This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and 'first contact' through to either recovery or to long-term illness, death and dying.

Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Past, Present—and Future Perfect?Taking Psychiatry Beyond Its Single Message MythologiesK. W. M. Fulford (bio)I am grateful to John Sadler and his colleagues for their generous invitation to contribute to this collection marking Philosophy, Psychiatry, & Psychology (PPP)'s thirtieth birthday. True to our editorial tradition of "no nonsense" publishing, the "ask" was a reflection on PPP's past, present and future, limited to 500 words. In fact, one word does it (...) for me—collegiality.Collegiality was our watch word from the start. I still treasure a group photo taken at an early pre-meeting of the Association for the Advancement of Philosophy and Psychiatry (AAPP) convened by Michael Schwartz at his home in 1992, when, among other initiatives, PPP was conceived through transferring our then-nascent journal proposal from a small British publishing house to its current international publisher, the Johns Hopkins University Press. Michael and I had met earlier by phone when he had called the Royal College of Psychiatrists in London to enquire about its recently launched Philosophy Group and (by mere chance) I happened to be standing next to the person who took the call! PPP, with John and myself its founder editors, was subsequently born as, and has remained, a joint venture between our two groups: and Peter Zachar's recent initiative in building closer links with the International Network for Philosophy and Psychiatry (INPP) has taken us an important step towards the vision shared by Michael, John and myself that PPP should grow to reflect and represent a global open society of philosophy and mental health.As a pointer to the future, this global open society was no mere utopian vision but a joint commitment to what we conceived as a necessary ambition. Contemporary disenchantment with the repeated failures of translation of current narrowly empirical models of psychiatry, points to the truth of our German colleague, Paul Hoff's, characterization of the history of psychiatry as a history of serial collapses into single message mythologies. This disenchantment might seem to offer an opportunity for colonial expansion of philosophy into psychiatry (a re-assertion, perhaps, of phenomenology?). But PPP was born out of the "decade of the brain" and has remained throughout an ally of, not competitor to, the neurosciences. [End Page 3] So, while it is true that, with Peter's initiative, and with editorial and other innovations introduced by John, PPP is actively extending its reach (to new areas of philosophy, and to new voices, informed notably by experience as well as by training), this expansion remains a collegial not colonial enlargement of the field. I need hardly point to the challenges presented by the inclusive ambitions of such enlargement (not least to maintaining the highest standards of editorial and peer review). But PPP's collegiality provides the foundation for the work needed to deliver on these challenges. Even if imperfectly realized, this collegiality will help to take us beyond the single message mythologies by which our discipline has too long been hobbled. [End Page 4]K. W. M. Fulford K.W.M. (Bill) Fulford is a Fellow of St Catherine's College and Member of the Philosophy Faculty, University of Oxford; Emeritus Professor of Philosophy and Mental Health, University of Warwick Medical School; and Founder Director of the Collaborating Centre for Values-based Practice, St Catherine's College, Oxford (valuesbasedpractice.org).Copyright © 2023 Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.2 (2004) 165-173 [Access article in PDF] Professional Judgment, Critical Realism, Real People, and, Yes, Two Wrongs Can Make a Right! K.W.M. Fulford Anthony Colombo Keywords values, values-based practice, models of disorder, concept of mental illness, user-centred practice, patient-centred practice, multidisciplinary