The deformation and wear events that underlie microwear and macrowear signals commonly used for dietary reconstruction in fossil animals can be replicated and quantified by controlled laboratory tests on extracted tooth specimens in conjunction with fundamental micromechanics analysis. Key variables governing wear relations include angularity, stiffness (modulus), and size of the contacting particle, along with material properties of enamel. Both axial and sliding contacts can result in the removal of tooth enamel. The degree of removal, characterized (...) by a “wear coefficient,” varies strongly with particle content at the occlusal interface. Conditions leading to a transition from mild to severe wear are discussed. Measurements of wear traces can provide information about contact force and particle shape. The potential utility of the micromechanics methodology as an adjunct for investigating tooth durability and reconstructing diet is explored. (shrink)

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has (...) defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society. (shrink)

In this paper, I argue for an account of metaphorical content as what is said when a speaker utters a metaphor. First, I show that two other possibilities—the Gricean account of metaphor as implicature and the strictly semantic account developed by Josef Stern—face several serious problems. In their place, I propose an account that takes metaphorical content to cross-cut the semantic-pragmatic distinction. This requires re-thinking the notion of metaphorical content, as well as the relation between the metaphorical and the literal.

Imaginative and creative capacities seem to be at the heart of both games of make-believe and figurative uses of language. But how exactly might cases of metaphor or idiom involve make-believe? In this paper, I argue against the pretense-based accounts of Walton (1990, 1993), Hills (1997), and Egan (this journal, 2008) that pretense plays no role in the interpretation of metaphor or idiom; instead, more general capacities for manipulating concepts (which are also called on within the use of pretense) do (...) the real explanatory work. This result has consequences for both our understanding of metaphor and idiom as well as for the use of figurative language by fictionalists in ontology. (shrink)

The pattern of impairments exhibited by some individuals on the autism spectrum appears to challenge the relevance-theoretic account of metaphor ( Carston, 1996, 2002 ; Sperber and Wilson, 2002 ; Sperber and Wilson, 2008 ). A subset of people on the autism spectrum have near-normal syntactic, phonological, and semantic abilities while having severe difficulties with the interpretation of metaphor, irony, conversational implicature, and other pragmatic phenomena. However, Relevance Theory treats metaphor as importantly unlike phenomena such as conversational implicature or irony (...) and like instances of ordinary literal speech. In this paper, I show how Relevance Theory can account for the prima facie incongruity between its treatment of metaphor and the case of individuals with autism. (shrink)

The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to (...) toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

In this article I explore the ways in which legal language, discourses, and narratives construct new dominant identities for women who kill their children. These identities are those of the ‘bad’, ‘mad’, or ‘sad’ woman. Drawing upon and critiquing statutes, case law, and sentencing remarks from England and Wales, I explore how singular narrative identities emerge for the female defendants concerned. Using examples from selected cases, I highlight how the judiciary interpret legislation, use evidence, and draw upon gender stereotypes in (...) carefully constructing macro-narratives which produce gendered identities for filicidal women, thus nullifying the challenge these women pose to appropriate femininity and the motherhood mandate. Each of the narrative identities discussed deny the agency of the female defendants that they are attached to, albeit in subtly different ways, by denying their ability to make any degree of choice in relation to their filicidal actions. Although such identity construction and agency denial may not always be damaging to these filicidal women per se, its pervasiveness within legal discourse reinforces and reproduces damaging gender stereotypes surrounding women and femininity. (shrink)

Many teachers of bioethics often express concern, in their writings and otherwise, about the theoretical basis (or lack of it) of bioethics and the allied issue of relativism. The companion articles by Tong and Momeyer are in this vein and rightly address such issues within the context of a liberal arts education. This article addresses such issues in a different venue, i.e., bioethics teaching in the clinical sphere of health care institutions. It presumes to suggest that many of these theoretical (...) concerns, as well as the threat of relativism, seldom arise in this sphere. Rather, a broad based, well accepted body of moral truth has been fashioned over the last quarter century and it is this that clinical bioethics regularly keys to and to which most moral dilemmas are referred for resolution. The various forms of this pedagogy, e.g., case consultations or institutional policy statements, are charted out in this regard, as well as the often tactical character of much of this teaching, i.e., not "what should we do?", but "how might we best do it?". The article then goes on to conclude with a reflection on the use and abuse of power in clinical bioethics teaching and consultation. (shrink)

