A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over (...) from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT. (shrink)

Although there is universal consensus both in the science education literature and in the science standards documents to the effect that students should learn not only the content of science but also its nature, there is little agreement about what that nature is. This led many science educators to adopt what is sometimes called “the consensus view” about the nature of science (NOS), whose goal is to teach students only those characteristics of science on which there is wide consensus. This (...) is an attractive view, but it has some shortcomings and weaknesses. In this article we present and defend an alternative approach based on the notion of family resemblance. We argue that the family resemblance approach is superior to the consensus view in several ways, which we discuss in some detail. (shrink)

Mental health research and care in the twenty first century faces a series of conceptual and ethical challenges arising from unprecedented advances in the neurosciences, combined with radical cultural and organisational change. The Oxford Textbook of Philosophy of Psychiatry is aimed at all those responding to these challenges, from professionals in health and social care, managers, lawyers and policy makers; service users, informal carers and others in the voluntary sector; through to philosophers, neuroscientists and clinical researchers. Organised around a series (...) of case studies in five key topic areas - concepts of disorder, the philosophical history of psychopathology, philosophy of science, ethics and philosophical value theory, and philosophy of mind - the book provides a detailed introduction to the field and a framework for study and skill development. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. There is an introduction for philosophers to classification and descriptive psychopathology, and for practitioners to philosophical methods (including logic). The philosophical topics covered include philosophical methods (analytic and Continental); phenomenology, hermeneutics and existentialism, logical empiricism and its successors; idealism and realism; reasons and causes; and modern theories of mind and brain, free will and personal identity. Topics from mental health include psychiatry and 'anti-psychiatry'; Jaspers' psychopathology and the new neurosciences; the future of psychiatric classifications; strengths-based approaches, recovery practice, social inclusion and diversity; and key topics in psychopathology, such as delusion, autism, disorders of volition, thought insertion and other experiences in schizophrenia. The Oxford Textbook of Philosophy of Psychiatry aims to secure the skills-base of the discipline by bringing philosophers closer to the realities of practice in mental health, and mental health practitioners closer to the resources of philosophy as a partner to the sciences in responding to the challenges of twenty-first century mental health and social care. (shrink)

E.J. Lowe claims that quantum physics provides examples of ontic indeterminacy, of vagueness in the world. Any such claim must confront the Evans-Salmon argument to the effect that the notion of ontic indeterminacy is simply incoherent (Evans 1978, Salmon 1981: 243-46). Lowe argues that a standard version of the Evans-Salmon argument fails quite generally (Lowe 1994). Harold Noonan (1995) has outlined a non-standard version of the argument, but Lowe argues that this non-standard version fails for specifically quantum mechanical reasons (Lowe (...) 1997). He claims that it is perfectly coherent to suppose that his quantum case is an example of ontic indeterminacy. In this paper, I raise some objections to Lowe's claim. (shrink)

This is a reply piece to a series of book symposium contributions to my book, Resisting Scientific Realism. The contributions were by Steven French, Peter Vickers, Stathis Psillos, and Kyle Stanford.

Realists and anti-realists disagree about whether contemporary scientists are epistemically privileged. Because the issue of epistemic privilege figures in arguments in support of and against theoretical knowledge in science, it is worth examining whether or not there is any basis for assuming such privilege. I show that arguments that try to explain the success of science by appeal to some sort of epistemic privilege have, so far, failed. They have failed to give us reason to believe (i) that scientists are (...) prone to develop theories that are true, (ii) that our current theories are not apt to be replaced in the future, and (iii) that science is nearing its completion. (shrink)

The paper addresses the possibility of providing a meta-justification of what appears to be crucial epistemic desiderata involved in the method of reflective equilibrium. I argue that although the method of reflective equilibrium appears to be widely in use in moral theorising, the prospects of providing a meta-justification of crucial epistemic desiderata are rather bleak. Nor is the requirement that a meta-justification be provided obviously misguided. In addition, I briefly note some of the implications of these results for our use (...) of the method of reflective equilibrium and for the best interpretation of the method. (shrink)

