This article concerns the criteria for when a group can collectively hold a belief. By proposing a cognitive non-summative account of group belief (GB), I highlight three necessary features at the individual level: commonality, mutuality, and group-based considerations. My account asserts that group G believes proposition p if and only if a sufficient majority of its members believe (1) pG, where pG is “Given some G-based considerations, p,” and (2) “the majority of (...) G also believe that pG.” The article critiques three significant accounts of GB: Anthony Quinton’s simple summative account, Margaret Gilbert’s and Raimo Tuomela’s conative non-summative views, and Jennifer Lackey’s modified summativism. (shrink)

The partitioned Bonferroni mean operator can efficiently aggregate inputs, which are divided into parts based on their interrelationships. To date, it has not been used to aggregate linguistic Pythagorean fuzzy numbers. In this paper, we extend the PBM operator and partitioned geometric Bonferroni mean operator to the linguistic Pythagorean fuzzy sets and use them to develop a novel multiattribute group decision-making model under the linguistic Pythagorean fuzzy environment. We first define some novel operational laws for LPFNs, which take (...) into consideration the interactions between the membership degree and nonmembership degree from two different LPFNs. Based on these novel operational laws, we put forward the interaction PBM operator, the weighted interaction PBM operator, the interaction PGBM operator, and the weighted interaction PGBM operator. Then, we study some properties of these proposed operators and discuss their special cases. Based on the proposed LPFWIPBM and LPFWIPGBM operators, a novel multiattribute group decision-making model is developed to process the linguistic Pythagorean fuzzy information. Finally, some illustrative examples are introduced to compare our proposed methods with the existing ones. (shrink)

Smartphones with Global Positioning System (GPS) apps offer simple and accurate tools to collect data on human mobility. However, their associated ethical challenges remain to be assessed. We used the Emanuel framework to assess the ethical concerns of using smartphone GPS to record mobility patterns of young adults in rural South Africa for a larger study on mobility and HIV risk (Sesikhona). We conducted four focus groups (FGDs) with individuals eligible for the Sesikhona study. FGD data were coded using the (...) Emanuel framework. Participants perceived use of smartphone GPS to study human mobility and HIV risk as valuable. They raised concerns about invasion of privacy and confidentiality. Also mentioned were risk/benefit ratio, informed consent and ongoing respect. Concerns expressed provided a useful evidence-base for the development of a guide to inform future participants about ethical issues arising in the use of GPS technology to track mobility and health-related issues. (shrink)

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.

The physical meaning of the particularly simple non-degenerate supermetric, introduced in the previous part by the authors, is elucidated and the possible connection with processes of topological origin in high energy physics is analyzed and discussed. New possible mechanism of the localization of the fields in a particular sector of the supermanifold is proposed and the similarity and differences with a 5-dimensional warped model are shown. The relation with gauge theories of supergravity based in the OSP(1/4) group is (...) explicitly given and the possible original action is presented. We also show that in this non-degenerate super-model the physic states, in contrast with the basic states, are observables and can be interpreted as tomographic projections or generalized representations of operators belonging to the metaplectic group Mp(2). The advantage of geometrical formulations based on non-degenerate super-manifolds over degenerate ones is pointed out and the description and the analysis of some interesting aspects of the simplest Riemannian superspaces are presented from the point of view of the possible vacuum solutions. (shrink)

Evidence-based nursing practice is based on three pillars: the available research, known preferences of the patient or patient group and the professional experience of the nurse. For all pillars, research is the tool to expand the evidence we have, but when implementing evidence-based practice in paediatric nursing two of the pillars demand that children are included as respondents: practice research on the nursing interventions in paediatrics and the preferences of patients, something recognized by scholars and practitioners. (...) But including a vulnerable group as children in nursing research raises specific ethical issues that need to be considered by researchers. What are ethical considerations that are currently raised about doing research with children and what do we learn by synthesizing the narrative of these studies of why the issues are raised and which solutions can be offered for these issues? In this article, considerations on three ethical principles according to the Belmont report are described by examining recent research. Twenty-one studies were found addressing relevant ethical aspects including vulnerability, gaining consent, designing quantitative or qualitative research methods and considerations regarding the execution of the study. Ethical considerations should be much more a case of continuous awareness and attitude, then box-ticking exercise, although there are sufficient international guidelines available specifically for research that includes children to aid researchers. (shrink)

While Mindfulness-Based Interventions (MBIs) have been shown to be effective for a range of patient populations and outcomes, a question remains as to the role of common therapeutic factors, as opposed to the specific effects of mindfulness practice, in contributing to patient improvements. This project used a mixed-method design to investigate the contribution of specific (mindfulness practice-related) and common (instructor and group related) therapeutic factors to client improvements within an MBI. Participants with mild-severe depression (N= 104; 73% female,Mage (...) = 40.28) participated in an 8-week MBI. Specific therapeutic factors (formal out-of-class meditation minutes and informal mindfulness practice frequency) and social common factors (instructor and group ratings) were entered into multilevel growth curve models to predict changes in depression, anxiety, stress, and mindfulness at six timepoints from baseline to 3-month follow-up. Qualitative interviews with participants provided rich descriptions of how instructor and group related factors played a role in therapeutic trajectories. Findings indicated that instructor ratings predicted changes in depression and stress, group ratings predicted changes in stress and self-reported mindfulness, and formal meditation predicted changes in anxiety and stress, while informal mindfulness practice did not predict client improvements. Social common factors were stronger predictors of improvements in depression, stress, and self-reported mindfulness than specific mindfulness practice-related factors. Qualitative data supported the importance of relationships with instructor and group members, involving bonding, expressing feelings, and instilling hope. Our findings dispel the myth that MBI outcomes are exclusively the result of mindfulness meditation practice, and suggest that social common factors may account for much of the effects of these interventions. Further research on meditation should take into consideration the effects of social context and other common therapeutic factors. (shrink)

