Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Apocalyptic expectations of Armageddon and a New Age have been a fixture of the American cultural landscape for centuries. With the approach of the year 2000, such millennial visions seem once again to be increasing in popularity. Stephen O'Leary sheds new light on the age-old phenomenon of the End of the Age by proposing a rhetorical explanation for the appeal of millennialism. Using examples of apocalyptic argument from ancient to modern times, O'Leary identifies the recurring patterns in apocalyptic texts and (...) movements and shows how and why the Christian Apocalypse has been used to support a variety of political stances and programs. The book concludes with a critical review of the recent appearances of doomsday scenarios in our politics and culture, and a meditation on the significance of the Apocalypse in the nuclear age. Arguing the Apocalypse is the most thorough examination of its subject to date: a study of a neglected chapter of our religious and cultural history, a guide to the politics of Armageddon, and a map of millennial consciousness. (shrink)

(1996). Compatibilist semantics in metaphysics: A case study. Australasian Journal of Philosophy: Vol. 74, No. 1, pp. 117-134. doi: 10.1080/00048409612347101.

In lieu of an abstract, here is a brief excerpt of the content:A Day in the Life of a Spanish InterpreterGianna O'LearyThe good thing about Mondays is they almost guarantee I'll be able to sleep at least until 8 am. If I have a double shift, my supervisor will try to "un-zombie me" for the night as much as possible.I get out of my car and head to the three small offices that are the interpreter's dominion. It takes me about (...) ten minutes because the hospital is huge, and our offices are located on the other side of the building. One office is my supervisor's, the other is the sign language supervisor's, and the third is for all of us Spanish interpreters working today.My first hour is all about phones. I sit at the desk and open EPIC, the hospital software where doctors, nurses, therapists, and yes, interpreters, work with the rest of the staff. I listen to the first voicemail; it's nothing unusual. It's from a mom who needs a follow-up appointment with Neurology. I call Mom back (at Children's, all our clients' parents are "Mom" and "Dad," they seem to like it, and I never heard a complaint about it). Her daughter has a seizure disorder, and she's due for a followup. They need to do it because the girl is growing, and she is outgrowing her Keppra medication; the doctor will probably increase the dose. They will also do an EEG to make sure her seizure activity is under control.I continue picking up the phone, listening to messages, calling people back, and documenting the messages that were not answered. Other interpreters will take them later and try to call them again. In the meantime, when nobody answers, I translate a few of the forms for the Autism clinic. Their patients are usually two to three years old, and moms are usually worried they have not talked yet. Usually, when asked what they want for their child, their answer is for them to talk and act like normal children. If you work at a children's hospital, it's a very common goal.My first appointment of the day is with the ENT (ears, nose, and throat) clinic. I go to the clinic's virtual space and see the patient has not arrived. Five minutes later, there is no sign of him, so I call them. Mom forgot about the appointment, and she is very apologetic. We reschedule it and I let ENT know. Then, I send a message to the hospital interpreter to ask if they need help. "Yes, please!" Someone just asked them to go help with rounds. Can I go?"Sure! Send me the name and number of the room."I am glad to have this little app on my phone, and that we text more than anything when we need help. It helps me keep everything on track. I have an anxiety disorder so severe that when I get anxious (and work always makes me anxious), my brain imitates symptoms of ADHD. I do not have ADHD per se, but if I think I am making a mistake, that I am not learning fast enough, or, that lives could be in danger (like, for example, in a hospital), my thoughts race, and it is very hard for me to focus on anything. For functionality purposes, I suffer from ADHD about 70% of the time I'm at work.This little app can be my personal hell. If I am interpreting for a doctor and the pager goes off, my mind will not rest. My anxiety takes over. What if it's urgent? What if someone—not only someone—but a child, is dying? If I haven't checked my messages and the pager is going off, my mind is, too. It has been almost two years since I started this job, and so far, nobody has died during my service, so my brain understands it may be ok to relax a little. In the end, anxiety is anxiety, and it will get you. It will find something to worry about. Anxiety shines with creativity and thrives in a high-paced... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesGianna O'Leary, Paul Hostovsky, Yilu Ma, Leo Almazan, Hilda Sanchez-Herrera, Marisa Rueda Will, Elaine Hsieh, Manuel Patiño, Felicity Ratway, Liliana Crane, Laisson DeSouza, Nilsa Ricci, Linda Pollack-Jackson, Kelley Cooper, Mateo Rutherford-Rojas, Rosa C. Moreno, Maja Milkowska-Shibata, Patricia Coronado, and Catalina Meyer• A Day in the Life of a Spanish Interpreter• Deaf Interpreter• "Call me Dr. XXX!"• Translating Care for the Voiceless Patient• Are We There (...) Yet? A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access Compliance• One Interpreter's Journey of Interpreting for Pregnancy Loss• More Than Words: Communicating for the Quality of Care• From Linguistic Bridge Builder to Aspiring Physician• Towards Language Justice: A Call to Identify and Overcome Structural Barriers• Voices in the Shadows: The Hidden Complexities of Being a Medical Interpreter• The Voice of Patients: The Exclusive Work of a Human Who Can Advocate• Don't Mute the Messenger• The Ramp and the Stop Sign• How Policies and Practices in Medical Settings Impact Communication Access with Deaf Patients and Caregivers• And When May I Cry? Juggling Emotions in Healthcare Interpreting• To Engage or Not to Engage: An Interpreter and a Mother's Need for Connection in the Cardiothoracic Unit• Witnessing Trauma: Emotional Challenges in Medical Interpretation• Being an Interpreter—Beyond Linguistics• 1-800-Quit-NowCopyright © 2024 Johns Hopkins University Press... (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