teamwork We are grateful to our four commentators for putting much-needed conceptual air and space around the models project. Published originally as an empirical (...) study of the different implicit models of disorder, held by users of services, carers, nurses, psychiatrists, and social workers (Colombo et al. 2003), our paper outlined the philosophical roots of the models project in linguistic analytic philosophy of the "Oxford school" (Fulford and Colombo 2004). Our four commentators provide extra dimensions of understanding, respectively from professional education (Williams 2004), sociology (Bendelow 2004), Heideggerian phenomenology (Heginbotham 2004), and mental health policy and practice (Williamson 2004).Since the original study, the models project has been taken forward as a key contribution to a range of philosophy-into-practice initiatives called, collectively, Values-Based Practice. In this brief response, we outline the key features of Values-Based Practice and indicate how these connect with some of the many thoughtful points about models made by our commentators. Values-Based Practice Values-Based Practice, then, is the theory and skills-base for effective health care decision making where different, and hence potentially conflicting, values are in play (Fulford 2004). Premised on the democratic meta-value of equal respect for all voices, Values-Based Practice relies, much as a political democracy relies, on good process rather than preset outcomes for its practical effectiveness. The ten pointers to good process in Values-Based Practice are summarized in Figure 1. We return to the implications of these for the work on models below.Relying on good process may be thought to be a recipe more for relativism and indecision in clinical decision making than for practical effectiveness. To the contrary, however, the 'values democracy' of Values-Based Practice, again like a political democracy, carries a number of clear and coherent implications for policy and practice in health care. [End Page 165] Click for larger viewFigure 1 10 Pointers to Good Process in VBP [End Page 166]Examples of the implications of Values-Based Practice for policy and practice are given in the Values Framework shown in Figure 2. This is a policy framework for the development of Values-Based Practice in mental health produced by a project group in the National Institute for Mental Health in England (NIMHE), the section of the UK's National Health Service (NHS) responsible for implementing government policy on mental health as embodied in the National Service Framework for Mental Health (Department of Health 1999) and subsequent policies. The framework gives three key principles of Values-Based Practice (the three Rs of recognition, raising awareness, and respect) and then summarizes some of the specific implications of the approach. Racism, for example, is incompatible with Values-Based Practice because racism is by definition intolerant of diversity. Again, we indicate some of the policy implications of Values-Based Practice for the points about models made by our commentators below.Training for mental health practitioners in Values-Based Practice will be rolled out from April 2005, through both voluntary and statutory bodies, in each of the eight regions of the National Health Service of England and Wales. This roll out will be supported by training methods developed and piloted in a unique joint venture between Warwick University's Department of Philosophy and Medical School, and an in-service training provider, the Sainsbury Centre for Mental Health (Fulford, Williamson, and Woodbridge 2002; Woodbridge and Fulford 2003). These training methods are the basis of a detailed workbook for Values-Based Practice (Woodbridge and Fulford 2004). The workbook will be launched in July 2004 at a conference in London by the Minister of State with responsibility for mental health, Rosie Winterton. Professional Training and Professional Judgment The models project has been central to the development of... (shrink)

