Lone conducted weekly philosophical discussions for first and second graders on human rights and how to be treated in society. With “The right to be treated equally” as a nearly unanimous response, Lone records these reactions in a formatted list.

Philosophy in Education: Questioning and Dialogue in Schools is intended for philosophers and philosophy students, precollege classroom teachers, administrators and educators, policymakers, and pre-college practitioners of all kinds. This text book offers a wealth of practical resources and lesson plans for use in precollege classrooms, as well as consideration of many of the broader educational, social, and political topics in the field.

Matthew Lipman wrote that “questioning is the leading edge of inquiry.” This reflects the primacy of the question in a community of philosophical inquiry. The heart of the transformative potential of philosophy for children is student engagement in a dialogue grounded in the questions that most appeal to the group and the collaborative attempt to construct meaning and cultivate deep understanding. The students’ responsibility for choosing the question to begin their discussion enhances the democratic nature of the community and highlights (...) the preeminence within the inquiry of the issues that perplex the students. There is a significant relationship between having the children choose the question for discussion and the role of epistemological modesty – the acknowledgement that all members of the group, including the facilitator, are fallible and hold views that could end up being mistaken - in a community of philosophical inquiry. In order to encourage children to engage in what Lipman called “creative questioning,” it’s essential that we trust their judgment and support their cultivation of the inclination to question. (shrink)

_A Conversation with Cardiologist and Professor Dr. Jens Flensted Lassen._ The essay is a conversation with cardiologist Jens Flensted Lassen about the cultural history of the heart, the connections between the humanities and the hard sciences.

The problem of synthesis and reconciliation of the Ramanuja and Sirhindi is of vital significance and importance, and no serious student of comparative philosophy can deliberately neglect it. Epistemologically speaking, these two philosophers have been forced to tackle the same problem(s), and in solving them, their methods and hypotheses have been noticeably similar. The emphasis of this paper is to recognize, highlight, and compare the aspects valued in Ramanuja’s epistemological views with those of the Sirhindi. I will also discuss the (...) basic postulates of Ramanuja and Sirhindi’s epistemology and underline certain epistemological approaches to knowledge and justification for formulating the arguments to find out new dimensions in outlining their fundamental epistemological positions. This paper explores certain elements in the identities of these two philosophers and attempts to demonstrate a thread of continuity, especially with regard to their methods and thoughts. This paper also brings out a brief critical account of their epistemological views. (shrink)

This paper describes how body regimes are effectuated in the prevailing treatment strategy of physiotherapy. The process of self‐mastering in the context of sports‐related injuries is highlighted. Through a Foucauldian perspective on body regimes the aim is to shed light on the process of individualization and self‐mastery in rehabilitation. The treatment of illness in the physiotherapy clinic does not characterize the patient as sick, and exempt the patient from daily duties and expectations. The empirical data include 17 qualitative illness narratives (...) and several years of fieldwork observing patients with anterior cruciate ligament (ACL) injuries in a physiotherapy clinic. The study demonstrates how the expectation that the patients be active and self‐mastering permeates the total process of treatment. The individual responsibility for personal well‐being is a recurrent phenomenon in public health services in general, and specifically prominent in the rehabilitation of sports injuries. (shrink)

This paper argues that a lonely death is, by definition, a bad death and that society as a whole, as well as individuals in society are obligated to assure a certain degree of well‐being, flourishing, or care among and for fellow individuals. Individuals can then be said to have a right against dying a lonely death. Such a right has corresponding duties. The paper further specifies what such duties may entail based on what individuals may need on their deathbed, specifically (...) focusing on the need for human touch. Assuming that human touch might indeed be needed by some individuals in order to avoid a lonely death, the paper explores potential implications from a public health perspective, particularly during infectious disease outbreaks such as COVID. (shrink)