In accord with the motto of the Passionists—“We preach Christ crucified”—Breton located the essence of Christianity in a faith and love marked by open-ended questioning and dialogue and by an exodic movement of the spirit. Neoplatonism enabled him to raise his love of free inquiry to a high spiritual plane, and to bring into lucid focus the figure of Christ, ridding it of false absolutizations. Seeing the encounter with Buddhism as the next step in this purification of Christian vision, he (...) pored over Nagarjuna in his last days. The totality of Breton’s life and work enacts a lighter, humbler understanding of the Gospel, one fully responsive to modern and postmodern questions. (shrink)

This book is of interest to those working at the intersection of contemporary debates in philosophy, ethics, politics and cultural studies.

This paper canvasses the various dimensions along which theories of truth may disagree about the extent to which truth is minimal.

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of medicine is (...) secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

Tout s’est passé très vite, prenant l’Église au dépourvu. Le mouvement pour la reconnaissance des mariages et des unions civiles entre personnes du même sexe a connu un succès extraordinaire. La hiérarchie de l’Église catholique oppose une fin de non-recevoir à toute reconnaissance positive des couples homosexuels, en invoquant une morale sexuelle qu’on dit ancienne et invariable,..

Paul Ricoeur’s narrative and critical hermeneutics provides the conceptual resources to accommodate Barthes’ and similar critiques of subjectivity whilepositing a revised form of authorial intention similar to the “postulated author” of Alexander Nehamas and the “creative process” of Richard Wollheim. Though influenced by Barthian critiques, all three thinkers retain a notion of authorial intent*one distinct from the intentions of the historical author*necessary for the understanding of meaning in the philosophy of literature. Yet, the implications of this allow us to reverse (...) the Ricoeurian insight of understanding human action as a text, and show how human action provides clarification on authorial intention. Using Ricoeur and Nehamas, I would like to revisit the issue of authorialintention in order to show the insights this offers for hermeneutics and philosophy of literature. If authorial intention is properly reestablished as distinct from theintentions of the historical writer, we can turn to a minimalistic version of the analytic philosophy of action based on Ricoeur and Carlos Moya to provide auseful heuristic conceptual framework to look at both authorial and ‘readerly’ intention.In employing the philosophy of action, this conceptual framework will be used instrumentally in aid of interpreting the text and providing further analysisand conceptual clarity to the notion of authorial intention. Further, analyzing ‘writerly’ and ‘readerly’ intention as action*communicative action*sidesteps thephilosophical issue of the ‘artistic process’ which had absorbed the attention of aesthetics since Plato, without sidestepping the issues of authorial intention andreaderly intention.1 I will argue that in using variants of the philosophy of action, we can ignore psychological issues and instead focus on the broader issues ofmeaning-expression at the heart of both readerly and writerly intention. I will then demonstrate this heuristic framework using Hölderlin’s epic poetry and Blanchot’s The Writing of the Disaster. (shrink)