In the current climate of dramatic advances in the neurosciences, it has been widely assumed that the diagnosis of mental disorder is a matter exclusively for value-free science. Starting from a detailed case history, this paper describes how, to the contrary, values come into the diagnosis of mental disorders, directly through the criteria at the heart of psychiatry's most scientifically grounded classification, the American Psychiatric Association's DSM (Diagnostic and Statistical Manual). Various possible interpretations of the prominence of values in psychiatric (...) diagnosis are outlined. Drawing on work in the Oxford analytic tradition of philosophy, it is shown that, properly understood, the prominence of psychiatric diagnostic values reflects the necessary engagement of psychiatry with the diversity of individual human values. This interpretation opens up psychiatric diagnostic assessment to the resources of a new skills-based approach to working with complex and conflicting values (also derived from analytic philosophy) called 'values-based practice.' Developments in values-based practice in training, policy and research in mental health are briefly outlined. The paper concludes with an indication of how the integration of values-based with evidence-based approaches provides the basis for psychiatric practice in the twenty-first century that is both science-based and person-centred. (shrink)

This edited volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organised around the main stages of the clinical encounter from the patient's perspective. This introductory chapter opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare.

In this paper, we propose to analyze the phenomenon of Christian prayer by way of combining two different analytical frameworks. We start by applying Schutz’s theories of “intersubjectivity,” “inner time,” “politheticality,” and “multiple realities,” and then proceed by drawing on the ideas and insights of linguistic philosophers, notably, Wittgenstein’s “language-game,” Austin’s “speech act,” and Evans’s “logic of self-involvement”. In conjoining these accounts, we wish to demonstrate how their combination sheds new light on understanding the phenomenon of prayer. Prayer is a (...) complex phenomenon that involves two major dimensions: the private and the social, as Matthew and Acts, respectively, demonstrate. Schutz’s study of the phenomenon of “inner time” and the “polithetical” structure of consciousness, at both the subjective and intersubjective level, provides a useful lens to analyze these two dimensions. In addition, prayer, in following a specific set of rules, can also be considered as a specific, i.e., religious “language-game”. In the last analysis, however, we propose to analyze prayer within the Schutzian framework of “multiple realities,” “enclaves,” and “symbolic appresentation,” which permits accessing the “religious finite province of meaning” in the very midst of the paramount reality of everyday life. In a nutshell, we claim that Christian prayer is a practice of constructing and living within a “religious province of meaning” in the everyday world; it is a practice that revolves around self-involving language-activities such as praising, confessing, thanksgiving, or requesting to God, which enable the praying subject to transfigure the language of everydayness and “see through” the world of everyday life in order to let it appear in a different light, e.g., the light of grace, gift, and salvation. (shrink)

This article is a response to the proposal, made by Thornton elsewhere in this special issue of PPP, that the "space of reasons" (as defined by the work particularly of Sellars and McDowell) might contain the conceptual resources for naturalizing biological function statements without reducing their ostensibly teleological meanings to the "space of causes". I agree with Thornton, (1) that ordinary reductive naturalism (as in Wakefield's work) is unable to mark the key distinction between a functional system's function(s) and its (...) other properties, and (2) that his proposed non-reductive naturalism (or neo-naturalism) is able to mark this distinction. I disagree with him, though, that neo-naturalism is value-free. The space of reasons certainly contains much that is important for psychopathology (meanings, notably). I argue, though, against Thornton, that neo-naturalism is able to define functions only because the "space of reasons" smuggles into the language of biology an evaluative element of meaning, deeply hidden but still logically operative, in the teleological sense in which biological functions are explanatory. In the final section of the paper, I set Thornton's proposal in a wider historical perspective. (shrink)

The effects of the vacuum electromagnetic fluctuations and the radiation reaction fields on the time development of a simple microscopic system are identified using a new mathematical method. This is done by studying a charged mechanical oscillator (frequency Ω 0)within the realm of stochastic electrodynamics, where the vacuum plays the role of an energy reservoir. According to our approach, which may be regarded as a simple mathematical exercise, we show how the oscillator Liouville equation is transformed into a Schrödinger-like stochastic (...) equation with a free parameter h′ with dimensions of action. The role of the physical Planck's constant h is introduced only through the zero-point vacuum electromagnetic fields. The perturbative and the exact solutions of the stochastic Schrödinger-like equation are presented for h′>0. The exact solutions for which h′shrink)

[About the book]: This volume is a state-of-the-art survey of the psychology of reasoning, based around, and in tribute to, one of the field's most eminent figures: Jonathan St B.T. Evans.In this collection of cutting edge research, Evans' collaborators and colleagues review a wide range of important and developing areas of inquiry. These include biases in thinking, probabilistic and causal reasoning, people's use of 'if' sentences in arguments, the dual-process theory of thought, and the nature of human rationality. These foundational (...) issues are examined from various angles and finally integrated in a concluding panoramic chapter written by Evans himself.The eighteen chapters, all written by leading international researchers, combine state-of the-art research with investigation into the most fundamental questions surrounding human mental life, such as:What is the architecture of the human mind?Are humans rational, and what is the nature of this rationality?How do we think hypothetically? The Science of Reason offer s a unique combination of breadth, depth and integrative vision, making it an indispensable resource for researchers and students of human reason. (shrink)