Background: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students’ education and especially the focus on ethical reasoning. Aim: The aim of this study was to explore and describe nursing students’ ethical reasoning and their supervisors’ experiences related to participation in clinical group supervision. Research design: The study is a qualitative interview study with interpretative description as an analysis approach. Participants and (...) research context: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5). Ethical considerations: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden. Findings: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions. Discussion and conclusion: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice. (shrink)

Buddhism has long been recognized as a religion of peace and non-violence. In today’s world, various conflicts take place between nations, religions, and ethnic groups. Buddha saw that people can live together freely as individuals, equal in principle, and therefore responsible for each other. Buddha explains that every member of the human family, man and woman alike, has an equal right to liberty. He recognized that each of us is just a human being like everyone else. The Buddha has given (...) this example in his own monasteries. The monks who belonged to different castes were given the opportunity to spend time together in the same monastery, which included holding meetings altogether, irrespective of ethnicity, caste, or religion, walking together in the Pindapātha, and holding Dhamma discussions together in the one Dhamma hall. The objective of this study is to identify Buddha’s teaching on social and ethnic harmony throughout the Buddhist scriptures (Pāli Canon) and consider its application in conflict resolution. Special attention will be paid to the doctrine preached by the Buddha which can be applied to build mutual understanding, relationships, and peace. The study method in this study is historical texts (Sutta Pitaka) content analysis and is carried out using the library survey methodology. (shrink)

There is currently much interest in bringing together the tradition of categorial grammar, and especially the Lambek calculus, with the recent paradigm of linear logic to which it has strong ties. One active research area is designing non-commutative versions of linear logic (Abrusci, 1995; Retoré, 1993) which can be sensitive to word order while retaining the hypothetical reasoning capabilities of standard (commutative) linear logic (Dalrymple et al., 1995). Some connections between the Lambek calculus and computations in groups have long been (...) known (van Benthem, 1986) but no serious attempt has been made to base a theory of linguistic processing solely on group structure. This paper presents such a model, and demonstrates the connection between linguistic processing and the classical algebraic notions of non-commutative free group, conjugacy, and group presentations. A grammar in this model, or G-grammar is a collection of lexical expressions which are products of logical forms, phonological forms, and inverses of those. Phrasal descriptions are obtained by forming products of lexical expressions and by cancelling contiguous elements which are inverses of each other. A G-grammar provides a symmetrical specification of the relation between a logical form and a phonological string that is neutral between parsing and generation modes. We show how the G-grammar can be oriented for each of the modes by reformulating the lexical expressions as rewriting rules adapted to parsing or generation, which then have strong decidability properties (inherent reversibility). We give examples showing the value of conjugacy for handling long-distance movement and quantifier scoping both in parsing and generation. The paper argues that by moving from the free monoid over a vocabulary V (standard in formal language theory) to the free group over V, deep affinities between linguistic phenomena and classical algebra come to the surface, and that the consequences of tapping the mathematical connections thus established can be considerable. (shrink)

Our study adopted a person-based approach with the aim to identify socio-behavioral profiles of primary school students based on peer group perception. The study involved 109 classes and their teachers, from the first three grades of elementary school. The final student sample consisted of 424 children, aged 6–9 years ( M = 94.9 months; SD = 9.7), of whom 58.3% were male. We used peer-group nomination to investigate the aspects that are linked to peer group (...) acceptance and perception of classroom behaviors, with reference to academic and relational criteria. We identified and defined six clusters. We validated these clusters by taking into consideration the children’s academic performances and the teacher’s perceptions of their relationship with the single students. The identified clusters were related to both of these aspects, and they show predictive value when referring to children’s behaviors as evaluated by their teachers. Implications for theory and educational policies are discussed. (shrink)

In this paper, I examine one central strand of Lackey’s The Epistemology of Groups, namely her account of group justified belief and the puzzle cases she uses to develop it. Her puzzle cases involve a group of museum guards most of whom justifiably believe a certain claim but do so on different bases. Consideration of these cases leads her to hold that a group justifiably believes p if and only if (1) a significant proportion of its operative (...) members (a) justifiably believe p on (b) bases that are consistent when combined and (2) the total evidence which members of the group do and should have had sufficiently support p. I question her judgement about these cases and condition 2, by examining the nature of group evidence as well as ‘transmission’ principles governing the relationship between the epistemic standing of members of a group and the group itself. (shrink)

The aim of this paper is to argue that our understanding of the issue of institutional group minds might be broadened if we consider alternative meta-metaphysical frameworks to those which are presently presupposed in the field. I argue that the two major camps in the contemporary philosophical debate about group beliefs, namely strong realism and eliminative reductionism, share a commitment to some form of meta-philosophical realism. Two alternative metaontological frameworks for the discussion of the issue of group (...) belief are outlined: fictionalism and deflationism. Fictionalism about group minds, although unpopular in the philosophical debate, is still a much-discussed option in legal theory and the theory of the firm in economics. I argue that, once formulated properly, the fictionalist position deserves serious consideration. The other alternative option is deflationism: I develop a sketch of the deflationary approach to group beliefs that is based on Thomasson’s approach to the existence of groups. The final parts of the paper are devoted to a discussion of the resulting four-element classification of the possible views on the reality of group minds: realism, eliminative reductionism, fictionalism, and deflationism. I offer some proposals with regard to the criteria that might be used to choose between these theories. (shrink)

This article tries to present a broad view on the values and ethicalissues that are at stake in efforts to rationalize health policy on thebasis of economic evaluations (like cost-effectiveness analysis) andrandomly controlled clinical trials. Though such a rationalization isgenerally seen as an objective and `value free' process, moral valuesoften play a hidden role, not only in the production of `evidence', butalso in the way this evidence is used in policy making. For example, thedefinition of effectiveness of medical treatment or (...) health care serviceis heavily dependent on dominant individual or social views about thegoals of the particular treatment or service. There is also a concernthat a reliance on EBM in health policy will occur at the expense ofwidely shared social values like equity and solidarity. Moreover, thereis a concern that when economic considerations and rational proceduresbecome more influential, various `outside' groups third parties likeinsurance companies and policy makers will get a stronger influence onmedical practice which may lead to a change in the patient-providerrelationship. The authors conclude that social values and patientpreference should be explicitly addressed when health policy making isbased on economic and other scientific evidence. (shrink)