A number of multi-stakeholder initiatives (MSIs) and commodity roundtables have been created since the 1990s to respond to the growing criticism of agriculture’s environmental and social impacts. Driven by private and global-scale actors, these initiatives are setting global standards for sustainable agricultural practices. They claim to follow the new standard-making virtues of inclusiveness and consensus and base their legitimacy on their claim of balanced representation of, and participation by, all categories of stakeholders. This principle of representing a wide range of (...) interests with a balance of power is at the heart of a new type of action that forms part of a broader political liberal model for building coalitions of interest groups. The intention of this symposium is to assess the nature of processes and outcomes of this model while paying particular attention to the forms of inclusion and exclusion they generate. In this introduction, we highlight the differences in theoretical approaches to analyzing MSIs and the manifestation of power through them. We distinguish between more traditional political–economy approaches and approaches concerned with ideational and normative power, such as convention theory. We discuss some of the main paradoxes of MSIs related to their willingness to be “inclusive” and at the same time their exclusionary or “closure” effects due in part to interactions with existing political economic contexts and embedded power inequalities, as well as more subtle manifestations of power linked to the favoring of some forms of knowledge and engagement over others. (shrink)

In his historical novel from 1835, Prince Otto of Denmark and his Time, the poet Bernhard Severin Ingemann (1789-1862) established the unknown, yet historical character, Prince Otto of Denmark (1310-1346) as the hero of the novel. This choice has puzzled critics ever since, due to the fact that Prince Otto seems less a potential king than his brother Valdemar IV (1320-1372) who actually became a king of Denmark. Georg Brandes (1842-1927) claimed that Otto mirrored Ingemann’s persona as weak and feminine, (...) a “monk” not suited for kingship. In his ridicule of Prince Otto and Ingemann, Brandes reveals his ideas about gender, masculinity and femininity, but as this article seeks to show, such ideas are tied to time and place. Read from the distance of 2019, Ingemann’s feminine medieval hero might seem more modern and progressive than Brandes would have him. In this sense, the article is a piece of “queer medievalism”. (shrink)

Logic is not just about single-agent notions like reasoning, or zero-agent notions like truth, but also about communication between two or more people. What we tell and ask each other can be just as 'logical' as what we infer in Olympic solitude. We show how such interactive phenomena can be studied systematically by merging epistemic and dynamic logic.

This is an exciting time for people working in pre-college philosophy in the United States, as the last decade has seen slow but steady growth in the field. As the field develops, there is an expanding need for high-quality resources in a variety of areas: (1) for philosophers and other philosophy educators working with teachers, graduate and undergraduate students, and other adults to train skilled pre-college philosophy teachers; (2) for philosophy educators teaching philosophy in K–12 classrooms; and (3) for pre-college (...) teachers attempting to introduce philosophy into their own classrooms. This article evaluates five books that have been published in the last few years, all aimed at pre-college practitioners. Ranging from the very practical to the more theoretical, each of these books seeks to enhance the ability of philosophy educators to teach philosophy in pre-college classrooms. (shrink)

Children are capable of contributing unique insights to philosophy, making their involvement in philosophical conversations important for them as well as for adults and the discipline in general. The chapter begins by examining whether children are capable of engaging in philosophical inquiry at all, which leads to an analysis of the related issue of what it means to do philosophy. The chapter then explores children’s philosophical thinking and in particular children’s epistemic openness, and considers the value of philosophy for children, (...) both instrumental and intrinsic. The ways that the failure to listen, solely on the basis of age, to children’s ideas and questions is argued to constitute a form of epistemic injustice, and the chapter concludes by claiming that paying attention to children’s philosophical engagement can help raise awareness about what a philosophical approach can offer to our combined thinking about ethics, social and political problems, and other important issues. (shrink)

Although much has been written about the nature of philosophy and how the discipline can be defined, little attention has been paid to the ways we develop the facility to reflect philosophically or why cultivating this ability is valuable. This article develops a conception of “philosophical sensitivity,” a perceptual capacity that facilitates our awareness of the philosophical dimension of experience. Based in part on Aristotle's notion of a moral perceptual capacity, philosophical sensitivity starts with most people's natural inclinations as children (...) to reflect about life's fundamental mysteries; when this capacity is cultivated with training over time, our attentiveness to the philosophical features of ordinary life becomes almost second nature. In much the same way an aesthetically sensitive person notices certain qualities of experience not readily perceptible by others, philosophical sensitivity involves the development of a particular way of seeing the world. (shrink)

Are children natural philosophers? They are curious about the mysteries of the human experience and about questions such as the meaning and purpose of being alive and whether we can know anything at all. Pre-college philosophy takes as a starting point young people's inherent interest in large questions about the human condition. Philosophy and Education: Introducing Philosophy to Young People seeks to illuminate the ways in which philosophy can strengthen and deepen pre-college education.

