Scheduling surgical procedures among operating rooms is mistakenly regarded as merely a tedious administrative task. However, the growing demand for surgical care and finite hours in a day qualify OR time as a limited resource. Accordingly, the objective of this manuscript is to reframe the process of OR scheduling as an ethical dilemma of allocating scarce medical resources. Recommendations for ethical allocation of OR time—based on both familiar and novel ethical values—are provided for healthcare institutions and individual surgeons.

If individuals possess robust rights over their own persons and legitimately acquired possessions does any action on the part of another person that has any physical effect on the right-holder or her property to which the right-holder has not consented violate those rights? If so, it seems that almost every ordinary exercise of one’s rights—e.g., starting one’s car up in one’s own driveway, emitting some smoke while grilling in one’s own backyard—violate the rights of one’s neighbors. To avoid this conclusion (...) must the libertarian theorist shift to a less robust understanding of rights? This chapter argues against the need for such a general attenuation of rights. Any sensible delineation of rights must leave moral elbow room for the exercise of those rights. So, a sensible delineation of rights will not construe the minor physical intrusions under consideration as moral boundary-crossings. (shrink)

_Ghosts in the Consulting Room: Echoes of Trauma in Psychoanalysis_ is the first of two volumes that delves into the overwhelming, often unmetabolizable feelings related to mourning. The book uses clinical examples of people living in a state of liminality or ongoing melancholia. The authors reflect on the challenges of learning to move forward and embrace life over time, while acknowledging, witnessing and working through the emotional scars of the past. Bringing together a collection of clinical and theoretical papers, _Ghosts (...) in the Consulting Room _features accounts of the unpredictable effects of trauma that emerge within clinical work, often unexpectedly, in ways that surprise both patient and therapist. In the book, distinguished psychoanalysts examine how to work with a variety of ‘ghosts’, as they manifest in transference and countertransference, in work with children and adults, in institutional settings and even in the very founders and foundations of the field of psychoanalysis itself. They explore the dilemma of how to process loss when it is unspeakable and unknowable, often manifesting in silence or gaps in knowledge, and living in strange relations to time and space. This book will be of interest to psychotherapists and psychoanalysts, as well as social workers, family therapists, psychologists, and psychiatrists. It will appeal to those specializing in bereavement and trauma and, on a broader level, to sociologists and historians interested in understanding means of coping with loss and grief on both an individual and larger scale basis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Room for Maneuver When Raising Critical DoubtJan Albert Van Laar1When interlocutors start talking at cross-purposes it becomes less likely that they will be able to resolve their initial difference of opinion (Van Eemeren and Grootendorst 1992, 125). How much room should we give a party for rephrasing or revising her adversary’s standpoint in a manner that suits her individual purposes in the dialogue? Certainly, as textbooks in argumentation (...) and critical thinking make clear, we should steer clear of erecting and attacking straw men (Ennis 1996, 172; Govier 1985, 109–12; Groarke, Tindale, and Fisher 1997, 123). Still, a critic in a discussion or debate should be given some room to maneuver in order to rephrase the arguer’s position in her own words or to get at the underlying position of the arguer. In this article, I will be dealing with this issue from the pragma-dialectical perspective of strategic maneuvering between the shared dialectical objective of resolving a difference of opinion and the individual rhetorical objective of persuading the other side. According to existing accounts of the straw man fallacy (Talisse and Aikin 2006; Van Eemeren and Grootendorst 1992; Walton 1996), the criterion for fallaciousness resides in whether or not the critic misrepresents or distorts the arguer’s actual position. In this article I intend to provide more detailed guidelines for critics: a critic distorts or [End Page 195] misrepresents a position when she changes the formulation or nature of the arguer’s standpoint, even though this contribution by her cannot be reconstructed as containing a proposal for a change that might be acceptable to the arguer.In section 2 I will elaborate on the notion of confrontational maneuvering, that is, of strategic maneuvering between the dialectical and rhetorical goals that arise from the confrontation stage of a critical discussion. In section 3 I will characterize the form of maneuvering where an antagonist reformulates or modifies the protagonist’s standpoint in an opportune way. In section 4 I will examine the conditions under which applications of maneuvering of this kind can be sound and legitimate from a dialectical perspective and relate these conditions to the straw man fallacy. In section 5 the results of the preceding sections will be applied to a case.2. Confrontational ManeuveringIn argumentative discourse, participants typically try to achieve two kinds of objectives. First, they try to be dialectically reasonable, and second, they are out for some kind of personal triumph. The act, by the critic, of reformulating or revising the arguer’s standpoint will be dealt with from this dual perspective of strategic maneuvering (Van Eemeren and Houtlosser 2000, 2003). In order to analyze and evaluate the maneuver under discussion, I will elaborate in this section, first, on the notion of critical discussion in order to clarify the meaning of dialectical reasonableness and fallaciousness; second, on the importance of reconstruction for understanding argumentative discourse; third, on the notion of a confrontation stage; and fourth, on the distinction between direct and indirect maneuvering. These notions will be applied as follows: critics have some room for maneuvering when raising critical doubt, even when they change the arguer’s position or formulation, because there are contexts of utterance within confrontations where such a contribution does allow for a reconstruction in such a way that the result is not a direct and fallacious confrontational maneuver but, rather, an indirect and dialectically reasonable one.According to the pragma-dialectical methodology developed by Van Eemeren and Grootendorst (1984, 1992, 2004), an argumentative discourse must be reconstructed and evaluated from the perspective of a critical discussion. A critical discussion is a normative procedure that starts from a difference of opinion and that is solely aimed at resolving this dispute on the merits of the case (as perceived by the participants). When following [End Page 196] this procedure, discussants start by putting their difference of opinion into words in the confrontation stage; they proceed by deciding on the procedural and material starting points in the opening stage and by exchanging arguments and criticisms in the argumentation stage; and then they bring their discussion to a close by deciding in the concluding stage on whether the initial... (shrink)