Wegner, Giuliano, and Hertel (1985) defined the notion of a transactive memory system (TMS) as a group level memory system that “involves the operation of the memory systems of the individuals and the processes of communication that occur within the group (p. 191). Those processes are the collaborative procedures (“transactions”) by which groups encode, store, and retrieve information that is distributed among their members. Over the past 25+ years, the conception of a TMS has progressively garnered an increased (...) interest among social and organizational psychologists, communication scholars, and management theorists (Ren & Argote 2011). But there remains considerable disagreement about how exactly Wegner’s appeal to group memory should be understood. My goal in this paper is contribute to this debate, by articulating more clearly the value of conceptualizing groups as TMSs. This value, I argue, consists in providing us with a blueprint for how to explain group memory in terms of collective information-processing mechanisms. Collective information-processing mechanisms are dependent on, and interact with, the brain-bound information-processing of individuals, but cannot be reduced to the latter. In my analysis, I lean on extant accounts of mechanistic explanation in the philosophy of science (Bechtel & Richardson 1993; Machamer, Darden, & Craver 2000; Wimsatt 2007) that have been used to analyze the explanatory practices of psychology and cognitive neuroscience (Bechtel 2008, 2009). Based on my reconstruction of Wegner’s conceptualization of a TMS, I argue that the reality of emergent group cognition is compatible with its mechanistic explanation. More generally, my analysis shows that group cognition cannot be reduced to individual cognition, while avoiding the false dilemma between “wholism” and “nothing but-ism” which has hampered traditional construals of the “group mind” thesis (Allport 1968). (shrink)

Previous research with speech and non-speech stimuli suggested that in audiovisual perception, visual information starting prior to the onset of corresponding sound can provide visual cues, and form a prediction about the upcoming auditory sound. This prediction leads to audiovisual interaction. Auditory and visual perception interact and induce suppression and speeding up of the early auditory event-related potentials such as N1 and P2. To investigate AV interaction, previous research examined N1 and P2 amplitudes and latencies in response to audio only, (...) video only, audiovisual, and control stimuli, and compared AV with auditory perception based on four AV interaction models. The current study addresses how different models of AV interaction express N1 and P2 suppression in music perception. Furthermore, the current study took one step further and examined whether previous musical experience, which can potentially lead to higher N1 and P2 amplitudes in auditory perception, influenced AV interaction in different models. Musicians and non-musicians were presented the recordings of a keyboard /C4/ key being played, as well as CO stimuli. Results showed that AV interaction models differ in their expression of N1 and P2 amplitude and latency suppression. The calculation of model and has consequences for the resulting N1 and P2 difference waves. Furthermore, while musicians, compared to non-musicians, showed higher N1 amplitude in auditory perception, suppression of amplitudes and latencies for N1 and P2 was similar for the two groups across the AV models. Collectively, these results suggest that when visual cues from finger and hand movements predict the upcoming sound in AV music perception, suppression of early ERPs is similar for musicians and non-musicians. Notably, the calculation differences across models do not lead to the same pattern of results for N1 and P2, demonstrating that the four models are not interchangeable and are not directly comparable. (shrink)

The extent to which people anticipate and are influenced by the potential future consequences of their current behavior is called Consideration of Future Consequences. A well-established tool to measure this construct is the 14-item Consideration of Future Consequences Scale. The CFC-14 has shown appropriate psychometric properties in several languages. This scale comprises two factors: the CFC-Immediate and the CFC-Future. The main goal of this study was to assess the psychometric properties and internal consistency of the CFC-14 Scale in Spanish, using (...) an Argentine sample. A secondary goal was to determine its convergent validity with impulsivity, and determine differences across gender and age groups. Using a web-based survey, we collected data from 512 participants aged 13-74 years. Confirmatory Factor Analysis showed a 2-factor model as the best solution for 13-items version. Standardized regression weights ranged from.50 to.66 for CFC-F and between.43 and.83 for CFC-I. Composite reliability was also adequate: CFC-F achieve? =.80 and CFC-I? =.82. There were no differences across gender and age. The CFC-F subscale and UPPS-P subscales correlations, were negative and significant, highlighting the negative and moderate correlation between CFC-F and the lack of premeditation, a dimension strictly related to intertemporal decisions making. Thus, CFC-14 has adequate psychometric properties in an Argentinian population, although more studies are necessary to determine the robustness of these findings. (shrink)

In public health research, tracking folk racial categories (in disease risk, etc.) is a double-edged tool. On the one hand, tracking folk racial categories is dangerous because it reinforces a problematic but fairly common belief in biological race essentialism. On the other hand, ignoring racial categories also runs the risk of ignoring very real biological phenomena in which marginalized communities, likely in virtue of their marginalization, are sicker and in need of improved resources. Much of the conversation among epidemiologists and (...) philosophers of medicine concerning the issue of tracking folk racial categories in public health research springs forth from largely black/white binarized health inequities. While health inequities between black and white Americans are certainly a very important topic, I am interested in investigating the complications to this conversation about the potential harms of tracking folk racial categories in public health research generated by the consideration of Indigenous identities in the US—groups whose health inequities are typically tracked based on the folk racial category of “Native American” or “American Indian,” but whose unique identity categories and community membership problematize the current spectrum of approaches to tracking folk racial categories in epidemiologic research. This paper will draw on scholarship by and about Indigenous people in the US context to address an undertheorized facet of the conversations concerning the potential harms of tracking folk racial categories in public health research, including the potential undermining of American Indian sovereignty and Indigenous epistemologies. I will end on some methodological considerations inspired by the inclusion of Indigenous identities in the US in the conversation about tracking folk racial categories in epidemiologic research. (shrink)

