558 -/- --------- -/- The concept or the theory of Death in the thought of Jean Baudrillard is not given the particular attention (...) it needs. When one speaks of the thought of Baudrillard, one rarely will mention ‘death’ as one of the keywords of his corpus. I think, though, that it deserves such a key place, for three reasons. Firstly, because the theme of Death is a gargantuan concept in the history of Philosophy and it even emerges with the definition of Philosophy itself, since, at least, Plato. Every philosopher, more or less is preoccupied with it, as an archetypical necessity of both human culture and of philosophy in particular. It is always interesting to see how each philosopher or each person thinks on it, as their thoughts on Death are a departure point and an indication of their whole philosophical system or, for non-philosophers, of their whole way of life. Secondly, it is important to examine this theme in Baudrillard because it inseparably interconnects, explains, and is explained by all the other, key, and the less prominent themes in his philosophy. Baudrillard’s thinking might take new dimensions when viewed through his thoughts on Death. Finally, Baudrillard is considered a difficult thinker, because, unlike other philosophers, he grasps themes which people are used to seeing as the pre-occupation or within the realm of fiction, even science-fiction. I would like to show, using simple language, that his philosophy, especially surrounding the subject of Death, is completely naked of any metaphysical, romanticised, fantastic, or fiction-like properties; it is realistic and political. (shrink)

We examine three assumptions commonly held in the corporate reputation literature: (1) reputation ratings of owners and investors are generally representative of all stakeholders; (2) stakeholders will generally provide a higher reputation rating to firms that emphasize corporate social responsibility versus firms that do not; and (3) profitability is the primary criterion of importance to all stakeholders when rating a firm's reputation. Using an exploratory in‐class exercise, our findings suggest that: (1) there are significant differences among stakeholder groups in their (...) reputation ratings; (2) firms that emphasize corporate social responsibility are not rated more highly across all stakeholder groups; and (3) for all stakeholder groups, the ethicality criterion explained more of the variance in firms' reputation ratings than the profitability criterion. (shrink)

This pedagogical essay explores the tendency of undergraduate media ethics students to do what Bernard Gert calls “morality by slogans” and their tendency to misuse Aristotle's golden mean slogan. While not solving the dilemma of morality by slogans, the essay suggests some ways of rectifying the misuse of the golden mean and encouraging its more authentic application.

As neuroscience methods begin to dominate emotion research it is critical for researchers to remember that peripheral embodiments are critical to understanding emotional experience and emotion—behavior links. Much of modern emotion research assumes reliable mind—body connections that suggest that changes in emotional states influence bodily responses and, vice versa, that somatovisceral information shapes emotional experiences. However, there may be important qualifications to the link between the mind and the (peripheral) body. For example, the ability to sense internal and external bodily (...) states declines in older age as does activation of physiological systems, all of which may contribute to an impairment in emotional experiences and how emotions influence behavior. I describe this phenomenon as maturational dualism and suggest implications of this for emotion in older adults. (shrink)

Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the (...) controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)