Relevance Theory is a cognitively oriented theory of pragmatics, i.e., a theory of language use. It builds on the seminal work of H.P. Grice1 to develop a pragmatic theory which is at once philosophically sensitive and empirically plausible (in both psychological and evolutionary terms). This entry reviews the central commitments and chief contributions of Relevance Theory, including its Gricean commitment to the centrality of intention-reading and inference in communication; the cognitively grounded notion of relevance which provides the mechanism for explaining (...) pragmatic interpretation as an intention-driven, inferential process; and several key applications of the theory (lexical pragmatics, metaphor and irony, procedural meaning). Relevance Theory is an important contribution to our understanding of the pragmatics of communication. (shrink)

In his ‘Letter on “Humanism”’, Martin Heidegger advances a critique of humanism while insisting that this critique does not imply that he ‘advocates the inhuman’. There are two reasons why Heidegger might be concerned to rebut this accusation. First, one might worry that any rejection of humanism commits one to rejecting its central values, such as the idea that human beings have an essential worth. Second, Heidegger might be concerned to distance his critique from the inhuman policies of National Socialism, (...) with which he was associated in the early 1930s.In this paper, I offer an interpretation of Heidegger's conception of ‘the inhuman’ to shed light on his critique's normative implications. Through this examination of Heidegger's views, I raise concerns about the political prospects of his anti-humanism, and, more tentatively, of anti-humanistic thought in general. First, I reconstruct Heidegger's critique of humanism, his positive conception of the human essence, and his cryptic account of evil in the Letter. I argue that the view that emerges involves a problematic displacement of human responsibility for evil, which Heidegger interprets as symptomatic of the modern epoch in the ‘history of Being’. Moreover, while his account opposes ‘the inhuman’ in a ‘Being-historical’ sense, I argue that it disavows crucial normative resources for resisting ‘the inhuman’ in the ordinary moral sense. (shrink)

This books delves into the major tenets of Syrianus' philosophical teachings on the Timaeus and Parmenides based on the testimonia of Proclus, as found in Proclus' commentaries on Plato's Timaeus and Parmenides , and Damascius, as reported in his On First Principles and commentary on Plato's Parmenides.

Although long touted as an ethical and legal requirement, some clinicians still seem to offer less than fully adequate informed consent processes; similarly the counseling of patients and families, particularly about post-intervention scenarios, is often perfunctory at best. Keyed to a narrative of a patient's experience with surgery for a deviated septum, this article reflects on why such less than adequate clinician behaviors tend to occur and what might be done about them. Certain legal misconceptions about informed consent are highlighted (...) in this reflection, as well as why certain clinicians seem to take such a narrow view of their responsibilities to patients. Further reference in this regard is also made to a recently constructed module on informed consent for medical residents. In it, though legal requirements for informed consent are reviewed, the basic perspective taken regards informed consent as a clinical intervention that pursues certain basic goods and values, only one of which lies in determining when legal closure for such processes has occurred. (shrink)