Some prominent accounts of scientific evidence treat evidence as an unrelativized concept. But whether belief in a hypothesis is justified seems relative to the epistemic situation of the believer. The issue becomes yet more complicated in the context of group epistemic agents, for then one confronts the problem of relativizing to an epistemic situation that may include conflicting beliefs. As a step toward resolution of these difficulties, an ideal of justification is here proposed that incorporates both an unrelativized evidence (...) requirement and the requirement of the security of the evidence on which a conclusion from data is based. The latter requirement incorporates the consideration of epistemic modal statements. (shrink)

The increasing concern about ethics and integrity in research communities has brought attention to how students and junior academics can be trained on this regard. Moreover, it is known that ethical behaviour and integrity not only involve individual but also group norms and considerations. Thus, through action research and participant observation, this research investigates the learning processes through which 64 students collaboratively develop research ethics and integrity competencies. The aim was to understand how bachelor, master and PhD students (...) approach ethical dilemma cases through a collaborative process. The data consisted of recorded group work on ethics cases, student group reports, and post-training questionnaires. Later, the analyses considered groups as the unit of analysis. These data were analysed through content analysis utilizing the SOLO taxonomy to identify levels of understanding and assess evolvement of ethical sensitivity during a case-based training session. The results show that all groups reached the level of understanding where the groups demonstrated that concepts had been understood appropriately, but occasionally struggled to make connections between them. Students perceived working collaboratively as beneficial. The results help teachers of research ethics and integrity to make pedagogically justified choices in their teaching. Drawing on the results of this study, we propose a tool for the formative assessment of student learning of research ethics and integrity. (shrink)

This study is to show how the Logic-Based Therapy (LBT) method can be applied to groups in an attempt to point out possible risks and benefits of its application related to a group context. From observation and analysis a single practical case has been outlined, taking into consideration influence of group dynamics on the counselees’ cognitive processes during the LBT session. Judging from the analysis of the outlined results, it seems that intersubjectivity can play an important role (...) if considered as a productive resource in the co-construction of a changing process among LBT group members during the application of its six steps. In particular, new research fields on the need to analyze LBT in groups have been opened, exploiting the possibility to consider the group as an autonomous entity, especially in long term counseling therapies. (shrink)

Background: Medical education literature suggests that ethics education should be learner-centered and problem-based rather than theory-based. Team-based learning is an appropriate method for this suggestion. However, its effectiveness was not investigated enough in medical ethics education. Research question: Is team-based learning effective in medical ethics education in terms of knowledge retention, in-class learner engagement, and learner reactions? Research design: This was a prospective controlled follow-up study. We changed lecture with team-based learning method to teach four (...) topics in a 2-week medical ethics clerkship, while the remaining topics were taught by lectures. For comparison, we formed team-based learning and lecture groups, in which the students and instructor are the same, but the topics and teaching methodologies are different. We determined in-class learner engagement by direct observation and student satisfaction by feedback forms. Student success for team-based learning and lecture topics in the end-of-clerkship exam and two retention tests performed 1 year and 2 years later were compared. Ethical considerations: Ethical approval for the study was granted by Akdeniz University Board of Ethics on Noninvasive Clinical Human Studies Ethics committee. Findings: Short-term knowledge retention did not differ; however, team-based learning was found superior to lecture at long-term retention tests. Student satisfaction was high with team-based learning and in-class engagement was better in team-based learning sessions. Discussion: Our results on learner engagement and satisfaction with team-based learning were similar to those of previous reports. However, knowledge retention results in our study were contrary to literature. The reason might be the fact that students prepared for the end-of-clerkship pass/fail exam (short term) regardless of the teaching method. But, at long-term retention tests, they did not prepare for the exam and answered the questions just using the knowledge retained in their memories. Conclusion: Our findings suggest that team-based learning is a better alternative to lecture to teach ethics in medical education. (shrink)

Background: The nurses’ moral sensitivity is the first step to make right decisions in difficult moral situations. Therefore, its education and promotion is highly important. Research objectives: The aim of this study was to examine the impact of poetry-based ethics education on the nurses’ moral sensitivity. Research design and methods: This was a semi-experimental study. The sample consisted of 108 nurses who were selected by convenience sampling method and randomly assigned to three groups: intervention with poetry (G1), who read (...) a booklet about values and principles of professional ethics as well as poems related to these subjects for 1 month; intervention without poetry (G2), who only read the booklet without any poetry; and control group (G3), who did not receive any intervention. Data were collected by Moral Sensitivity Questionnaire that was completed by the participants prior to the intervention (T1), 1-month post-intervention (T2), and 2-month post-intervention (T3). Data were analyzed by SPSS 16 software. Ethical considerations: This study was conducted in accord with the principles of research ethics and regulations relating to informed consent. Findings: Changes in the mean score of total moral sensitivity were significantly higher in G1 than in G2, which was in turn significantly higher than in G3. This increase was significant from T1 to T2 and T2 to T3 (P < 0.001). In all subscales, there was a significant difference between the mean changes in the three groups, so that in these subscales, the mean changes in G1 were significantly higher than those in other groups. Discussion: In line with previous studies, our results showed the effectiveness of poetry-based education on the transfer of educational concepts and increase moral sensitivity scores with greater lasting effect. Conclusion: The use of interdisciplinary subjects such as poetry, due to its entertaining, fun, and lasting effect on minds; level of awareness; and actions of nurses, can help raise nursing moral sensitivity. (shrink)