The primary aim of this research was to investigate the intricate relationship between the structural elements of experiences and their essential role in meaning formation. The analysis focused on understanding the nature of mental representations and the subjective, phenomenal qualities that emerge within experiences. To achieve this, an integrated approach, combining cognitive semantics with phenomenological analysis, was employed to examine the compositional complexities of the dynamic interaction between a priori and immediate experiences and their significance in meaning formation. The study (...) highlights the interconnectivity of structural elements within experience as a critical factor in shaping the phenomenal qualities of mental representations. Another key contribution of this study is the introduction of the “fulfiller” concept, which underscores the importance of absent qualities in meaning formation-an often-overlooked aspect in traditional models that focus solely on present attributes. The “fulfiller” concept emphasizes how absence, in addition to presence, influences meaning assignment. This inclusion enhances our understanding of meaning formation by considering both the tangible and intangible dimensions of the experiential-intentional process, offering a more comprehensive framework for understanding how meaning emerges from the complex interaction of present and absent qualities. (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

This short work sets out to argue that the set of simple expressions comprising the lexicon of a given individual and the lexis of a given community are not just contingently but necessarily finite at any given moment in time. Where the lexicon is concerned, this is done by adapting a very simple argument presented by Fred Dretske (1965) concerning whether an individual can count to infinity. This is extended to the more challenging case of the lexis of a community (...) by introducing lexicalization as a condition, which facilitates the same sort of argument as presented for the lexicon. Though the lexicon and lexis are often implicitly assumed to be finite, with little need for further argumentation, there does appear to be grounds for the stronger and more interesting claim that they are necessarily finite at any given moment in time. (shrink)

The aim of this essay is to describe and reflect upon the concrete particulars of one academician's work as an expert ethics witness. The commentary on my practices and the narrative descriptions of three cases are offered as evidence for the thesis that it is possible to act honorably within a role that some have considered to be inherently illicit. Practical measures are described for avoiding some of the best known pitfalls. The discussion concludes with a listing of the distinctive (...) competencies and understandings that are useful in serving as an expert ethics witness. (shrink)

One of the main concerns in defining health is determining its status in relation to value. The main proposals in this direction generally assume a strict dichotomy between descriptive and evaluative dimensions. This essay argues that such a dichotomy leads to a theoretical inconsistency, which becomes evident once a definition of health is practically operative. A new conceptual framework uniting these two moments is proposed as an alternative, capable of preserving the fundamental insights of both descriptive and evaluative accounts of (...) health, and of avoiding the theoretical inconsistencies on the level of practical application. (shrink)

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined (...) for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy. (shrink)

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)

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

Most of the economic models on basic income account just for pecuniary forms of work, i. e. “time spent making money”, in employment. This restriction is a drawback of these analyses and of the standard economic labor supply model itself. If one wants to understand the potential effects of basic income on individual and social welfare, one should not restrict observation to the pecuniary uses of time. The objective of this contribution is to rethink the meaning of work usually applied (...) in economic models, based on contributions of other social scientists. This reassessment is undertaken through the development of a microeconomic model, which discusses the effects of basic income on time use and interprets work not just as a source of income, but also of non-pecuniary benefits. Further, we disentangle the usual work-leisure dichotomy in two other ones. (shrink)

Goff argues that Galileo erred in denying that sensory qualities are present in the physical world and that we should correct his error by supposing that all matter has an intrinsic conscious aspect. This paper argues that we should be open to another theoretical option. Galileo's real error, I argue, was not about the location of sensory qualities, but about their very existence. Like most people, Galileo assumed that sensory qualities are instantiated somewhere. I argue that this is a theoretical (...) assumption which can and should be questioned. If we drop it, we can give a natural account of the function of sensory quality talk and explain how our puzzlement about consciousness arises. (shrink)

This collection examines prevalent assumptions in moral reasoning which are often accepted uncritically in medical ethics. It introduces a range of perspectives from philosophy and medicine on the nature of moral reasoning and relates these to illustrative problems, such as New Reproductive Technologies, the treatment of sick children, the assessment of quality of life, genetics, involuntary psychiatric treatment and abortion. In each case, the contributors address the nature and worth of the moral theories involved in discussions of the relevant issues, (...) and focus on the types of reasoning which are employed. 'Medical ethics is in danger of becoming a subject kept afloat by a series of platitudes about respect for persons or the importance of autonomy. This book is a bold and imaginative attempt to break away from such rhetoric into genuine informative dialogue between philosophers and doctors, with no search after consensus.' Mary Warnock. (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)