The diverse papers which make up this book are variations on a theme which is based in biological science - yet none of the contributors is really a biologist. Our metaphor for describing what we are doing here is that we have gathered together in a room because that particular room provides us with a certain view of our individual areas of interest - a view that may have been previously obscured. We are visiting the house of biology in (...) the hope that we may see more clearly things that we each find baffling about our particular field of work in education, research, or daily living. (shrink)

BackgroundOccupational burnout is a mental health problem that among nurses may lead not only to physical and psychological complications, but also to a decrease in the quality of patient care. Considering the stressful nature of surgery, operating room nurses may be at a greater risk. Therefore, the present study aimed to identifying factors associated with the occupational burnout from the perspective of operating room nurses.Materials and methodsThis qualitative study was conducted in Iran in 2021 using conventional content analysis. Sampling was (...) performed using purposeful sampling method with maximum variation. In order to collect data, individual, semi-structured interviews were performed with 18 operating room nurses. Interviews continued until data saturation. Data were recorded, transcribed and analyzed using steps proposed by Graneheim and Lundman. Data management was performed using MAXQDA-2020 software. Four criteria provided by Guba and Lincoln were used to improve the study’s trustworthiness and rigor.ResultsA main theme, 4 categories and 15 subcategories were extracted from the data. The main theme is “gradual burnout due to job tension” and categories and subcategories include organizational factors, interpersonal factors, Occupational nature factors as well as individual factors.ConclusionNumerous factors associated with burnout in operating room nurses, which may put the personnel under more pressure. According to these factors, nursing managers and operating room nurses can consider effective strategies to prevent or coping with burnout. (shrink)

_Demons in the Consulting Room: Echoes of Genocide, Slavery and Extreme Trauma in Psychoanalytic Practice_ isthe second of two volumes addressing the overwhelming, often unmetabolizable feelings related to mourning, both on an individual and mass scale. Authors in this volume explore the potency of ghosts, ghostliness and the darker, often grotesque aspects of these phenomena. While ghosts can be spectral presences that we feel protective of, demons haunt in a particularly virulent way, distorting experience, our sense of reality and (...) our character. Bringing together a collection of clinical and theoretical papers, _emons in the Consulting Room_, reveals how the most extreme types of trauma can continue to have effects across generations, and how these effects manifest in the consulting room. Essays in this volume consider traumas that have affected multiple generations of people, such as the Holocaust, experiences in the gulags, and the experience of slavery. Authors here consider the clinical challenges of working with the demonic force in severe childhood abuse and the effects of serious and prolonged physical injury and illness. Inevitably, there is in such difficult clinical work, the combined effects of hauntings in the analysts and in patients and often in the surrounding culture. In this book, distinguished psychoanalysts explore the myriad forms of ghosts and the demonic, which interfere and disrupt the endlessly difficult psychic work of mourning. It will be of interest to psychotherapists and psychoanalysts, as well as social workers, family therapists, psychologists, and psychiatrists. _emons in the Consulting Room _ill appeal to those specializing in bereavement and trauma and, on a broader level, to sociologists and historians interested in understanding means of coping with loss and grief on both an individual and larger scale basis. (shrink)

Background For the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients’ basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard. Aim This study determines the direction of future research by identifying ethical issues experienced in the operating room. Method This scoping review is based on the (...) methodological framework suggested by Arksey and O’Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected. Findings Five categories were identified: Professional ethics, Organizational ethics, Patients’ rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses’ (ICN) code of ethics, with the exception of one element, that is, global health. Conclusions This study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