Essay I explores brain machine interface technologies. These make direct communication between the brain and a machine possible by means of electrical stimuli. This essay reviews the existing and emerging technologies in this field and offers a systematic inquiry into the relevant ethical problems that are likely to emerge in the following decades. Essay II, co-written with professor Sven-Ove Hansson, presents a novel procedure to engage the public in ethical deliberations on the potential impacts of brain machine interface technology. We (...) call this procedure a Convergence seminar, a form of scenario-based group discussion that is founded on the idea of hypothetical retrospection. The theoretical background of this procedure and the results of the five seminars are presented here. Essay III discusses moral enhancement, an instance of human enhancement that alters a person’s dispositions, emotions or behavior in order to make that person more moral. Moral enhancement could be carried out in three different ways. The first strategy is behavioral enhancement. The second strategy, favored by prominent defenders of moral enhancement, is emotional enhancement. The third strategy is the enhancement of moral dispositions, such as empathy and inequity aversion. I argue that we ought to implement a combination of the second and third strategies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Theatrical Understanding: Considerations for James HamiltonNoël Carroll (bio)The publication of The Art of Theater by James Hamilton is a seminal event in the philosophy of theater.1 As the first book-length study of theater in the analytic tradition of philosophy, it will be a touchstone for many years of future discussion and debate. Anyone interested in the philosophy of theater will need to address Professor Hamilton’s accomplishment.The leading (...) idea in The Art of Theater is that theatrical performance is an independent art form. That is, theatrical performance, as such, is not, as Aristotle suggested by his demotion of spectacle, a mere adjunct to literature, or essentially a medium for illustrating dramatic and comedic texts. Theatrical performance itself is an art in its own right. This view of theater art has been increasingly apparent in the practices of modern theater in the West, but these practices—as exemplified by Gordon Craig, Vsevolod Meyerhold, Jacques Copeau, Bertolt Brecht, Antonin Artaud, Jerzy Grotowski, and, more recently, Robert Wilson—merely revealed what has always been the case: that theater is at root a performing art.Although for centuries theater in the West had been conceptualized as a text-based art, Hamilton maintains that this tradition is local. Theatrical performances in other cultures need not be the enactment of antecedently written-out texts. Furthermore, even within Western culture, most of us see and discuss plays without ever reading the texts upon which they are based. Hamilton takes these facts to support his view that theatrical performance is an autonomous art form. Among other things, this means that the critical model that presumes that the success of a theatrical performance must be assessed against the effectiveness of its implementation of the pertinent preexisting literary text is a misguided one. Although a preexisting literary text may be an ingredient in the production of a theatrical performance, fidelity to the aforesaid text is not mandated by the art of theater. [End Page 15]Insofar as theatrical performance is an art in its own right, it may—and quite clearly, as in the cases of the Performance Group, Kraken, Mabou Mines, etc., often does—adapt written texts for its own purposes. Moreover, refashioning the text, where there is one, is not simply an avant-garde practice; most productions edit the text for their own purposes. Kenneth Branagh’s Hamlet, which omitted no word from the accepted version of the text, was the exception to the rule. Thus, what Hamilton calls the ingredients model of the relation of texts to theatrical performances has the advantage on its side of better corresponding to actual practices, as compared to the notion that a theatrical performance is to be understood as a matter of bringing a literary text to life.Of course, one apparent advantage that the text-implementation model of theatrical performance might seem to possess is that it appears to have a way ready-to-hand for identifying theatrical performances. Gielgud’s performance, Olivier’s performance, and Burton’s performance are, ex hypothesi, all performances of Hamlet because they are all performances of Shakespeare’s text to which they all roughly comply. If, following Hamilton, we sever the relationship to the play-text, how can we account for the way in which we identify theatrical performances?2 That is, independently of reference to texts, how do we identify a theatrical performance as another instance of Hamlet?In order to solve this problem, Hamilton introduces the idea of “a basic understanding” of a theatrical performance. The basic understanding of a theatrical performance is, on Hamilton’s account, said to involve no more than comprehending on a moment-to-moment basis the ongoing bits of dialogue and stage action as they evolve, as well as understanding the transitions from one scene to another while also responding physically in a suitable manner to the evolving story (for example, laughing where laughter is appropriate) or emoting responsively to what is happening onstage. So, one has a basic understanding of a scene if, when the Musketeer says “On guard,” the spectator takes this to be an invitation to a duel; and when a rival character draws his sword, the... (shrink)

Le groupe de statues figurées d’une famille d’un hérôon, situé à l’intérieur de la ville antique de Palatiano, près de Kilkis, publié en 1972, a acquis une place éminente dans la recherche des statues honorifiques de l’époque hellénistique et impériale. Cependant, pour son interprétation, on a suivi une piste erronée, puisqu’il a été considéré que le chef de la famille – Patraos, fils de Zoilos – est l’homme qui est représenté nu, selon le type de l’Hermès Richelieu. Dans sa phase (...) initiale, le monument comprenait trois statues, alors que l’on en a ajouté deux autres par la suite. Nous proposons ici une nouvelle restitution du groupe et une nouvelle identification des figures avec les personnes mentionnées sur les plaques inscrites de la base. L’interprétation du groupe que nous présentons est fondée d’une part sur le sens de chacun des types statuaires qui sont adoptés pour la représentation des personnes dans le cadre social de l’époque et d’autre part, sur les éléments dont nous disposons sur la provenance et le caractère des statues analogues. (shrink)

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics. Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students. Research design: This is a repeated measurement quasi-experimental study. Participants and research context: The participants were nursing students in (...) a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software. Ethical considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline. Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups. Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students. (shrink)

ABSTRACTHélène Landemore's Democratic Reason offers a new justification for democracy and for broad-based citizen participation, appealing to the “emergent” intelligence of large, diverse groups. She argues that ordinary citizens should rule as directly as possible because they will make better informed, more intelligent decisions than, for example, appointed officials, councils of experts, or even elected representatives. The foundation of this conclusion is the premise that “diversity trumps ability” in a wide range of contexts. But the main support for that (...) claim is merely a series of computer experiments that are strongly biased toward that result and tell us essentially nothing about decision making in real-world political settings. Moreover, Landemore's analyses of alternative forms of rule deal only in abstract comparisons between sharply distinguished ideal types. Among other difficulties, they entirely overlook the central consideration in such comparisons: the relative ability of any decision-making process to go beyond stereotyped, intrinsic strategies and integrate multiple sources and varieties of information. In the end, Landemore's claims for the superior intelligence of broadly participatory forms are thus not supported by credible evidence. (shrink)