In recent work, Judith Butler has sought to develop a ‘new bodily ontology’ with a substantive normative upshot: recognition of our shared bodily condition, they argue, can support an ethic of nonviolence and a renewed commitment to egalitarian social conditions. However, the route from Butler’s ontological claims to their ethico-political commitments is not clear: how can the general ontological features of embodiment Butler identifies introduce constraints on behaviour or political arrangements? Ontology, one might think, is neutral on questions of politics. (...) In this paper I reconstruct Butler’s response to this challenge, arguing that there is an interesting and plausible path from ontology to politics. I draw on Heidegger’s ontological/ontic distinction to elucidate the central concepts of Butler’s ontology: vulnerability, precariousness, and interdependency. I argue that one of Butler’s central attempts to derive an ethic of nonviolence from ontology is unpersuasive, resting on a conflation of the ontological and ontic senses of ‘interdependency’. Nonetheless, I contend that Butler is right that genuinely acknowledging our vulnerability is likely to make us more responsive to the claims of others, loosening the grip of ideals of invulnerability and sovereign independence. These ideals and the violence they encourage amount to a disavowal of our ontological condition, while commitment to nonviolence is a way of acknowledgingshrink)

Do continuing education (CE) mandates increase participation in ethics programs and enhance their perceived outcomes? In a study of 5,198 North American psychologists, significant differences were found between mandated and nonmandated psychologists in relation to their participation in ethics programs but not in the perceived outcomes associated with those trainings. Although 64.3% of those psychologists operating under ethics mandates reported completing at least one ethics training within the previous year, only 40.7% of those without such mandates reported doing likewise. Overall, (...) both groups tended to view their ethics training quite favorably in relation to its perceived outcomes, though they differed in relation to their endorsement of CE mandates. Results are discussed in relation to the ongoing development of evidence-based CE and its role in developing critical professional competencies. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

This volume brings together original research that throws new light on how standards of behavior for medical practitioners are articulated in different religious, social, and political contexts.

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive (...) of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the living human body alone, but on the patientqua person. (shrink)

Since the early 1970s humanistic psychology has struggled to remain a relevant force in the social and psychological sciences, we attribute this in part to a conceptualisation of the self rooted in theoretically outmoded thinking. In response to the issue of relevancy a sociocultural turn has been called for within humanistic psychology, which draws directly and indirectly on the conceptual insights of Michel Foucault. However, this growing body of research lacks a unifying conceptual base that is able to encompass its (...) new perspectives and the movement’s theoretical antecedents. This analysis suggests a way forward by offering a potential reconceptualisation of the self in humanistic psychology through the existential-phenomenology of Martin Heidegger. We argue that Heidegger’s conception of the self takes account of subjectivities produced in discourse and institutional practice, while acknowledging the human capacity for actualisation in his concept of the authentic-self. (shrink)

Based on a reading of Basil’s Ad Adulescentes and the epistles, it is clear that Basil finds moral value in Homer and Hesiod. The trickier issue is to what extent Basil uses Homer and Hesiod in his homilies. It seems that Basil does not abandon his respect for the utility of Hellenic paideia for the Christian in his homilies. Rather, he must approach Homer and Hesiod more gingerly because he fears that his uncultivated audience will have difficulty with reading texts (...) allegorically; at the literal level, Homer and Hesiod can potentially corrupt the unsophisticated listener. What we have in the homilies are less explicit references to Homer and Hesiod—they are the source of literary flourish, the origins of which probably went over the heads of Basil’s audience. As seen above, Basil also uses the poets—when read at the literary level—as counter-examples to Christian conduct. Basil in no way, then ‘lies’ or ‘changes his view’ on Greek paideia, as is oftentimes argued by scholars, but, rather, he adjusts his use of paideia depending on what his audience can handle at any given time. (shrink)

Contrary to the ecumenical spirit of our time, the differences among the Christian religions bring into question what one can say or do in common with fellow Christians. This issue, echoing the program of this journal, accentuates those differences, specifically when we focus on the Christian who is ill and suffering. At the bedside, it is the specifics of a religion, including not only its doctrines, but its informing and sustaining narratives, that must particularly be brought into play for the (...) sake of the patient. Given this, our focus in this article regards what such a view implies for the clinician who is caring for a Christian patient whose religion he mayor may not share, in general or in its specifics. Our basic conclusion is that the tendency for the clinician to act as both the patient's spiritual counselor, as well as his clinician, is generally neither prudent nor appropriate. Both hats should not be worn concurrently. This view is advanced not only because of concerns regarding patient vulnerability and the possible abuse of power, but also because the two roles may collide with or undermine each other. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

This paper examines instructional issues such as how, when, and where the medical humanities are taught in medical school settings. The author interviewed seven humanities scholars teaching in medical schools using openended questions which elicited data illustrating 1) informants' teaching styles; 2) where/how their teaching currently fits in the medical curriculum; 3) their suggestions on ideal curricular integration of the medical humanities; and 4) informants' teaching successes.