We provide a solution to the well-known “Shooting-Room” paradox, developed by John Leslie in connection with his Doomsday Argument. In the “Shooting-Room” paradox, the death of an individual is contingent upon an event that has a 1/36 chance of occurring, yet the relative frequency of death in the relevant population is 0.9. There are two intuitively plausible arguments, one concluding that the appropriate subjective probability of death is 1/36, the other that this probability is 0.9. How are these two (...) values to be reconciled? We show that only the first argument is valid for a standard, countably additive probability distribution. However, both lines of reasoning are legitimate if probabilities are non-standard. The subjective probability of death rises from 1/36 to 0.9 by conditionalizing on an event that is not measurable, or whose probability is zero. Thus we can sometimes meaningfully ascribe conditional probabilities even when the event conditionalized upon is not of positive finite (or even infinitesimal) measure. (shrink)

I will argue that MLS theory does not provide a complete, self- sufficient approach to theorizing about evolutionary transitions. As a formal, mathematical theory about evolution within a population, it presupposes but does not address the material structure of the population that realizes the model. An MLS model might tell us whether a cooperative trait could be- come fixed in a population, for example, but it won’t be able to explain how the cooperation actually works to produce an adaptive effect (...) on the group’s fitness. It also won’t be able to account for the sources of variety in the pos- sible modes of cooperation available to a population. MLS theory can tell us when fitness has transferred from one level of units to another, but it can give misleading answers unless we have some other, principled guide for picking out units (Clarke 2012; Clarke 2014). Furthermore, it is commonly acknowl- edged among biologists that actually measuring the fitness of an individual— sometimes even obtaining and interpreting proxy measurements—is diffi- cult in practice and prone to error (Hendry 2005; Orr 2009). Hence even if MLS theory were sufficient in principle, there would still be room for other approaches in practice that avoided the difficulties and limitations of depend- ing on fitness alone. (shrink)

Biological kin share up to half of their genetic material, including predisposition to disease. Thus, variants of clinical significance identified in each individual’s genome can implicate an exponential number of relatives at potential risk. This has renewed the dilemma over family access to research participant’s genetic results, since prevailing US practices treat these as private, controlled by the individual. These individual-based ethics contrast with the family-based ethics – in which genetic information, privacy, and autonomy are considered to (...) be familial – endorsed in UK genomic medicine and by participants in a multi-method study of US research participants presented here. The dilemma reflects a conflict between US legal and ethical frameworks that privilege “the individual” and exclude “the family” versus actual human genetics that are simultaneously individual and familial. Can human genetics succeed in challenging bioethics’ hegemonic individualism to recognize and place the family at the center of the room where bioethics happens? (shrink)

Reasonable individuals can disagree about philosophical questions. This disagreement sometimes takes the form of conflicting intuitions; the seminar room provides many examples. Experimental philosophers, who have devoted themselves to the systematic study of intuitions, have found empirical support for what anecdotes suggest. Their data often reveals that a significant minority of subjects have intuitions counter to those of the majority.1 A recent replication of [Knobe, 2003a] discovered three distinct subgroups of subjects with three distinct patterns of response. Only about one-third (...) of subjects gave the expected asymmetric responses to Knobestyle probes. The other two-thirds gave symmetric responses to harm and help probes, with about half judging side-effects were intentional in both harm and help cases and half judging that they were intentional in neither [Nichols and Ulatowski, 2007]. (shrink)

Is there room for a metaphysics of existence above and beyond the logic of ‘exists’? This paper defends an affirmative answer. It takes its point of departure from a recent polemic of Paul Edwards against Heidegger. According to Edwards, following Frege and Russell, Heidegger mistakenly assumes that existence belongs to individuals. I argue that although Heidegger does indeed make this assumption, he is not mistaken in so doing. My main concern, however, is neither to defend Heidegger nor to reply to (...) Edwards; it is to vindicate the metaphysics of existence against the most damaging objection it faces. (shrink)

In 2020, COVID-19 patients overwhelmed hospital beds in several Spanish cities, producing an increase in mortality derived from a lack of resources. The provision of new spaces to be reconfigured as healthcare centers for COVID patients was one of the measures implemented. In Madrid, two of these COVID centers drew enormous media and political repercussions due to their high cost and the controversy surrounding the quality of the care they offered. In this scenario of misinformation, several doctors and patients rejected (...) to be transferred to such medical centers, but they were nonetheless compelled to make the move. This manuscript underscores how this lack of transparency affects health workers, patients, and the relationship between them, and brings out the question of how many essential bioethical principles can be individually violated by a matter of public health. New guidelines for the transfer of patients should be designed from an ethical perspective and updated, as the epidemic continues, to improve the modern understanding of human factors in times of uncertainty. The lesson that these centers provide us is that we must rethink crisis resource management from a new perspective that prioritizes access to quality information. In its absence, the principle of autonomy must prevail. (shrink)

Syllogisms (e.g. “All A are B; All B are C; What is true about A and C?”) are a long‐studied area of human reasoning. Riesterer, Brand, and Ragni compare a variety of models to human performance and show that not only do current models have a lot of room for improvement, but more importantly a large part of this improvement must come from examining individual differences in performance.

