In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

When is it justifiable to exclude a person who wishes to enter a country? What are the acceptable moral bases for immigration policy? These questions lie at the heart of this book, the first interdisciplinary study of the fundamental normative issues underpinning immigration policy. A distinguished group of economists, political scientists, and philosophers offer a provocative discussion of this complex topic. Among the issues addressed are the proper role of the state in supporting a particular culture, the possible destabilization of (...) the political and social life of a country through immigration, the size and distribution of economic losses and gains, and the legitimacy of discriminating against potential immigrants in favor of members of the resident population. The need for serious consideration of this subject is beyond question. This volume should advance discussion in an area of great practical as well as philosophical importance. (shrink)

This book completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine.

In his 1917 lecture “Science as a Vocation,” Max Weber challenged current and aspiring scholars to abandon any pretense that science bears within itself any meaning. In a disenchanted age, he argued, science could at best offer “knowledge of the techniques whereby we can control life... through calculation,” and any meaning or moral direction to scientific research—including religious meaning—must be imposed on it from without. Weber presciently anticipated that many present-day health care practitioners would struggle to find meaning for their (...) work within complex “state-capitalist” health care systems, along with predictable quasi-religious responses. But how are Christian practitioners to practice faithfully in a disenchanted age? The authors of this special issue lean deeply into the loci of Christian theology and Christian practice, some challenging the views of the body and of nature that informed Weber’s theory of disenchantment, and all offering resources and paths by which practitioners might “look the fate of the age full in the face” with courage and wisdom. (shrink)

Emotion in Aesthetics is the first book on aesthetics to provide an extensive theory of emotion; application of the cognitive-emotive theory to aesthetics; analysis of the relationship between aesthetics, metaphor and emotion; a full theory of meaning and its application to aesthetics; discussion of the relationship between aesthetics, music and language in terms of phonetics, phonology and intonation; an analysis of humanistic aesthetics; a well-developed naturalistic theory of ethics as applied to aesthetics and emotion. Stress is placed on the views (...) of contemporary philosophers as well as some of the main historical accounts of emotion in aesthetics. The important recent work on emotion has not hitherto been applied to aesthetics. As a result there is still much confusion in aesthetics about aesthetic emotion and related concepts, such as the expression theory of emotion. The present book has been written to show how the theory can be used to clarify the issue, resulting in a major breakthrough in aesthetics. In addition, the theory presented is valuable in relating aesthetics to ethics and humanism. (shrink)

Huston Smith has argued that the universal source of wholeness, which he refers to as the primordial tradition, is essential to a meaningful life. Indeed embracing this tradition is, said Smith, an act of rejoining the human race. Our current forms of organized religion offer us ritualized expressions of this tradition, yet often fail to provide us with transpersonal growth; it is this transpersonal growth that reconnects us with the source of religion. This essay differentiates mainstream religion from a way (...) that we can begin to construct a physical theory of the primordial tradition–a necessary first step toward reclaiming the source of religion. (shrink)

This paper examines the relationship between organizational ethical culture in two large international CPA firms, auditors'' personal values and the ethical orientation that those values dictate, and judgments in ethical dilemmas typical of those that accountants face. Using an experimental task consisting of multiple judgments designed to vary in "moral intensity" (Jones, 1991), and unique as well as tried-and-true approaches to variable measurements, this study examined the judgments of more than three hundred participants in our study. ANCOVA and path analysis (...) results indicate that: (1) Ethical judgments in situations of high moral intensity are affected by personal values and by environmental variables, such as the professional code of conduct (direct and indirect effects) and previous ethics instruction (direct effect only). (2) Corporate ethical culture, and a relatively strong firm rules-orientation, affect auditors'' idealism but not relativism, and therefore indirectly affect ethical judgments. Jones'' (1991) moral intensity argument is supported: differences in the characteristics of specific judgment tasks apparently result in different decision processes. (shrink)

The cytokine interferon‐γ (IFN‐γ), initiates both cell cycle arrest and cell death in certain cell lines. Through a novel strategy of cell transfection with episomal vectors expressing antisense cDNAs, Deiss et al.(1.2) have demonstrated that it is possible to isolate genes that are required for the initiation of cell death by the cytokine IFN‐γ. This approach, referred to as TKO, for Technical Knock Out, has identified several genes whose activity appears to be essential for the induction of apoptosis by IFN‐γ (...) in HeLa cells. Interestingly, these genes appear to mediate IFN‐γ‐induced apoptosis in HeLa cells, but their inhibition by antisense does not ameliorate the anti‐proliferative effects of IFN‐γ in these cells. The clever strategy employed by these authors holds promise for others who wish to isolate genes required for other differentiative processes in cultured cell lines. (shrink)

This essay (written by Mark in dialogue with Stephan and including supporting commentary by Stanley Krippner and others1) is not a comprehensive survey of psi and anthropology, nor does it contain a thorough overview of Castaneda's work. Rather, it seeks to explore two primary questions. First, whatever became of the interest in psi and anthropology that led to the founding of the Society for the Anthropology of Consciousness? Second, what is the relationship between the anthropology of consciousness and transpersonal psychology? (...) Answers to these questions offer a glimpse into the historical origins of SAC as well as a historical understanding of the relationship between SAC and the Association for Transpersonal Psychology2. (shrink)