This article explores the role of an international open society of mental health stakeholders in raising awareness of values and thereby reducing the vulnerability of psychiatry to abuse. There is evidence that hidden values play a key role in rendering psychiatry vulnerable to being used abusively for purposes of social or political control. Recent work in values-based practice aimed at raising awareness of values between people of different ethnic origins has shown the importance of what we call “values auto-blindness” – (...) a lack of awareness of one’s own values as a key part of our background “life-world” – in driving differential rates of involuntary psychiatric treatment between ethnic groups. It is argued that the vulnerability of psychiatry to abuse stems from values auto-blindness operating on the judgments of rationality implicit in psychiatric diagnostic concepts. Acting like a “hall of mirrors,” an international open society of mental health stakeholders would counter the effects of values auto-blindness through enhanced mutual understanding of the values embedded in our respective life-worlds across and between the diverse perspectives of its constituents. The article concludes by noting that a model for the required open society is available in the contemporary interdisciplinary field of philosophy and psychiatry. (shrink)

This volume of articles, literature and case studies illustrates the central importance of human values throughout healthcare. The readings are structured around the main stages of the clinical encounter from the patient's perspective.

Ten years ago the Royal Institute of Philosophy marked the establishment of the Society for Applied Philosophy with a series of public lectures, published in an earlier book in this series, under the title Philosophy and Practice. Looking back it i s hard to believe this was only ten years ago. Applied philosophy still has its critics. But it is now so pervasive, so much the norm, that it seems to have been with us always. Law, medicine, education, nursing, the (...) environment, politics, economics … almost it seems, no subject is quite respectable nowadays without its philosophy and its philosophical exponents. (shrink)

These are exciting times for philosophy and psychiatry. After drifting apart for most of this century, the two disciplines, if not yet fully reconciled, are suddenly at least on speaking terms. With hindsight we may wonder why they should have ignored each other for so long. As Anthony Quinton pointed out in a lecture to the Royal Institute of Philosophy a few years ago, it is remarkable that philosophers, in a sense the experts on rationality, should have had so little (...) to say about the phenomena of irrationality. There have been partial exceptions, of course. Descartes and Kant both touched on madness; and there were, notably, important philosophical influences on the development of modern psychiatry in the late nineteenth and early twentieth centuries. Yet even John Locke, who was a doctor as well as philosopher, confined himself to a fair-l y superficial distinction between what we should now call mental illness and mental defect—those with, in Locke's view, respectively too many ideas and too few. (shrink)

Decision-making depends on bringing evidence together with values: decision theory for example employs probabilities and utilities; health economic decisions employ measures such as quality of life. The hypothesis guiding this chapter is that bringing evidence together with values in clinical decision-making requires an exercise of phronesis. Our aim however is not to justify our guiding hypothesis. It is rather to outline an account of phronesis that is in principle fit for the purposes of clinical decision-making if our guiding hypothesis is (...) correct. The chapter has three sections. Section 1 describes the growing gap between evidence and values in clinical decision-making: the missing link, we suggest, required to bridge this gap, is an appropriate account of phronesis. Section 2 provides an initial characterisation of the required account of phronesis via Michael Polanyi’s twin stipulation on the nature of tacit knowledge. Section 3 then fills out the required account using John McDowell’s characterisation of phronesis as a situation specific but at the same time conceptually structured form of practical discernment. A McDowellian account of phronesis, we argue, in satisfying Polanyi’s twin stipulation, provides an in-principle bridge between evidence and values. We conclude with a note on some of the further requirements if the gap is to be bridged not only in principle but in practice too. (shrink)

The article is devoted to the analysis of features of functioning of the digital government in the Chinese State in the first decades of the 21-st century and the perspectives of its further development. In this work the authors give a brief description of the essence of phenomenon of digital government in general. The article explores the specific features of this process in the People’s Republic of China in the third millennium. This research examines the influence of functioning of e-government (...) bodies in Сhina on the internal political situation in the country – taking into account such aspects as building a dialogue between authorities and society, perfection of the public service system providing the Chinese citizens with essential public goods, the merits and the demerits of China’s online government are taken into account. This article examines such significant factors in the development of e-government in China as the impact of the global situation at the present stage on international politics and the country’s information security system. This article analyzes the features of the relationship between the Chinese authorities and media corporations operating on the Internet market of the Middle Kingdom, and studies the reasons for the contradictions between them. The study also comprehended strategy of the authorities of the People’s Republic of China in matters of information security of the state, including the active use of Chinese hackers in network conflicts with Western countries, and the actions of special units of the Chinese armed forces created to counter foreign cyber terrorism. (shrink)