The term 'primary health care' (PHC) has come into widespread use by policy-makers, managers and health professionals in the past two decades. There is a variety of definitions and an even wider variety of uses of the term. The purpose of this paper is to examine critically existing definitions and uses, with a particular focus on their usefulness in health policy, clinical practice and research relating to health care systems. The paper has three parts. First, we examine the principal types (...) of definition and identify core features of primary care common to most definitions. Second, we discuss the application of these criteria to a range of services in the UK National Health Service (NHS). Lastly, we examine the ways in which policymakers, health professionals, researchers and lay people use the term, also drawing primarily on UK experience. We conclude by reflecting on the likelihood of achieving a single unambiguous definition and the usefulness of the term for different purposes. (shrink)

This article discusses the relations between the artistic, theoretical and psychoanalytic work of Bracha Lichtenberg Ettinger. It is particularly concerned with the claims her work makes on behalf of the feminine. After considering her conceptualization of feminine subjectivity and a feminine symbolic space, an extensive discussion of her art is given. Drawing on the work of Deleuze and Guattari, her art’s creative encounter with this feminine symbolic space is viewed in terms of a matrixial refrain. This refrain is seen as (...) producing a variety of feminine times which provide the basis for what could be called existential ethic in the feminine. (shrink)

This article describes a philosophy session with ten-year-old students centered around aesthetics, and in particular on questions about the meaning of music. The students explore the nature of music and art, including questions about what makes something music, artist intention, and the relation of art and the expression of emotion. The session involves a performance of John Cage’s work 4’ 33” and the way in which the performance can inspire a conversation with young people about philosophy of music. The article (...) depicts such a conversation in a fifth grade classroom. The students examine whether silence can be music, whether art must express emotion, and whether it is the external properties of a work or our experience of it that define it as music. Music is deeply important to most people, and yet it evokes some of the most challenging questions of aesthetics. Discussing these questions can serve to illustrate some of the ways in which philosophical enigmas lie behind many of our most ordinary experiences. The surprising experience of attending a performance of Cage’s work, combined with being outside of the classroom for a special event and the relevance of music in the students’ lives, create a powerful environment for philosophical inquiry. The students are able to grasp immediately the complex issues raised by the work, and the resulting search for meaning within the philosophical community of inquiry can be a transformative moment. (shrink)

Mask-wearing political protests have been global front page news for several years now; yet, almost no literature exists which attempts to engage the symbolic density and ritual role played by such mask-wearing acts. We argue that mask-wearing has political potentiality which relates to deeper-lying anthropological features of mask-wearing. The powers of the mask reside in the transformative ability of masks to unify and transcend key oppositional categories such as absence/presence and death/life, creating possibilities where conventional boundaries of the possible/impossible no (...) longer restrict. By questioning the communicative rationality of the modern ‘public’ and the ‘sphere’ in which it operates, we approach mask-wearing as a ‘communicative opening’. Building on earlier critiques of liberal democratic normativity, we further argue that the ‘utopia of transparency’ is itself a regulatory power and that mask-wearing exposes the very notions that were supposed to form the background of modern, emancipatory politics: transparency, free speech and representative democracy. (shrink)