The strongest version of the principle of the Identity of Indiscernibles states that of necessity, there are no distinct things with all their universals in common (where such putative haecceities as being Aristotle do not count as universals: I use 'universal' rather than 'property' here and in what follows for the simple reason that 'universal' is the term of art that most safely excludes haecceities from its instances). It is commonly supposed that Max Black's famous paper 'The identity of indiscernibles' (...) (2) refutes this thesis. (Armstong's [1], chapter 9 is representative here.) Black argues ([2], p. 156) that it is perfectly possible that there be a world consisting solely of two indiscernible spheres at some distance to each other and that this world constitutes a counterexample to the principle above. The strongest version of the bundle theory of substance claims that of necessity, the substances that make up the world are bundles of universals.1 It is commonly supposed that a consequence of Black's defeat of the principle of the Identity of Indiscernibles is that this bundle theory of substance is mistaken. (Again, Armstong's [1] is representative.) I shall argue that Black's thought experiment does not defeat the bundle theory and that, as a result, the bundle theory can be used to salvage the principle of the Identity of Indiscernibles. (shrink)

After nearly fifty years of mea culpas and explanatory additions, the biopsychosocial model is no closer to a life of its own. Bolton and Gillett give it a strong philosophical boost in The Biopsychosocial Model of Health and Disease, but they overlook the model’s deeply inconsistent position on dualism. Moreover, because metaphysical confusion has clinical ramifications in medicine, their solution sidesteps the model’s most pressing clinical faults. But the news is not all bad. We can maintain the merits of holism (...) as we let go of the inchoate bag of platitudes that is the biopsychosocial model. We can accept holism as the metaphysical open door that it is, just a willingness to recognize the reality of human experience, and the sense in which that reality forces medicine to address biological, psychological, and social aspects of health. This allows us to finally characterize Engel’s driving idea in accurate philosophical terms, as acceptance of consciousness in the context of medical science. This will not entirely pin down medicine’s stance on dualism, but it will position it clearly enough to readily improve patient care. (shrink)

In this essay, we explore a fresh avenue into mind-body dualism by considering a seemingly distant question posed by Frege: "Why is it absurd to suppose that Julius Caesar is a number?". The essay falls into three main parts. In the first, through an exploration of Frege’s Julius Caesar problem, we attempt to expose two maxims applicable to the mind-body problem. In the second part, we draw on those maxims in arguing that “full blown dualism” is preferable to more modest, (...) property-theoretic, versions. Finally, in the third part we close by suggesting that full blown dualism need not be spooky, resurrecting a broadly Lockean, rather than Cartesian, metaphysical picture. (shrink)

This paper provides a detailed study of fraud in practice through an empirical investigation of B.P.Sayers, a family-owned stockbroking firm that had been in existence for over 100 years and that collapsed due to the fraudulent activities of the firm's junior partner. An interpretive narrative methodology has been employed which has resulted in the development of a detailed understanding of fraud and moral breakdown in organizations, resulting from a failure of responsibility that arises from a dysfunctional work identification and its (...) moral implications. In developing this account of fraud, the conceptual framework utilized is drawn from the moral philosophical work of Emmanuel Levinas who explicated how the breakdown of social relations of responsibility results, in turn, in moral breakdown. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