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what expanded responsibilities and tactics physicians should embrace to protect and enhance such patients' autonomy; and (3) the standards, criteria, and mechanisms (...) by which paternalistic interventions might be justified in cases when the diminishment remains too substantial to merit acceptance of the patients' directives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pride in Giving Care and Other Life Lessons from Certified Nursing AssistantsDelese WearMy father spent the last three weeks of his life in a hospice care facility. It's funny, now reading these narratives written by Certified Nursing Assistants (CNAs), that I can't picture him without Gloria, the CNA who worked the 7-3 shift, floating quietly in and out of his room, tending to him, tending to us, speaking quietly (...) to Dad even when he was no longer conscious, offering us conversation, often her affectionate observations of Dad and curiosity about his life, sometimes about life on the "outside," a kind of respite from total attention on Dad and our grieving. I remember the smell of the lotion she rubbed on his body. I remember no other caregivers in his room; there obviously were, but I can't picture them now, only Gloria. We never spoke directly to the medical director of the hospice. He was a phantom, rounding at 5 or 6 a.m.; we came to believe he did so to avoid speaking to families.Those three weeks led to my conceptions about CNAs—the nature of the work they do, the kinds of people who do such work, the awesome responsibilities involved in such work, and not least, the physical and emotional resiliency of those who undertake such work. My and my family's often recited, "How does she do this every day?" was answered time and again in the narratives written by CNAs in this issue of the journal.But before moving forward, I want to make note of how I will refer to the authors of these narratives. The name of one's occupation, the title one uses, and how others refer to your occupation, is obviously meaningful. If the snapshots of CNAs provided in these narratives are somewhat representative, we find those who refer to themselves and their occupation as nursing assistants, nurse assistants, Certified Nursing Assistants (CNAs), State Licensed Nursing Assistants (SLNA), or simply aides, to name a few. While it is beyond the space offered here, I want to make note of this, recognizing that titles/labels matter, and to acknowledge that status. As CNA Nanci Robinson notes, "most of us are certified... I wouldn't call an LPN a PN and leave out she's licensed." Passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), required each State to establish State-approved nurse aide training programs and establish requirements for nurse aide competency. Thus, I will refer to all the authors here as Certified Nursing Assistants (CNAs). I do wonder how significant of an issue these variations of titles are within the larger nursing assistant culture, and how it may contribute to disparities regarding pay schedules, duties, status, training and other relevant issues among all nursing assistants.In spite of problems, stressors, and other quality of life issues for CNAs, most of them spoke with pride and meaning regarding what was for many their "life's work," similar to what one might expect to find in other care giving occupations. Some spoke of a "love of the work," its "rewards" and "joys," [End Page 165] and the intense satisfaction of "making a difference" in patients' or residents' lives. These attitudes were not vague abstractions but were grounded throughout the narratives in rich examples of the affirming aspects of their work.It appears that much of the pleasure comes from what many refer to as the "hands on," "direct care," or "front line" nature of the work—often what other health professionals might view as things they would not want to do. And of course these other professionals—registered nurses, occupational therapists, and physicians—could make the same claim when describing the "hands-on" joys of their work. But the differences, it would seem, are profound between these other caregivers and CNAs. The CNA narratives report fundamentally intimate and often daily relationships with their clients/residents/patients. Danny Reed describes the "delight" he feels "in restoring dignity to every human in need of it regardless of cause," referring to himself as a "participant observer in a caring relationship," not as a "detached clinician." Many spoke directly... (shrink)

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and (...) opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques. (shrink)