The United States Constitution embodies both the real and the ideal. It is a concrete written text that uses particular words, has a history, and possesses certain limits; it is also a statement of the aspirations and dreams of a society. This dual identity requires that the Constitution be understood both as written positive law, and as an expression of a national vision and set of ideals. ;I argue for a conceptual theory of law that is positivistic in the sense (...) that it relies for the identification of law on social conventions that form the foundations for determining what counts as law. My view is drawn from H. L. A. Hart's legal positivist view, but it departs from this view to argue that judicial custom can be, along with Hart's rule of recognition, an additional social custom that provides criteria for identifying and creating law. Judicial custom involves the acceptance over time by judges of certain principles as authoritative in the context of adjudicative decisionmaking. I contend that both rules and principles can be part of law, and that principles attain the status of law through judicial custom. ;I rely on this understanding of law to argue for a theory of constitutional adjudication that is an alternative to both originalism and traditional non-originalist theories. Originalism is the view that judges can decide constitutional cases exclusively on the basis of two grounds: the text or the original intentions or understanding of its framers. The theory of law that I defend accepts that these grounds are important for any constitutional decision, but holds that constitutional decisions can also legitimately be made on the basis of constitutional theories. Such theories explain the often broad and abstract language of constitutional provisions by articulating hypotheses about the principles that underlie the text. I argue that the central constitutional commitment is to each individual's right to self-determination. This requires protection of an aspect of personal liberty that involves the deeply personal and unique nature of each person's aspirations, ideas, and initiatives. (shrink)

Philosophy for children is a worldwide movement to acknowledge and encourage children's philosophical capabilities and interests by developing spaces for children to pursue philosophical inquiry. Unlike the typical undergraduate philosophy class, philosophy for children sessions emphasize philosophical concepts, questions, and discussion rather than focusing on mastering arguments made by contemporary or historical philosophers. The aim is to cultivate an attentiveness to the philosophical dimension of life, or philosophical sensitivity. Despite the growth of philosophy for children around the world, the field (...) remains on the periphery in both the academy and in school systems in the United States. In addition to the effort to heighten the field's prominence and enlarge its scope and influence, other important current issues in the field being addressed by scholars include the following: an exploration of epistemic injustice and philosophical recognition of young people; social inequalities and obstacles to reaching diverse populations; and development of philosophy of childhood. (shrink)

‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home‐care services. The aim of this article is to analyse ‘client involvement’ in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home‐care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The study has a focus (...) on the relational aspects of home care and the structural, political and administrative frames that rule home‐ care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home‐care practice remains limited. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global (...) and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

Background Several studies suggest that deviations from proper authorship practices are commonplace in medicine. The aim of this study was to explore experiences of and attitudes towards the handling of authorship in PhD theses at medical faculties in Denmark, Norway, and Sweden. Methods Those who defended their PhD thesis at a medical faculty in Scandinavia during the second half of 2020 were offered, by e-mail, to participate in an online survey. Survey questions dealt with experiences of violations of the first (...) three of the ICMJE authorship criteria and misuse of authorship order in the thesis articles, as well as respondents’ attitudes to these matters. Both questions with fixed response alternatives and questions with free-text responses were used. Quantitative data were analysed statistically using the Table functions in SPSS 25 and Chi-2 tests. Free-text responses were analysed qualitatively using manifest content analysis. Results 287 valid questionnaires were returned (response rate: 34.1%). Almost half (46.0%) of the respondents reported that the ICMJE authorship criteria were not fully respected in at least one of the papers in their thesis, while a vast majority (96.7%) found it important that authorship is handled according to the ICMJE authorship criteria. 24.4% reported inadequate handling of authorship order in at least one paper. The qualitative results provide a wide spectrum of examples of how the ICMJE authorship criteria are circumvented. Conclusion Despite increasing educational efforts to reduce deviations from good research practice at Scandinavian universities, the handling of authorship in medical papers remains problematic. (shrink)

This article aims to make a case for the need to sensitize the medical community on the importance of providing sexual health information in the care of intersex adolescents and young adults for whom sexuality and intimacy are sensitive subjects—and to go beyond a narrow focus on surgical outcomes. For this purpose, this article gives voice to the lived experience of “Emma,” a young adult who identifies as intersex. Setting up strong collaboration between medical teams and intersex support groups might (...) be the best way forward to provide high-quality care to youth born with variations of sex characteristics. (shrink)

Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction on the mental health of student teachers when offered at their educational institution in a real-life context.Methods: A parallel randomized controlled trial was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of clinical depression or a diagnosis of psychosis or schizophrenia, abuse of alcohol, drugs, (...) and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling.Results: The study group included 67 student teachers with 34 allocated to the intervention group ; and 33 students allocated to a waiting list control group. At baseline, mean Perceived Stress Scale scores were 18.88 in the intervention group and 17.91 in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up. Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found.Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099]. (shrink)

Essay Review of two books of A.N. Maxwell, last of the Neo-Popperians: The Comprehensibility of the Universe (1998) and The Human World in the Physical Universe (2001).