Upshot: The commentaries raise a plethora of issues, extending the article’s problematic in insightful ways. In this response, we chose to focus on two interesting views on the “powerful idea” in the constructionist sense, on systems versus causal-rule thinking and on the affective aspect of collaborative learning.

Recent years have seen an increasing interest in the study of continuous-time computational models. However, not so much has been done with respect to setting up a complexity theoretic framework for such models. The present paper intends to go a step into this direction. We consider problems over the real numbers which we try to relate to Lyapunov theory for dynamical systems: The global minimizers of particular energy functions are supposed to give solutions of the problem. The structure of such (...) energy functions leads to the introduction of problem classes U and NU; for the systems we are considering they parallel the classical complexity classes P and NP. We then introduce a notion of reducibility among problems and show existence of complete problems for NU and for PU, a polynomial hierarchy of continuous-time problems.For previous work on the computational capabilities of continuous-time systems see the surveys by Cris Moore [9] and by Pekka Orponen [10]. Our paper presents a step into the direction of creating a general framework for a complexity theory of continuous-time systems as outlined in [10]. It is closely related to work done by A. Ben-Hur, H. Siegelmann, and S. Fishman [12, 11]. (shrink)

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

Marie Stenlund’s careful reading of values-based practice and her demonstration of its links with Martha Nussbaum’s Capabilities Framework are innovative theoretically and have potentially important implications for policy and practice in mental health. As she indicates the two approaches converge in a number of key respects. Notably, both recognise the diversity of individual human values. This diversity crucially underpins contemporary person-centred conceptions of recovery in mental health based on quality of life as defined by reference to the values of (to (...) what is important from the perspective of) the person concerned rather than that of a generic professional ‘needs assessment’.1 2 Where the two theories diverge, too, Stenlund finds practically important consequences. Thus Nussbaum’s Capabilities Framework, as Stenlund indicates, is outcomes-oriented, while values-based practice focuses on process. The two approaches are not however thereby necessarily inconsistent. Drawing on early accounts of values-based practice (from 2006 and 2009), Stenlund suggests a degree of implicit blurring between it and Nussbaum’s capabilities. Here we need to be careful: values-based practice does not (as Stenlund suggests) regard recovery as an outcome; it …. (shrink)

Suppose some person 'A' sets out to accomplish a difficult, long-term goal such as writing a passable Ph.D. thesis. What should you believe about whether A will succeed? The default answer is that you should believe whatever the total accessible evidence concerning A's abilities, circumstances, capacity for self-discipline, and so forth supports. But could it be that what you should believe depends in part on the relationship you have with A? We argue that it does, in the case where A (...) is yourself. The capacity for "grit" involves a kind of epistemic resilience in the face of evidence suggesting that one might fail, and this makes it rational to respond to the relevant evidence differently when you are the agent in question. We then explore whether similar arguments extend to the case of "believing in" our significant others -- our friends, lovers, family members, colleagues, patients, and students. (shrink)

Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mental illness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mental illness from analyses of disease in terms of failure (...) of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality. (shrink)

Brazilian and US American children were compared for differences in tolerance and punishment expectancy. We hypothesized that participants would be less tolerant and more punishing of moral than conventional violations; tolerance and punishment expectancy would relate with age; Brazilians would tolerate less and expect more punishment than US Americans; and social domain would moderate effects of age and nationality. The sample had 129 matched children from Brazil and the USA. Moral/conventional-violation vignettes were used. Mixed-model GLMs suggested that children were less (...) tolerant and more punishing of moral than social-conventional violations. Age effects were significant for tolerance. Brazilians scored lower on tolerance and higher on punishment expectancy than US Americans; they also differentiated less between violation domains than US Americans. These and other results suggest that Brazilians tolerate less but expect more punishment for violations than US Americans. Discussion is based on cultural and socio-historical differences between the two nations. (shrink)