Neoplatonic allegorical interpretation expounds how literary texts present philosophical ideas in an enigmatic and coded form, offering an alternative path to the divine truths. The Neoplatonist Porphyry’s _On the Cave of the Nymphs_ is one of the most significant allegorical interpretation handed down to us from Antiquity. This monograph, exclusively dedicated to the analysis of _On the Cave of Nymphs_, demonstrates that Porphyry interprets Homer’s verse from Odyssey 13.102-112 to convey his philosophical thoughts, particularly on the material world, relationship between (...) soul and body and the salvation of the soul through the doctrines of Plato and Plotinus. The Homeric cave of the nymphs with two gates is a station where the souls descend into genesis and ascend to the intelligible realm. Porphyry associates Odysseus’ long wanderings with the journey of the soul and its salvation from the irrational to rational through escape from all toils of the material world. (shrink)

Written by leading researchers in educational and social psychology, learning science, and neuroscience, this edited volume is suitable for a wide-academic readership. It gives definitions of key terms related to motivation and learning alongside developed explanations of significant findings in the field. It also presents cohesive descriptions concerning how motivation relates to learning, and produces a novel and insightful combination of issues and findings from studies of motivation and/or learning across the authors' collective range of scientific fields. The authors provide (...) a variety of perspectives on motivational constructs and their measurement, which can be used by multiple and distinct scientific communities, both basic and applied. (shrink)

Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. Nature(representing interest in the causes of a problem) and Narrative (for understanding its meanings) will introduce the field and the series, by touching on a range of issue relevant to this interdisciplinary 'border country'.

It is well known that successive observations of the instantaneous state of a decaying system lead to a modified decay law. In the limit of infinitely frequent observations, the modified lifetime becomes infinite (“Zeno's paradox”). We study here the behavior of decaying systems under continuous rather than successive observations. Such continuous observation is achieved by a permanent coupling of the decaying system to a counter, which is sufficiently sensitive to the presence of the decay products. For two explicitly soluble models (...) we obtain a result very similar to Zeno's paradox: The observation again strongly modifies the decay law, and prevents the decay completely in the limit of a perfect (i.e., infinitely sensitive) counter. Like Zeno's paradox, however, this “watchdog effect” is not very likely to be detected in actual experiments, e.g., with radioactive nuclei. (shrink)

This article sets out a manifesto for the development of an international values-based practice fully engaged with the diversity of cultural values and implemented through the resources of the international movement in philosophy and psychiatry. Anticipated by mid-twentieth century ordinary language philosophy of the “Oxford School,” the last three decades have witnessed a remarkable flowering of cross-disciplinary work between philosophy and psychiatry. The article indicates the scope and scale of this work and then describes the emergence of contemporary values-based practice (...) as its philosophy-into-practice cutting edge. Values-based practice although originating in philosophy and psychiatry is currently being developed mainly in areas of bodily medicine such as surgery. As such, it has been criticized for focusing, as contemporary health care has largely focused, on the individual at the expense of cultural values. Hence arises the need for extending values-based practice internationally. The resources available from international philosophy and psychiatry for so extending values-based practice are outlined and some of the challenges are indicated. The article concludes with the hope that psychiatry in supporting the development of international values-based practice will by the same token take poll position in the development of contemporary science-led clinical care. (shrink)

This article sets out key contributions to the long-running debate about mental disorder from the ordinary language philosophy of the ‘Oxford School’. The distinction between definition and use of concepts underpinning ordinary language philosophy reframes the debate as a debate not just about mental disorder but about disorder in general, bodily as well as mental. The field work of ordinary language philosophy (focusing on the use of concepts as a guide to their meanings) shows that, attempts at elimination notwithstanding, there (...) is an essential evaluative element in the meaning of disorder, bodily as well as mental. The concept of disorder in the debate thus reframed presents a double challenge for analysis: to explain why disorder has evaluative connotations used of mental conditions but descriptive connotations used of bodily conditions. Philosophical value theory, derived by applying ordinary language philosophy to the language of values, provides a rich resource of ideas for meeting this double challenge. It meets the double challenge at the level of theory by allowing both aspects of the double challenge of disorder to be derived from a logical property that disorder shares with all other value terms. It meets the double challenge at the level of practice by supporting the development of a new approach to working with values alongside evidence in healthcare called values-based practice. Ordinary language philosophy, notwithstanding these several contributions, is no panacea. It helps us to make a start, no more and no less, in understanding mental disorder. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

Many have criticized the peer-review system employed in scientific publication because of the apparent lack of inter-referee reliability. It is often remarked that if referees cannot agree about the quality of a scientific manuscript, then the selection of manuscripts for publication is arbitrary. Some critics have even called for abolishing pre-publication peer-review. I argue that too much emphasis has been put on inter-referee reliability. As such, a lack of inter-referee reliability in the current peer-review system is not damning for the (...) system. I argue that peer review is effective at finding mistakes. (shrink)