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a (...) holistic, caring‐healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music‐based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well‐being of this vulnerable group of older persons. (shrink)

Group 3 as Sc–Y–La, rather than Sc–Y–Lu, dominates the literature. The history of this situation, including involvement by the IUPAC, is summarised. I step back from the minutiae of physical, chemical, and electronic properties and explore considerations of regularity and symmetry, natural kinds, and quantum mechanics, finding these to be inconclusive. Continuing the theme, a series of ten interlocking arguments, in the context of a chemistry-based periodic table, are presented in support of lanthanum in Group 3. (...) In so doing, I seek to demonstrate a new way of thinking about this matter. The last of my ten arguments is recast as a twenty-word categorical philosophical (viewpoint-based) statement. (shrink)

Background The smart home-based elder care presents a promising technological solution to address the challenges of aging. However, it has also unveiled a spectrum of ethical concerns, which may cause older adults to submit to negative emotions and psychological pressure. Aim To delineate the ethical dilemmas encountered by older adults in the context of smart home-based elder care, and to construct a model that elucidates the ethical issues across different dimensions. Research design This study follows a qualitative phenomenological (...) research design. Participants and research context The sample comprised 15 older adults and 10 adult children in two communities in Jinan, Shandong, China. Structured, in-depth interviews were performed to collect data and the Colaizzi descriptive analysis framework was adopted to analyze data. An ethical dilemma model was constructed based on framework of the Society Ecosystems Theory. Ethical considerations The proposal was approved by the Research Ethics Committee of the Second Hospital of Shandong University, China. Participation in this study was voluntary. Written and verbal consent was gained. All recordings were kept under the principle of confidentiality. Results Ethical dilemmas of smart home-based elder care were grouped into three themes with 10 sub-themes, and a model composed of three systems was built based on these findings. Discussion The ethical dilemmas experienced by the older adults with smart home-based elder care were various and multi-layered, which could be elucidated by the ethical dilemma model. Conclusion The model emphasizes the necessity for collaborative efforts among the whole society and the elderly individuals. Tailored support strategies should be implemented to address the ethical dilemmas of the macro, meso, and micro system. The results may improve the elderly population to receive a more content and convenient elder care experience. (shrink)

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To (...) solve the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)

Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure (...) on political processes and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system. Keywords: Bedside rationing, cost-constraints, rule-based rationing CiteULike Connotea Del.icio.us What's this? (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article (...) we analyze Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

The complex health and social circumstances of living-at-risk, frequent users of emergency departments (aREDFUs) in the health jurisdictions of high-income countries, and the related, significant challenges posed for emergency departments and the health care providers working within them, are identified and explored in the paper. Ethical analyses of a set of relevant domains are performed, i.e., individual and relational autonomy considerations, relevant social construction and personal responsibility conceptions, patient welfare principles (beneficence, nonmaleficence, continuity of care), harm reduction methodologies and (...) their applications, health equity, and justice considerations of the distributive, formal and social types. The outcomes of these analyses demonstrate that there are ethically compelling reasons for emergency departments to adopt an ethics-informed, policy-based approach to the longitudinal care and management of living-at-risk, frequent users of emergency departments. From a formal justice perspective, the development and uses of such an approach are justified by a demonstrable relevant difference between living-at-risk, frequent users of emergency departments and other persons and groups of patients who visit emergency departments. We propose an example of such a policy-based approach. Examples of possible, pragmatic applications of this approach, which help ensure that aREDFUs who present to the ED are managed in a fair and optimally consistent manner, are provided for the consideration of an urban emergency department’s policymaking working group. (shrink)

Background: Families and clinicians must often weigh competing priorities when making medical decisions for a pediatric patient at the end of life. Few empirical data exist regarding the importance that clinicians place on varying priorities and whether clinical practice conforms to decision-making standards discussed in the literature. Methods: We administered a discrete choice experiment to understand the relative importance of nine pediatric end-of-life decision-making priorities using responses from 364 nurses and physicians from three intensive care units (ICUs) (pediatric ICU, pediatric (...) cardiothoracic ICU, neonatal ICU) in a large children's hospital, with a 54% response rate. We used latent class analysis to characterize subgroups of health professionals based on their patterns of importance for the nine attributes and examined differences in class membership using multinomial logistic regression. Results: Eighty-two percent of respondents were nurses, consistent with the proportion of nurse and physician staff in the units. Latent class analysis separated our sample of health professionals into five distinct classes. All five groups rated the child's comfort and the best interests as most important but differed regarding how they valued other considerations: Group 1 rated highly consideration of the entire family and medical judgment; Group 2, the entire family's interests, parents’ preferences, and religious beliefs; Group 3, maintaining harmony between parents and medical team; Group 4, responsible use of medical resources; and Group 5, medical evidence and prolonging the child's life. Those with more years of experience were less likely to fall in Group 5 (medical evidence/life-prolonging). Profession was not associated with group membership. Conclusions: Nurses and physicians who care for dying children prioritize foremost the child's best interests and comfort but then possess varying secondary priorities about what is most important when making medical decisions. Pediatric palliative care and ethics consultative services should be aware of and prepared to address these differing concerns. (shrink)

ABSTRACT Objectives: the purpose of this study is to explore laypersons’ attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. Setting: Osaka, Japan. Results: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt (...) an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double‐blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. Conclusions: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient‐doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates. (shrink)

In this chapter, Stephanie Collins examines the idea that individuals can acquire ‘membership duties’ as a result of being members of a group that itself bears duties. In particular, powerful and wealthy states are duty-bearing groups, and their citizens have derivative membership duties (for example, to contribute to putting right wrongs that have been done in the past by the group in question, and to increase the extent to which the group fulfils its duties). In addition, she (...) argues, individuals have duties to signal their willingness to coordinate with others so as to do more good than the sum of what each could do on their own. Putting these two things together, Collins suggests, individuals’ duties in (for instance) matters of global poverty might be largely driven by such group-based considerations, leaving little room for the duties that would follow from more individualistic reasoning. (shrink)