The article is devoted to the comprehension of formation and development of digital sector of the national economy in the People’s Republic of China in the first decades of the 21-st century. This study examined the essense of the digital economy as such, its inception and development, and the advantages, by which it supplies the world economy in the field of trade and services. The article explores the reasons, that led the transition of the Chinese State to digitalization at a (...) later date than in the USA and other Western countries, and Japan and Korea. This study examines the beginning of the process of creating the Internet technology sector in the Chinese economy with an explanation of the factors that caused the difficulties that PRC faced at the initial stage in this area at the initial stage. The work contains an analysis of the policy of the Chinese authorities in the field of the development of high technologies in the period under study. The authors explore the causes and consequences of fundamental changes which occurred during the formation of the network component of the national economy of China in 2010-s and explain the significant successes that the People’s Republic of China has achieved in the global high-tech market, taking into account the specifics of political situation in the country and its influence on the foreign economic policy of the Celestial Empire. (shrink)

From the perspective of values-based practice, there is much of interest in Lorenzo Gilardi and Giovanni Stanghellini's "I am a Schizophrenic." Their dialogue exhibits many of the key elements of VBP, it exemplifies the particular challenges presented by VBP in mental health, it illustrates the power of phenomenology in meeting these challenges, and it points by extension to an insight into contemporary psychiatry's professional identity as a medical profession.VBP is a resource for working with values—with what matters or is important (...) to those concerned—in healthcare. Avoiding preset answers, it offers instead a process that supports those concerned in a given situation... (shrink)

This introduction to the Journal of Business Research special issue on anti-consumption briefly defines and highlights the importance of anticonsumption research, provides an overview of the latest studies in the area, and suggests an agenda for future research on anti-consumption.

IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

Increasingly, national governments across the globe are prioritizing investments in neuroscience. Currently, seven active or in-development national-level brain research initiatives exist, spanning four continents. Engaging with the underlying values and ethical concerns that drive brain research across cultural and continental divides is critical to future research. Culture influences what kinds of science are supported and where science can be conducted through ethical frameworks and evaluations of risk. Neuroscientists and philosophers alike have found themselves together encountering perennial questions; these questions are (...) engaged by the field of neuroethics, related to the nature of understanding the self and identity, the existence and meaning of free will, defining the role of reason in human behavior, and more. With this Perspective article, we aim to prioritize and advance to the foreground a list of neuroethics questions for neuroscientists operating in the context of these international brain initiatives. (shrink)

The law of informed consent to medical treatment has recently been extensively overhauled in England. The 2015 Montgomery judgment has done away with the long-held position that the information to be disclosed by doctors when obtaining valid consent from patients should be determined on the basis of what a reasonable body of medical opinion agree ought to be disclosed in the circumstances. The UK Supreme Court concluded that the information that is material to a patient’s decision should instead be judged (...) by reference to a new two-limbed test founded on the notions of the ‘reasonable person’ and the ‘particular patient’. The rationale outlined in Montgomery for this new test of materiality, and academic comment on the ruling’s significance, has focused on the central ethical importance that the law now accords to respect for patient autonomy in the process of obtaining consent from patients. In this paper, we dispute the claim that the new test of materiality articulated in Montgomery equates with respect for autonomy being given primacy in re-shaping the development of the law in this area. We also defend this position, arguing that our revised interpretation of Montgomery’s significance does not equate with a failure by the courts to give due legal consideration to what is owed to patients as autonomous decision-makers in the consent process. Instead, Montgomery correctly implies that doctors are ethically obliged to attend to a number of relevant ethical considerations in framing decisions about consent to treatment, which include subtle interpretations of the values of autonomy and well-being. Doctors should give appropriate consideration to how these values are fleshed out and balanced in context in order to specify precisely what information ought to be disclosed to a patient as a requirement of obtaining consent, and as a core component of shared decision-making within medical encounters more generally. (shrink)