David Chalmers has recently developed a novel strategy of refuting external world skepticism, one he dubs the structuralist solution. In this paper, I make three primary claims: First, structuralism does not vindicate knowledge of other minds, even if it is combined with a functionalist approach to the metaphysics of minds. Second, because structuralism does not vindicate knowledge of other minds, the structuralist solution vindicates far less worldly knowledge than we would hope for from a solution to skepticism. Third, these results (...) suggest that the problem of external world skepticism should perhaps be construed as two different problems, since the problem might turn out to require two substantively different solutions, one for knowledge of the kind that is not dependent on other minds and one for knowledge that is. (shrink)

Background: Nursing documentation is an essential aspect of ethical nursing care. Lack of awareness of ethical dilemmas in nursing documentation may increase the risk of patient harm. Considering this, ethical dilemmas within nursing documentation need to be explored. Aim: To explore ethical dilemmas in nurses’ conversations about nursing documentation. Research design, participants and context: The study used a qualitative design. Participants were registered nurses from a Patient Hotel at a Danish University Hospital. Data were collected in three focus groups with (...) a total of 12 participants. Data analysis consisted of qualitative content analysis inspired by Graneheim and Lundman. Ethical consideration: This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality, anonymity and provision of informed consent. Findings: Ethical dilemmas were strongly present in nurses’ conversations about nursing documentation. These dilemmas were demonstrated in two themes: (1) a dilemma between respecting patients’ autonomy and not causing harm, which was visible in nurses’ navigation between written documentation and oral tradition, and (2) a dilemma concerning justice and fair distribution of goods, which was visible in nurses’ balancing between documenting deviations and proof of nursing practice. Discussion: Ethical dilemmas in nursing documentation regarding respecting patients’ autonomy and not causing harm accentuated discussions on professional responsibility and patient participation in clinical decisions. Dilemmas in justice and fair distribution of goods emphasised discussions on trust in relationships versus trust in electronic health records. Conclusion: Actual tendencies in the healthcare system may increase ethical dilemmas in nursing documentation. Sharing otherwise invisible and individual experiences of ethical dilemmas in nursing documentation among nurses, nurse leaders and decision-makers will enable addressing these in reflections and discussions as well as in considering adjustments of conditions for nursing documentation. (shrink)

In recent years, the number of foreign students studying at universities in Turkey has been increasing. Recent studies show that foreign students experience problems such as social exclusion and loneliness in city and university life. Loneliness is a concept that has a direct impact on psychosocial well-being. For this reason, it seems important to examine loneliness and religious coping skills in foreign students. The aim of this study is to reveal the loneliness and religious coping levels of foreign university students (...) in terms of socio-demographic variables. Correlational research method, one of the quantitative research designs, was used in the research. The sample of the study consists of 139 students, 121 of whom are Syrian nationals and 18 Africans. On the other hand, this research is important in that it is conducted in Kilis, one of the provinces where the Syrian population is the most dense, and mostly with Syrian university students. As a result of the research, it was determined that the positive religious coping levels of university students under the age of 20 were higher than those of students over the age of 20. It was found out that the prolongation of the residence period in Turkey positively increased the religious coping levels of the students, and the family types of the students (parents together, separate, loss of parents, etc.) did not have an effect on the levels of religious coping and loneliness. On the other hand, it was showed that there was no significant relationship between the number of siblings and religious coping and loneliness in foreign students, and lastly, the religious coping levels of the engineering faculty students were higher than the students studying in other departments. (shrink)

Our 2021 article, "Dying Well in Nursing Homes During COVID-19 and Beyond: The Need for a Relational and Familial Ethic," addresses the response to the COVID-19 pandemic within nursing homes and the impact it had on the lives of residents, care providers, and families. We acknowledge that, at the height of the pandemic, when infection and death rates were soaring in these facilities, extreme "lockdown" measures may have been justified; but these measures resulted in significant relational costs. The collateral damage (...) caused by these lockdown measures included extreme isolation, loss of community, and experiences of confusion, depression, and mental decline for the elderly residents that... (shrink)