The goal of this paper is to present a succinct overview, from a clinician’s perspective, of the importance and implications of research on heart failure in African Americans. It first gives a brief outline of the rationale and results of the African-American Heart Failure Trial, which showed evidence for the effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine, marketed as BiDil, in this population. Finally, it underscores the necessity of treating African Americans with evidence-based medicine given that humanistic (...) physicians and other clinicians strive to provide holistic treatment to their patients.Most researchers and clinicians recognize the difficulty with utilizing race as a category for inclusion in trials. While race lacks any true biologic definition, it is potentially beneficial as a consideration in clinical studies, based on prior evidence of certain potential differences across self-identified racial/ethnic groups in morbidity and mortality and responses to medicine. Even though use of race as a classification is a problematic distinction, it should not be ignored. If clinical trials demonstrate significant improvement with targeted treatment in African Americans, clinicians should not withhold life-saving drugs that result from such studies. (shrink)

The ‘consensus’ model of public reason, associated with John Rawls’s political liberalism, has been criticised for excluding certain reasons from receiving consideration where the justification of the constitutional essentials is concerned. One limitation of these criticisms is that they typically focus on the exclusion of reasons political liberals are committed to excluding, notably reasons based on religious and comprehensive views. I argue that public reason excludes some reasons, central to the interests of many oppressed groups, that public reason advocates (...) will agree should not be excluded.L’idée de raison publique comme «consensus», associée au libéralisme politique de John Rawls, a été attaquée du fait de sa supposée incapacité à permettre la prise en compte de certaines raisons dans les cas où la substance même de la constitution est en question. Une limitation de ces critiques est qu’elles se concentrent habituellement sur l’exclusion de ces raisons que les libéraux eux-mêmes s’efforcent d’exclure, en particulier des raisons fondées sur des vues globales ou religieuses. Je défends l’idée selon laquelle la raison publique exclut de fait certaines raisons, essentielles aux intérêts de nombreux groupes opprimés, que les tenants de la raison publique eux-mêmes considèreraient ne pas devoir être exclues. (shrink)

This article is based on qualitative research conducted in Delhi between May 2019 and October 2019 with children from the Salaam Baalak Trust (SBT) as part of a PhD. Data were collected from 30 children in focus group discussions using participatory methods, followed by semi-structured interviews. As the research was conducted among a vulnerable population (migrant street children), every effort was made to conduct the study ethically, including obtaining informed consent and upholding confidentially and anonymity. Careful consideration was (...) given as to how to tackle sensitive issues should they arise during data collection. The children agreed that the interim findings of the research would be shared with them through SBT. In addition, the researcher considered her position in the research and applied a reflexive approach to address ethical issues as they emerged. This article sets out the ethical principles applied in this research and the process followed to uphold each principle during data collection, taking into account the vulnerability of the group being studied and the context of the study (India). (shrink)

The rapid development in healthcare technologies in recent years has resulted in the need for health services, whether publicly funded or insurance based, to identify means to maximise the benefits and provide equitable distribution of limited resources. This has resulted in the need for rationing decisions, and there has been considerable debate regarding the substantive and procedural ethical principles that promote distributive justice when making such decisions. In this paper, I argue that while the scientifically rigorous approaches of evidence- (...) class='Hi'>based healthcare are claimed as aspects of procedural justice that legitimise such guidance, there are biases and distortions in all aspects of the process that may lead to epistemic injustices. Regardless of adherence to principles of distributive justice in the decision-making process, evidential failings may undermine the fairness and legitimacy of such decisions. In particular, I identify epistemic exclusion that denies certain patient and professional groups the opportunity to contribute to the epistemic endeavour. This occurs at all stages of the process, from the generation, analysis and reporting of the underlying evidence, through the interpretation of such evidence, to the decision-making that determines access to healthcare resources. I further argue that this is compounded by processes which confer unwarranted epistemic privilege on experts in relation to explicit or implicit value judgements, which are not within their remit. I suggest a number of areas in which changes to the processes for developing, regulating, reporting and evaluating evidence may improve the legitimacy of such processes. (shrink)

This experiment investigated the use of positive and negative hypothesis and target tests by groups in an adaptation of the 2-4-6 Wason task. The experimental variables were range of rule (small vs large), amount of evidence (low vs high), and trial block (1 vs 2). The results were in accordance with Klayman and Ha's (1987) analysis of base rate probabilities of falsification and with additional theoretical considerations. Base rate probabilities were more descriptive of participants' behaviour in target than in (...) hypothesis tests, under low than under high amount of evidence, and at the beginning of the process than at its end. The percentage of positive tests was higher under small than large range of rule. More falsifications than verifications resulted from hypothesis tests than would be expected by a random process. When evidence is richly available, the relative importance of falsification seems to decrease. An analysis of the group compositions before and after group discussion by the PCD model (Crott, Werner, & Hoffmann, 1996) revealed that the normative weight was approximately twice as large as the informational. Groups produced fewer false answers than their members individually. (shrink)

Background and Objectives People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research (...) and provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). Design This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. Results A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. Conclusions The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia. (shrink)