Is it harder to acquire knowledge about things that really matter to us than it is to acquire knowledge about things we don't much care about? Jason Stanley 2005 argues that whether or not the relational predicate 'knows that' holds between an agent and a proposition can depend on the practical interests of the agent: the more it matters to a person whether p is the case, the more justification is required before she counts as knowing that p. The evidence (...) for Stanley's thesis includes a number of intuitive judgments about examples. In this paper we provide parallel examples for which Stanley's thesis requires unwelcome knowledge-attributions, and argue that this is possible because his thesis conflicts with familiar and plausible principles about knowledge. (shrink)

Guanxi (literally interpersonal connections) is in essence a network of resource coalition-based stakeholders sharing resources for survival, and it plays a key role in achieving business success in China. However, the salience of guanxi stakeholders varies: not all guanxi relationships are necessary, and among the necessary guanxi participants, not all are equally important. A hierarchical stakeholder model of guanxi is developed drawing upon Mitchell et al.’s (1997) stakeholder salience theory and Anderson’s (1982) constituency theory. As an application of instrumental stakeholder (...) theory, the model dimensionalizes the notion of stakeholder salience, and distinguishes between and among internal and external guanxi, core, major, and peripheral guanxi, and primary and secondary guanxi stakeholders. Guanxi management principles are developed based on a hierarchy of guanxi priorities and management specializations. The goal of this application of instrumental stakeholder theory is to construct, for Western business firms in China, a means to reliably identify guanxi partners by employing the principles of effective guanxi. These principles are described in the form of testable propositions that advance social scientific research in this area of international business ethics. (shrink)

Felix Klein and Abraham Fraenkel each formulated a criterion for a theory of infinitesimals to be successful, in terms of the feasibility of implementation of the Mean Value Theorem. We explore the evolution of the idea over the past century, and the role of Abraham Robinson's framework therein.

Emotionally arousing events reach awareness more easily and evoke greater visual cortex activation than more mundane events. Recent studies have shown that they are also perceived more vividly and that emotionally enhanced perceptual vividness predicts memory vividness. We propose that affect-biased attention (ABA) – selective attention to emotionally salient events – is an endogenous attentional system tuned by an individual's history of reward and punishment. We present the Biased Attention via Norepinephrine (BANE) model, which unifies genetic, neuromodulatory, neural and behavioural (...) evidence to account for ABA. We review evidence supporting BANE's proposal that a key mechanism of ABA is locus coeruleus–norepinephrine (LC–NE) activity, which interacts with activity in hubs of affective salience networks to modulate visual cortex activation and heighten the subjective vividness of emotionally salient stimuli. We further review literature on biased competition and look at initial evidence for its potential as a neural mechanism behind ABA. We also review evidence supporting the role of the LC–NE system as a driving force of ABA. Finally, we review individual differences in ABA and memory including differences in sensitivity to stimulus category and valence. We focus on differences arising from a variant of the ADRA2b gene, which codes for the alpha2b adrenoreceptor as a way of investigating influences of NE availability on ABA in humans. (shrink)

Tuberculosis is caused by bacillus Mycobacterium tuberculosis. In this study, a mathematical model of tuberculosis is analyzed. The numerical behaviour of the considered model is analyzed including basic reproduction number and stability. We applied three numerical techniques to this model, i.e., nonstandard finite difference scheme, Runge–Kutta method of order 4, and forward Euler scheme. NSFD scheme preserves all the essential properties of the model. Acquired results corroborate that NSFD scheme converges for each step size. While the other two schemes failed (...) to preserve some properties of the model such as positivity and convergence. A graphical comparison presented in this study confirms the numerical stability of the NSFD technique shown here is maintained over a large area. (shrink)

