BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

The study of anarchism as a philosophical, political, and social movement has burgeoned both in the academy and in the global activist community in recent years. Taking advantage of this boom in anarchist scholarship, Nathan J. Jun and Shane Wahl have compiled twenty-six cutting-edge essays on this timely topic in New Perspectives on Anarchism.

Hannah Arendt's rich and varied political thought is more influential today than ever before, due in part to the collapse of communism and the need for ideas that move beyond the old ideologies of the Cold War. As Dana Villa shows, however, Arendt's thought is often poorly understood, both because of its complexity and because her fame has made it easy for critics to write about what she is reputed to have said rather than what she actually wrote. Villa (...) sets out to change that here, explaining clearly, carefully, and forcefully Arendt's major contributions to our understanding of politics, modernity, and the nature of political evil in our century.Villa begins by focusing on some of the most controversial aspects of Arendt's political thought. He shows that Arendt's famous idea of the banality of evil--inspired by the trial of Adolf Eichmann--does not, as some have maintained, lessen the guilt of war criminals by suggesting that they are mere cogs in a bureaucratic machine. He examines what she meant when she wrote that terror was the essence of totalitarianism, explaining that she believed Nazi and Soviet terror served above all to reinforce the totalitarian idea that humans are expendable units, subordinate to the all-determining laws of Nature or History. Villa clarifies the personal and philosophical relationship between Arendt and Heidegger, showing how her work drew on his thought while providing a firm repudiation of Heidegger's political idiocy under the Nazis. Less controversially, but as importantly, Villa also engages with Arendt's ideas about the relationship between political thought and political action. He explores her views about the roles of theatricality, philosophical reflection, and public-spiritedness in political life. And he explores what relationship, if any, Arendt saw between totalitarianism and the "great tradition" of Western political thought. Throughout, Villa shows how Arendt's ideas illuminate contemporary debates about the nature of modernity and democracy and how they deepen our understanding of philosophers ranging from Socrates and Plato to Habermas and Leo Strauss.Direct, lucid, and powerfully argued, this is a much-needed analysis of the central ideas of one of the most influential political theorists of the twentieth century. (shrink)

Theodor Adorno once wrote an essay to "defend Bach against his devotees." In this book Dana Villa does the same for Hannah Arendt, whose sweeping reconceptualization of the nature and value of political action, he argues, has been covered over and domesticated by admirers who had hoped to enlist her in their less radical philosophical or political projects. Against the prevailing "Aristotelian" interpretation of her work, Villa explores Arendt's modernity, and indeed her postmodernity, through the Heideggerian and Nietzschean theme (...) of a break with tradition at the closure of metaphysics.Villa's book, however, is much more than a mere correction of misinterpretations of a major thinker's work. Rather, he makes a persuasive case for Arendt as the postmodern or postmetaphysical political theorist, the first political theorist to think through the nature of political action after Nietzsche's exposition of the death of God. After giving an account of Arendt's theory of action and Heidegger's influence on it, Villa shows how Arendt did justice to the Heideggerian and Nietzschean criticism of the metaphysical tradition while avoiding the political conclusions they drew from their critiques. The result is a wide-ranging discussion not only of Arendt and Heidegger, but of Aristotle, Kant, Nietzsche, Habermas, and the entire question of politics after metaphysics. (shrink)

Wischik presents an extensive reply to our paper on conscientious objection, which explores the implications of distinguishing ‘medical acts’ from ‘socioclinical acts’. He provides an extensive legal analysis of the issues surrounding conscientious objection, drawing on the concepts of professional practice and consequentialism. Invoking some of these concepts, we respond and demonstrate that Wischik does not seriously engage with our argument. Instead, he merely proffers his preference for legal positivism, which – when viewed as the fount of justice (as Wischik (...) seems to hold) instead of a tool in its service – necessarily bases rightness on might rather than truth. We also argue that in several important areas, Wischik is factually mistaken. (shrink)

ABSTRACT This paper proposes a vision of rhetoric as metaphysical enactment. This position contrasts with traditionally accepted views of rhetoric as phenomenological practice, evidenced prominently in contemporary rhetorical theory. I advance a framework that employs metaphorical accommodation and indicates a way that rhetoric can be situated as a perpetually productive force. The analytic tradition affords a method and vocabulary that when placed in conversation with rhetorical studies offers an alternative for viewing rhetoric as metaphysical enactment. I determine that rhetorical theory (...) should engage with rhetoric as a measure of action, activity, and vitality that raises our awareness and connects us. (shrink)

A Publisher Correction to this paper has been published.