Recent accounting scandals involving the collapse of large corporate firms have brought into question the adequacy of ethics education within accounting programs. This paper investigates the ethical decisions of accountancy students and in particular analyses the effect of group (as opposed to individual) decision-making on ethical decisions. Final year accountancy students (sample size of 165) were randomly allocated into two experimental conditions. The participants were then presented with five (5) ethical vignettes. One experimental condition involved completing the ethical decisions as (...) individuals (60). The other involved completing the ethical decision-making as a group of 3–4 participants (34). A consistent pattern of behaviour was observed in the analysis of individual versus group responses. Individuals displayed stronger tendencies than groups to take the extreme actions of acting either unethically or ethically (whistleblowing), whereas groups displayed stronger tendencies to take the safer (neutral) options. It was concluded that groups reached consensus decisions, in an ethical context, probably as a result of peer pressure. The significant implication of this finding is in relation to the emphasis accounting programs place on group work. Group work may enhance students’ abilities to work as a team. However, as revealed in this study’s results, group work may not be an effective means of producing the optimal decision in all subject matter areas, especially complex areas such as ethical decision-making. (shrink)

Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, (...) this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions. (shrink)

In After Virtue, Alasdair MacIntyre argues that in modern ethical discourse, moral principles have been replaced by “fragments” that only partially represent their original meaning as derived from theological contexts. Today’s debates surrounding physician assisted suicide (PAS) and abortion highlight that the “fragment” of autonomy has been championed over principles such as justice, beneficence, and nonmaleficence with little justification. This acceptance of patient autonomy as the ultimate good distracts from societal ills that drive contentious medical decisions, further muddles society’s image (...) of the human person, and subliminally redefines the medical profession. Medical professionals who oppose these practices must commit themselves to forming physician-patient covenants of trust, rather than accepting consumeristic models of patient care that foster an inappropriate focus on self-determination. (shrink)

If I have understood Pearson's use of “a practice” correctly my main objection to his project is that it gives the current practices of teaching far too much normative force over the educational beliefs of teachers. While the principles of practical reasoning advocated by Pearson may serve to test the coherence of the various beliefs which are part of current practice, they do not suffice to test the reasonableness of such beliefs. To do this we need, at least for some (...) of these beliefs, to draw upon the resources made available to us by such theoretical practices as psychology, philosophy, history, etc. None of these, of course, nullifies the significance of regarding teaching as a practice. Indeed, such a conception is a forceful reminder that the theoretical practices which are concerned with education need to focus on current teaching practices if they are to guard against the sort of empty rationalism despised by Oakeshott, while saying something to the teaching profession. This will not give us an educational theory, but rather theoretical perspectives on teaching as a practice. (shrink)

Towards the end of Analyze This , during a shoot-out, the psychotherapistplayed by Billy Crystal falls in front of the mobster played by Robert de Niro andtakes a bullet in his shoulder. De Niro thanks him for taking the bullet, but Crystalprotests that he just tripped up. De Niro replies, ‘No Doc, you tripped on yourunconscious!’ In this observation, the mobster not only provides the key to thisfilm, he also opens up a way of understanding something essential about TheGodfather . (...) One of the central and, for me, unexplained problems in TheGodfather is the motivation for Michael Corleone’s transformation from modelcitizen and war-hero into the ruthless Don who takes his father’s place at thehead of one of New York’s mafia families. In this paper, I will use Analyze This –and Freud – to explain this transformation as a form of ‘tripping over theunconscious’. My suggestion is that Analyze This, in its self-consciously popFreudian fashion, actually gives us the basis for a more serious Freudianinterpretation of Michael’s transformation. If we approach Coppola’s film as atragedy in which the ostensible rise to power of Michael is, in effect, hisdownfall, then we are faced with the question of how to understand the natureof the forces that bring him to that end. Against the idea that Michael is simply destined to take over his father’s position, I will give an account of the underlying psychological forces that bring him to that culmination. (shrink)