Human lives are full of pleasures and pains. And humans are creatures that are able to think: to learn, understand, remember and recall, plan and anticipate. Ancient philosophers were interested in both of these facts and, what is more, were interested in how these two facts are related to one another. There appear to be, after all, pleasures and pains associated with learning and inquiring, recollecting and anticipating. We enjoy finding something out. We are pained to discover that a belief (...) we hold is false. We can think back and enjoy or be upset by recalling past events. And we can plan for and enjoy imagining pleasures yet to come. This book is about what Plato, Aristotle, the Epicureans and the Cyrenaics had to say about these relationships between pleasure and reason. (shrink)

Over the past year the debate over physician-assisted death has been waged in several courts and legislatures, and before at least one electorate as well. Measure 16, the Oregon Death With Dignity initiative that would permit physician-assisted suicide in some circumstances, was approved by the electorate; but it remains on hold while a permanent injunction issued against it by a Federal judge is reviewed by the United States Court of Appeals. Another Federal court judge's decision that the Washington statute criminalizing (...) physician-assisted suicide was unconstitutional when applied to the case of a competent terminally ill patient in intractable pain, was reversed by a three judge panel of that same United States Court of Appeals. (shrink)

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer (...) screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles. (shrink)

This study explores both the negotiating styles and moral reasoning processes of business people and governmental officials in Taiwan, so as to provide a footing for outsiders when negotiating with Taiwanese over environmental concerns. Findings imply that Taiwanese business people and governmental officials can and will reason both at the conventional level and at the postconventional level of moral judgment. But, results of this study also indicate that Taiwanese negotiating styles do not necessarily match their levels of moral reasoning. With (...) respect to pollution concerns, Taiwanese seem unwillingly to accept responsibility as autonomous individuals. Instead, responsibility is accepted when mandated by the law. (shrink)

Caton d’Utique est parfois présenté comme un exemple d’agent moral ayant toujours agi avec honnêteté. Il refuse tout compromis moral. J’analyse ici comment les auteurs antiques présentent cette honnêteté comme une forme d’inaptitude, plus précisément une inaptitude à envisager toute action injuste, et comment cela est présenté comme une forme d’obstination et d’échec empêchant d’interagir avec les gens tels qu’ils sont réellement. Je compare ces anciennes représentations et ces jugements sur Caton avec le traitement des « saints moraux » par (...) Susan Wolf. (shrink)

This stunning new edition retains the book's broad aims, intended audience, and multidisciplinary approach. New chapters take into account the more current backdrop of globalization, particularly events such as 9/11, and attendant developments that make a reconsideration of race relations in education quite urgent.

ABSTRACT:While tone at the top is widely regarded as an important predictor of ethical behavior in organizations, we argue that recent research overlooks the various conflicting ethical tones present in many multi-organizational work settings. Further, we propose that the resolution processes promulgated in many firms and professional associations to reconcile this conflict reinforce the tone at the bottom or a tone at the top of the employee’s organization, and that both of these approaches can conflict with the tone at the (...) top of other important organizations such as professional and regulatory organizations. Here we adapt Integrative Social Contract Theory’s priority rules to propose a multi-tone reconciliation process which prioritizes conflicting ethical tones based upon features of the organization and the effects on society. Using three contextualizations, we demonstrate the effectiveness of the multi-tone reconciliation process over current processes. We conclude with recommendations for future research and implications for practice. (shrink)

I explore some new directions—suggested by feminism—for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed—e. g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. “Crisis issues” currently dominate medical ethics, to the neglect of what I call “housekeeping issues.” (...) The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select—and neglect—to study as well as the “games” we play may be sending a message as loud as the words we do speak on ethics. (shrink)

Abstract:Recently, the idea that every hypothetical imperative must somehow be ‘backed up’ by a prior categorical imperative has gained a certain influence among Kant interpreters and ethicists influenced by Kant. Since instrumentalism is the position that holds that hypothetical imperatives can by themselves and without the aid of categorical imperatives explain all valid forms of practical reasoning, the influential idea amounts to a rejection of instrumentalism as internally incoherent. This paper argues against this prevailing view both as an interpretation of (...) Kant and as philosophical understanding of practical reason. In particular, it will be argued that many of the arguments that claim to show that hypothetical imperatives must be backed up by categorical imperatives mistakenly assume that the form of practical reasoning must itself occur as a premise within the reasoning. An alternative to this assumption will be offered. I will conclude that while instrumentalism may well be false, there is no reason to believe it is incoherent. (shrink)

In this paper we examine the weaknesses of development strategies which have been applied in Puerto Rico. The process of industrialization by invitation, referred to as Operation Bootstrap, was instituted by the United States of America by the end of the 1940s. This involved tax incentives and subsidies for companies and was dependent on industrial peace and low wages in labor-intensive, low-wage industries, especially those of textile and clothing. Naturally, women's labor was encouraged as a result of the lower cost, (...) as well as assumed dexterity, of the female in such areas. While these new activity areas for women also allowed other benefits in the form of legislation and increased social services, the inherent problems of rapid, labor-intensive industrialization also led to displacement and increased underemployment and impoverization of female headed families from the 1960s onwards. The paper explores some of the changes in gender relations which resulted from these policies and looks at the challenges which the feminist movement in Puerto Rico has made, particularly with regard to state processes to bring about beneficial changes in the economic, legal, political and social status of women in Puerto Rico. (shrink)