MOHAMMED SA, WALTERS KL, LAMARR J, EVANS‐CAMPBELL T and FRYBERG S. Nursing Inquiry 2012; 19: 116–127 [Epub ahead of print]Finding middle ground: negotiating university and tribal community interests in community‐based participatory researchCommunity‐based participatory research (CBPR) has been hailed as an alternative approach to one‐sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co‐sharing, mutual benefit, and community capacity building, it is often challenging (...) as well. In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 57-62 [Access article in PDF] Listening to People Or Listening to Prozac?Another Consideration of Causal Classifications Jennifer Hansen Keywords causal classification, descriptivism, melancholia, neurasthenia, depression, cultural relativism. The shape and detail of depression have gone through a thousand cartwheels, and the treatment of depression has alternated between the ridiculous and the sublime, but the excessive sleeping, inadequate eating, suicidiality, withdrawal from social interaction, (...) and relentless despair are all as old as the hill tribes, if not as old as the hills. In the years since man achieved the capacity for self-reference, shame has come and gone; treatments for bodily complaints have alternated and crossed with treatments for spiritual ones; pleas to external gods have echoed pleas to internal demons. To understand the history of depression is to understand the invention of human being as we now know and are him. Our Prozac-popping, cognitively focused, semi-alienated postmodernity is only a stage in the ongoing understanding and control of mood and character. (Solomon 2001, 286) ALTHOUGH ANDREW SOLOMON clearly believes that "the shape and detail of depression have gone through a thousand cartwheels," Jennifer Radden gives us pause before assuming that depression is just another name for Dame Melancholy. Solomon's claim depends on a deeper metaphysical claim about the nature of depression and its causes. The current method of psychiatric nosology, descriptivism, does not necessarily support equating melancholia and depression. Furthermore, it appears that adopting descriptivism as the sole method of classifying mental disorders commits us to cultural relativist psychiatry. Below I reconsider whether we want to rule out causal classifications and suggest that embracing both descriptivism and causal classifications offer us greater possibilities in understanding human illness and culture.Although the occasion for Jennifer Radden's essay is to investigate whether or not melancholia and depression refer to the same thing, her essay detours into a consideration of extra-descriptivist models of psychiatric illness versus the descriptivism of current psychiatric nosology. This detour turns out to be warranted; her purely academic question yields to a timelier question concerning the proper methodology for classifying mental disorders. Whereas debates about psychiatric nosology are perennial, the recent success of the new generation of antidepressants [End Page 57] is reviving biological psychiatry and its search for the neurochemical origins of depression. Hence, embedded in Radden's question concerning whether or not melancholia is the same thing as clinical depression, is another important question concerning the causes of mental illness, particularly depression.Currently, with its descriptivist approach, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify mental illness, such as clinical depression, based on underlying causes. The cluster of symptoms and behavioral signs that lead a clinician to diagnose one as depressed that are contained in either the DSM or the International Classification of Diseases (ICD) may be too fuzzy or elusive to give any clear distinction between major depression, mild depression, and the blues. For example, one group of epidemiologists points out that [t]he DSM-III, DSM-III-R, and DSM-IV acknowledge that depression, like many mental disorders, has no currently obvious natural classes... If natural classes of depression exist, then their nosology awaits the discovery of distinct and reliable genetic, biological, clinical, or other predictors of risk, severity, or clinical course. Clinicians have a tradition of separating depressions into subtypes; however, this subtyping has not yet led to clear-cut delineations of syndromes in populations. (Kaelber 1995, 4) The evidence is still insufficient to establish the biological or psychological origins of depression. Although many theories exist that explain why people become depressed, scientifically we are not yet in a position to determine which is the right theory. From a pragmatic perspective, however, whether or not we know what causes depression, we can nonetheless attempt to alleviate suffering from depression. And it is with this goal in mind that the DSM-IV and ICD-10 classify mental disorders.Now, given that our current methodology for psychiatric nosology does not establish causes, it is also insufficient for determining what... (shrink)

Background: Chronic Pain (CP) has serious medical and social consequences, and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving quality of life is timely. Although Acceptance and Commitment Therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the (...) change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a waiting list group. Methods: The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise 8 weekly self-management sessions, and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyse whether the iACTwithPain intervention will present superiority in improving CP’s impact and related health markers over the two other conditions, this study will follow a RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-months follow-ups. The interventions’ acceptability will also be assessed. Discussion: The iACTwithPain intervention is expected to improve CP patients’ psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP. (shrink)

Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. Objectives: To examine what the staff experience as promoters or as barriers to successful ethics reflection. Research design: The study has a qualitative (...) design, where 56 participants in municipal healthcare participated in 10 different focus-group interviews. Ethical considerations: The data collection was based on the participants’ informed consent and approved by the Data Protection Official of the Norwegian Centre for Research Data. Results: The informants had different experiences from ethics reflection group. Nevertheless, we found that there were several factors that were consistently mentioned: competence, facilitator’s role, ethics reflection groups organizing, and organizational support were all experienced as promoters and as a significant effect on ethics reflection groups. The absence of such factors would constitute important barriers to successful ethics reflection. Discussion: The results are coincident with other studies, and indicate some conditions that may increase the possibility to succeed with ethics reflection groups. A systematic approach seems to be important, the systematics of the actual reflections, but also in the organization of ethics reflection group at the workplace. Community healthcare is characterized by organizational instabilities as many vacancies, high workloads, and lack of predictability. This can be a hinder for ethics reflection group. Conclusion: Both internal and external factors seem to influence the organization of ethics reflection group. The municipalities’ instabilities challenging this work, and perceived as a clear inhibitor for the development. The participants experienced that the facilitator is the most important success factor for establishing, carrying out, and to succeed with ethics reflection groups. (shrink)

Groups based on the notion of a shared sacralized descent enjoyed considerable influence in religious, social or political affairs in Central Asia by grace of their actual or imagined ancestry. They were credited by titles like īšān, sayyid, hwāğa and tūra. The flexibility of multiple genealogy accounts provided ample space for negotiations of conceptions concerning identity, descent, and sacredness as well as for their affirmation or disapproval. The 19th century saw an increase in newly emerging, self-styled religious dignitaries, but (...) the strategies these people adopted to achieve their goals and the responses of their environment remain largely understudied, the more so if their attempts remained unsuccessful. This article explores the vain endeavour of two īšāns, father and son, to establish themselves in the religious market in the Ferghana Valley, and discusses the “making of new religious figureheads” during the tsarist and early Soviet period. Based on letters and documents from the īšāns‘ private holdings, the essay shows their efforts to present themselves as progeny of the Prophet Ayyūb – patron saint of the silk processing craftsmen – from whom they tried to levy donations, but met repeated refusal. (shrink)