Marušić & Schwenkler (Analytic Philosophy, 59, 309) offer a simple and elegant defense of strong cognitivism about intention: the view that an intention to φ is a form of belief that one will φ. I show that their defense fails: however simple and elegant, it fails to account for various aspects about intention and its expression, and faces distinctive challenges of its own, including a dilemma and counterexample. These also undermine Marušić & Schwenkler's claim to a best-explanation type of account (...) and recommend alternatives to strong cognitivism altogether. (shrink)

In the immediate post-war period, a set of thinkers, most notably Jacques Maritain, developed influential natural law theories of constitutional democracy. The central tenet of the natural law approach to the post-war settlement was that, without the type of foundational understanding of the constitutional system it was proposing, the new democratic political institutions would relapse into totalitarianism. In response to this natural law challenge, Hans Kelsen sought to explicate and defend a self-consciously secular and relativistic understanding of the basis of (...) constitutional democracy. This article will examine the debate between the Kelsenian and the natural law view of constitutional democracy. The debate raises questions of foundational importance, and a number of issues are of particular concern in the present global context. These issues concern the role of moral pluralism and its relevance to the structure of constitutional democracy, and the relationship between universal values and the common good of particular communities. (shrink)

I argue for two principles by combining which we can construct a sound cosmological argument. The first is that for any true proposition p's if 'there is an explanation for p's truth' is consistent then there is an explanation for p's truth. The second is a modified version of the principle that for any class, if there is an explanation for the non-emptiness ofthat class, then there is at least one non-member ofthat class which causes it not to be empty.

Hannah Arendt was one of the foremost political thinkers of the twentieth century, and her particular interests have made her one of the most frequently cited thinkers of our time. This Companion examines the primary themes of her multi-faceted work, from her theory of totalitarianism and her controversial idea of the 'banality of evil' to her classic studies of political action and her final reflections on judgment and the life of the mind. Each essay examines the political, philosophical, and historical (...) concerns which shaped Arendt's thought, and which prompted her to become one of the most unapologetic champions of the political life in the history of Western thought. (shrink)

Over the past century, six studies – the most recent data from 2000 – and one review have comprehensively examined the content of medical oaths and oath-taking practices, all focusing on North Amer...

While ideals of racial purity may be out of fashion, other sorts of purity ideals are increasingly popular in the United States today. The theme of purity is noticeable everywhere, but it is especially prominent in our contemporary fixation on health and hygiene. This may seem totally unrelated to issues of racism and classism, but in fact, the purveyors of purity draw upon the same themes of physical and moral purity that have helped produce white identity and dominance in the (...) US. Historically, this is where the purity rhetoric gets its power. To invoke purity ideals in the US is to mobilize this genealogy of racialized associations. Today's zealous preoccupation with hygiene is part of our living heritage in a racist culture.Just as ideas of race and racial purity were debunked by biologists long before the public would begin to question them, ideals of extreme hygienic purity linger with us, even flourish, despite scientific evidence of their futility and harm. Why are we still so enamored with purity? Because, to some extent, our very self-conceptions are at stake. Other scholars have described how our process of self individuation is based upon exclusion. The unique contribution of a genealogical approach to this issue is that, instead of merely locating the problem in ideologies held by others, it can evoke self-recognition and self-transformation. We will tend to assume the problem lies elsewhere until we learn to recognize ourselves in practices that reproduce cultural ideals. As inheritors of this racist culture, we are all lovers of purity, and we are all responsible for rethinking this value. (shrink)

The relation of Hannah Arendt's political theory to Martin Heidegger's philosophy is a fraught topic. This essay explores the basic structure of Arendt's appropriation of Heidegger, the better to defend her theory of political action against oft-repeated charges of elitism and exclusion. In my view, Arendt's critical reading of the canon is deeply indebted to Heidegger, even though her ultimate goal--the recovery of human plurality as a basic and irreducible dimension of politics and the public world--is radically un-Heideggerian in nature.

This book provides a study of Walter Benjamin's first philosophy in two senses: it focuses on his early philosophy as a source of insight into his later works, and it explores his thinking about the nature of truth, method, experience, the relation of body and mind, and the limits of human knowledge. While most attention is paid to Benjamin's later works, his writings from roughly 1914-1925 explore philosophical themes and develop a critical method. This book argues that this early work (...) founds a series of original and lasting questions and insights. Benjamin understands experience as a broken continuum of diverse forms of spiritual expression, each of which is ephemeral. This leads Benjamin to a series of thought figures: the notion of language as a medium of experience; a philosophy of perception based in the natural history of the human body; an emphasis on mimesis as a faculty of creative assimilation; and a discovery of memory as a power for excavation of meaning in past experience. This book demonstrates that the need for a new understanding of the metaphysical structure of experience, as well as a new conception of truth, play a special role in shaping Benjamin's subsequent work. Walter Benjamin's First Philosophy will be of interest to scholars and advanced students working on the thought of Walter Benjamin, 20th-century Continental philosophy, comparative literature, and modern German thought. (shrink)