Life's Solution builds a persuasive case for the predictability of evolutionary outcomes. The case rests on a remarkable compilation of examples of convergent evolution, in which two or more lineages have independently evolved similar structures and functions. The examples range from the aerodynamics of hovering moths and hummingbirds to the use of silk by spiders and some insects to capture prey. Going against the grain of Darwinian orthodoxy, this book is a must read for anyone grappling with the meaning of (...) evolution and our place in the Universe. Simon Conway Morris is the Ad Hominen Professor in the Earth Science Department at the University of Cambridge and a Fellow of St. John's College and the Royal Society. His research focuses on the study of constraints on evolution, and the historical processes that lead to the emergence of complexity, especially with respect to the construction of the major animal body parts in the Cambrian explosion. Previous books include The Crucible of Creation (Getty Center for Education in the Arts, 1999) and co-author of Solnhofen (Cambridge, 1990). Hb ISBN (2003) 0-521-82704-3. (shrink)

Background: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. Research objective: The aim was to explore the meaning of responsibility as it appeared in patients’ or caregivers’ experiences of calling an oncological emergency telephone. Design, participants and context: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the (...) oncological emergency telephone at a Danish university hospital was performed. Ethical considerations: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. Findings: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to ‘be watchful and alert’, ‘report symptoms the right way’ and ‘do crosschecking’ and (2) to deal with the burden of responsibility was to ‘feel safe when dealing with the burden of responsibility’ and ‘be relieved from the burden of responsibility’. Discussion: Too much responsibility and a potential imbalance between healthcare professionals’ expectations and callers’ knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. Conclusion: The meaning of responsibility appeared in the participants’ capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis. (shrink)