The mind is not structured anatomically, as emphasized by modern pathology. Instead, it is expanded as a whole in a subtle form behind the physical body. In the Indian system of medical philosophy, the mind is considered as the astral nerves made third body, which identified as the ‘Manomaya-sharira’ (subconscious mind). The mind is composed of millions of astralnadis, through which Pranic-energies circulate freely into the astral anatomy of mind. Seven-chakras are found parallel to the spine, serving as the major (...) seven innovation centres in the body. These Chakras facilitate the connection of the mind with the seven dimensions of the inner world. From these dimensions the Pranic-energies including Sattva, Raja, Tama are exported to the mind and its Nadi-tantras, influencing both the outer and inner subconscious minds. Subsequently, these elements, viz., Sattva, Raja and Tama are thrown from the mind to the outer world through the seven sense organs, manifesting as either constructive or destructive activities. Thus the mind exists due to ‘Prana’, (energy of Omkara) which increases through deeper meditation, sound sleep, and breathing exercises (O2). The positional behaviour of the mind shifts according to the physical and mental temperament, namely Triguna and Tridosha, or Panchavikara. The negative energy (Tama-guna) of the fourth dimension enters the astral Nadis-system of the mind via the interspace of the solar plexus, which crushes the mind’s structures, and consequently, all the Chakras are corrupted and the Nadis are blocked, so it generates a break in the circulation of ‘Prana’ into the Nadis. As a result, many socio-economic challenges and psychosomatic disorders occur. (shrink)

A new translation of five dialogues of Bruno translated in 1950 by Sidney Greenberg in The Infinite in Giordano Bruno under the title "Concerning the Cause, Principle and One." A rather superficial introduction fails to substantiate the claim that the "materialistic dialectic" is the core of Bruno. It is not clear why a new translation is needed, except for the fact that Greenberg's book is unfortunately out of print.—K. A. M.

In an attempt to discover that which makes man distinctively human Wilson takes as his starting point two opposing accounts of what distinguishes man from inanimate objects and indicates why both of them are invalid. The Cartesian concept maintains that man is distinct from the inanimate by virtue of his consciousness, the neo-Wittgensteinian views the distinction as one of behavior and interaction explicable in terms of reason and motives. Wilson agrees that emotion and behavior constitute the primary difference between man (...) and the inanimate but that this human type of activity is analyzable in causal terms. He refutes certain anti-causal arguments that posit a non-contingent connection between an emotion and its object. Wilson rightly points out that a necessary proposition is one that is necessarily true, but a relation cannot be true or false, and therefore cannot be necessarily or contingently true or false. In order to prove his thesis that the emotion-object relationship is one of causality the term "object" is restricted to that which has existential status. Emotions referable to non-existent objects are malfounded emotions and not causally connected. Wilson proposes that the problem does not lend itself to a logico-grammatical analysis of statements that assign objects to emotions, but that the approach requires a study in the philosophy of mind. Such an inquiry discloses that emotion is caused by a mental state, i.e., attention to the object in which a thought or belief about the object causes a certain feeling or reaction. After a rather complicated analysis of the emotion-object relationship in which he considers the questions of materialism, free will intentionality, and rationality, Wilson returns to his original concern and concludes that "a person’s action and his end of action make sense and form a coherent whole because they are rooted in a complex network of feelings and attitudes." This is what makes man distinctively human.—K. R. M. (shrink)

A scholarly account of an important and previously uninvestigated aspect of Bruno's philosophy. Yates sets out in the historian's careful way to show that "Bruno's philosophy and his religion are one and the same, and both are Hermetic." A treatment of the development of the Hermetic tradition from Ficino and Pico allows the author to show that "the philosophy of the infinite universe and the innumerable worlds... is not... scientific thinking" but a continuation of the tradition which was mistakenly thought (...) to stem from an ancient Egyptian magical religion. Although this is definitely the work of an historian, any philosopher interested in the beginnings of modern science or in Renaissance thought will find it a valuable aid and contribution.—K. A. M. (shrink)