O trumpismo nos Estados Unidos, assim como outras erupções populistas ao redor do mundo, demonstra que valores fundamentais herdados pelo Iluminismo são muito menos seguros no Ocidente do que fora presumido. Estima pela racionalidade e conhecimento objetivo e o respeito pela liberdade individual vem sendo enfraquecidos pela dissolução da sociedade em facções intransigentes. O abandono de princípios centrais que por muitas gerações serviram como base comum para a civilização Ocidental, fragmentou a sociedade Ocidental em campos aparentemente irreconciliáveis, não mais sujeitos (...) a uma mente comunal compartilhada. Como pode suceder que uma sociedade governada por uma mente social compartilhada, e já estabelecida de longa data, sumariamente se fragmenta em campos, de opinião muito diferentes, claramente sob a influência de princípios discrepantes? Seriam a desintegração de ideias e a dissolução da mente, consequências inevitáveis de conteúdo mental proliferante, de entropia intelectual talvez até inerente? Guiado pela semiótica de Peirce e pela filosofia da mente, e utilizando a chacoalhada provocada pelo Trump na vida social e político dos EUA como exemplo ilustrativo de um cismo cultural profundo, considerarei algumas possíveis causas estruturais de um crescente sectarismo e abordarei as condições semióticas que explicariam a desintegração da mente social. (shrink)

ABSTRACT School psychologists are frequently confronted with ethically challenging situations arising from the need to balance multiple parties’ competing interests and the challenge of serving as both student advocate and school employee. Use of a systematic decision-making model has been recommended as a way of improving the quality of school psychologists’ ethical decisions. In the present study, school psychology practitioners were randomly assigned to one of two conditions: a Critical Evaluative condition, requiring the use of a problem-solving approach to resolve (...) an ethical dilemma, or an Intuitive condition, which entailed generating a solution based solely on intuition and professional experience/judgment. Use of a formal decision-making model did not result in higher caliber ethical resolutions. Participants’ age and number of years in the field were significantly correlated with raters’ judgments that solutions considered the consequences of a chosen course of action. Most participants reported that they did not utilize an ethical decision-making model during the course of their practice, relying instead on consultation with peers/colleagues and their own professional experience. Implications of these findings are discussed in the context of school psychology practice. (shrink)

Following decades of maltreatment of women in obstetric care, professional respect for maternal autonomy in obstetric decision making and care have become codified in global and national professional ethical guidelines. Yet, using the example of birth after cesarean, identifiable threats to maternal autonomy in obstetrics continue. This paper focuses on how current scientific knowledge and obstetric practice patterns factor into restricted maternal autonomy as evidenced in three representative maternal accounts obtained prior and subsequent to birth after cesarean. Short- and long-term (...) remedies to improve the current state of restricted maternal autonomy in clinical practice surrounding decision making on birth after cesarean are provided. (shrink)

This article is an interrogation of a small practical project I recently undertook to examine the relation between ‘studio exercises’, commonplace in creative practices, and ‘training’ that is typical of corporate environments, to see how this affects the use of technology in each context. This project titled ‘Office Exercise’ focuses on the relationship between the roll of ‘experiment’ and ‘exercise’ in the production of creative work involving technology. As a series of works ‘Office Exercise’ examines creative practice involving technology and (...) the tensions it produces between the artistic applications of technology to a given situation and the simultaneous proficiency/competency of the use of this technology. (shrink)

Summary With the help of psychological and biological concepts it is possible todescribe adequately a fundamental class of inductive inferences that are intuitively correct. Moreover, by relying on evolutionary theories it is possible tojustify them, because they reflect innate, hence useful, capacities. These inferences, however, refer to the past, i.e. the inferred generalization is of the form All Awere B . The reason is that evolutionary theories only claim that innate capacitieshad survival value. With respect to inductive inferences about the (...) future the situation is different. In particular, they are affected by the Goodman paradox. In the article, a method is proposed which enables us to describe adequately a basic class of inductive inferences about the future which are intuitively correct. These inferences can also be justified, but their justification requires a very specific assumption. The conclusions arrived at in the article can be viewed as a satisfactory solution to the Goodman paradox. (shrink)

Aus dem Inhalt I. Unity and Hierarchy II. Beyond Unity towards Totality III. Cognition and Action IV. On some Transformations of the Concept of Ideal V. Ethics instead of the Dogmatic Dress VI. From Religion to Speculation VII. Religion and its Misplacement VIII. Will and Social Contract IX. Architectonics and Edifice Print-on-Demand-Nachdruck der Ausgabe von 1984.