이 글은 연명의료결정법이 2년간의 유예기간을 거쳐 2018년 2월부터 시행되고 있다는 점에 착안하여, 그것의 시행 발단이 된 상황을 두 가지로 제시하고(하나는 세브란스 병원 김할머니 사건과, 다른 하나는 죽음의 의료화 현상이다) 그 내용을 살펴보는데서 출발하였다. 그렇다면 연명의료결정법이 시행되는 궁극적 목적은 무엇인가? 그 과정을 필자는 ‘좋은 죽음이란 무엇인가’ 라는 물음을 통하여 고찰하였다. 그 결과 좋은 죽음이란 첫째, 가족이나 주변인과 마지막을 ‘함께’ 함으로써 관계단절 고독사를(필자는 가족과 함께 거주했지만, 치료의 공간에서 연명장치에 의존한 후 의사의 사망선고로 생을 마감함으로써 가족과의 작별인사나 주변과의 정리도 거의 생략되는 상황에서의 죽음, (...) 즉 임종과정에서의 ‘관계의 단절’을 의미) 해결하며, 둘째, 육체적인 집착 치료가 아닌 정신과 영혼의 상처까지 포함된 전인적 치료를 통한 ‘준비하고 맞이하는’ 죽음임을 도출하였다. 그렇다면 연명의료결정법 시행으로 그 가능성을(좋은 죽음의 가능성을) 타진할 수 있는가? 이다. 이에 대항 필자는 우선 무의미한 연명의료로 인한 의료집착적 행위로 인한 가족이나 주변인조차 마지막을 함께 하지 못하고 죽음에 이르는 상황을 ‘관계단절 고독사’로 정의하였다. 그리고 이 관계단절 고독사를 연명의료결정법의 시행으로 해결 될 수 있는가에 대하여 고찰하였다. 그 결과 첫째, 연명의료결정법은 호스피스 완화의료를 통해 암환자에게만 국한되어 있는 호스피스 서비스를 일정한 범위의 말기환자에게 확대 적용시키고 있다. 즉 호스피스에 대한 체계적이고 종합적인 근거 법령이 마련됨으로써 국민 모두가 무의미한 연명의료를 위해 중환자실에 고립될 필요가 없다는 것이다. 그런 한에서 연명의료결정법은 인간적 품위를 지키며 편안하게 삶을 마무리하는데 유의미하다고 평가된다. 둘째, 연명의료결정법은 임종과정에 있는 환자의 연명의료 결정을 사전연명의료의향서와 연명의료계획서를 통해 제도화시키고 있다. 즉 환자의 연명의료에 대한 자기결정이 존중되고 환자의 존엄과 가치를 보장시킴으로써 무의미한 연명의료를 위해 중환자실에 고립될 필요가 없다. 그런 한에서 연명의료결정법은 연명장치로부터 야기되는 관계단절 고독사의 유효한 방안일 수 있다. 다음으로 육체 중심의 집착적 치료에서 벗어나 그 동안 받았던 정신이나 영혼의 상처까지도 치료하기 위한 전제조건으로 단일체로서의 인간관을 제시하고, 이 인간관이 연명의료결정법의 호스피스 완화의료에도 유효함을 고찰하였다. 그 과정에서 필자는 호스피스 완화의료에서 전인적 돌봄을 위한 하나의 패러다임을 제시하였다, 즉 임종자가 죽음을 받아들이는 마지막 단계를 퀴블러-로스에 의한 임종단계에서 ‘수용’임을 통하여 알 수 있듯이, 환자가 자신의 심경을 주변인이나 간호하는 사람이 수용하고 있다고 느낄 때, 환자는 간호제공자와 상호 소통에 놀라운 영향을 줄 수 있다는 것이다. 그 결과 임종환자는 죽음을 어쩔 수 없이 ‘수용’하는 것이 아니라 ‘긍정적으로 수용’하고 내세에 대한 희망 속에서 평온한 죽음을 맞이할 수 있다는 것이다. 결국은 죽음을 앞둔 임종환자와 간호제공자(가족이나 주변인을 포함한 모든 간호제공자) 사이의 소통 내지는 관계가 중요하다는 의미이다. 결국 연명의료결정법에서 제시되는 호스피스 완화의료는 전인적 돌봄을 목표로 하지만 그럼에도 불구하고 임종기 환자의 죽음 수용 단계에 있어서 간호제공자와의 사랑과 공감을 토대로 한 관계가 강조되었을 때 임종기 환자는 ‘좋은 죽음’에 다가설 수 있는 지반을 마련하게 된다. 그리고 바로 이 지점에서 필자는 사랑과 공감을 바탕으로 간호제공자와 환자의 관계의 중요성을 강조함으로써 ‘공감의 생명윤리학’이라는 새로운 패러다임을 제시함으로써, 이것이 호스피스 완화의료에서 어느 정도 유효한지에 대하여 고찰하였다. 즉 이 글은 연명의료결정법 시행으로 좋은 죽음의 실현 가능성(관계적 고독사의 해결과 육체집착적 치료에서 벗어나 전인적 치료를 통한 준비하고 맞이하는 죽음)을 고찰함으로써 ‘공감의 생명윤리학’이라는 패러다임의 중요성을 밝히는 데 그 의미가 있다고 하겠다. (shrink)

Practically all modern definitions of war rule out that individuals can wage war. They conceive of war as a certain kind of conflict between groups. In fact, many definitions even restrict the term “war” to sustained armed conflicts between states. Instead of taking such definitions as points of departure, the article starts from scratch. I first explain what an explication of the concept of “war” should achieve. I then introduce the fundamental, and frequently overlooked, distinction between war as an historical (...) event and war as an action. It is war as action—which, unlike events, can be right or wrong—that I explicate. Testing our linguistic intuitions with different examples of conflict I isolate several criteria that a war proper has to fulfill and try to demonstrate that not only collectives but individuals, too, can wage war. In conclusion I examine alternative definitions of war and show that in comparison to them mine fares rather well. (shrink)

Conway Morris argues against Stephen Jay Gould's argument that the history of life is radically contingent by describing the abundance of convergences, wherein different lineages starting in different states, arrive at the same adaptations. A standard example is the evolution of the camera eye. This review assesses the validity of Conway Morris' argument.