There is a divide within political and legal theory concerning the justification of hate-crime legislation in liberal states. Opponents of Hate-Crime Legislation have recently argued that enhanced punishment for hate-motivated crimes cannot be justified within political liberal states. More specifically, Heidi Hurd argues that criminal sanction which target character dispositions unfairly target individuals for characteristics not readily under their control. She further argues that a ‘character’ based approach in criminal law is necessarily illiberal and violates the state’s commitment to political (...) neutrality. In the current paper, I attempt to show the difficulties and absurdity that follows from Hurd’s characterization of hate- rimes. I aim to show that punishment for undesirable character traits is consistent with western conceptions of criminal law. Upon doing so, I then go on to construct a positive argument for the justifiability of punishing for character traits as well as for the enhanced punishment associated with hate-motivated crimes. (shrink)

In the pure powers ontology (PPO), basic physical properties have wholly dispositional essences. PPO has clear advantages over categoricalist ontologies, which suffer from familiar epistemological and metaphysical problems. However, opponents argue that because it contains no qualitative properties, PPO lacks the resources to individuate powers, and generates a regress. The challenge for those who take such arguments seriously is to introduce qualitative properties without reintroducing the problems that PPO was meant to solve. In this paper, I distinguish the core claim (...) of PPO: (i) basic physical properties have dispositional essences, from a hitherto unnoticed assumption: (ii) the dispositional essences of basic physical properties exclusively involve type-causal relations to other basic physical properties. I reject (ii), making room for a structuralist ontology in which all basic physical properties are pure powers, individuated by their places in a causal structure that includes not only other powers, but also physically realized qualitative properties such as shapes, patterns and structures. Such qualities individuate pure powers in the way that non-mental input and output properties individuate realized mental properties in functionalist theories of mind, except that here it is basic physical powers that are individuated by relations to realized non-powers. I distinguish one Platonic and two Aristotelian version of this theory, and argue that the Aristotelian versions require that grounding is not always a relative fundamentality relation, because the powers ground the qualities that individuate them. By considering ontic structural realism, I argue that symmetric grounding is the best way to make sense of relational individuation in structuralist ontologies, and is therefore no additional commitment of the one proposed here. (shrink)

In our country, mildly mentally disabled students are being educated in general education classes by means of integration. An individualized education program (IEP) is being prepared for these students when needed. However, the impact of BEP on students with intellectual disabilities in religious education has not yet been sufficiently discussed. The purpose of this research is to examine the impact of the IEP on the achievement of religious education of mentally disabled students and the level of religious learning of these (...) students. For this purpose, in addition to the education given in the general education class for the 6 mildly mentally disabled integration students studying in the 4th grade of primary school, 2 hours of education were carried out in the support education room per week during the education and training year. Semi-experimental study was designed according to the single-tasked multiple-start model. Education process was evaluated by Achievement Test, the Teacher Observation Form, the pre-test based on the Self-Assessment Form, post-test and retention tests. As a result, it has been seen that BEP has a positive effect on the achievement of religious education of mentally disabled students (ZEKÖ). In this framework, it has been found that students are influenced by the society, especially by their peers, when they are given time they constitute religious knowledge, they understand normal individuals religious behaviours, they are more emotional, they forget religious information that is not used in everyday life and when they accomplish they increase self-confidence and self-esteem and internalize values.SummaryPeople differ in their creation. This difference is greater in people disabled. In terms of individual traits and educational qualifications, individuals with disabilities who are severely different from their peers and who have difficulty in playing the roles they should play are evaluated in several groups. One of these groups is mentally disabled. Mentally handicapped people have various rights as normal individuals. One of these rights is the right to education. National and international laws guarantee the educational rights of individuals with intellectual disabilities. Similarly, Islam and his best practitioner, the prophet Muhammad, did not consent to the transformation of the mentally disabled into begging masses or to their isolation, but rather to integrate them into society. According to Islam, individuals with intellectual disabilities have the “capacity to acquire rights“, even if they do not have "capacity to act". This right requires them to receive an education that takes into account their differences, just like normal individuals. Because of their learning characteristics, mentally retarded students differ from their peers, therefore they cannot benefit from the educational activities organized for normal students. So, these students need a special education to ensure that the mentally disabled are successful and live in society without being dependent.Inrecent years, in our country as well as in the world, the principle of "least restricted education environment" is taken into consideration for mentally handicapped people who need special education, which approaches to co-education with their peers. This approach is tried to-be applied at all educational levels. Due to the diagnosis and evaluation in the Guidance and Research Center, a large number of mentally retarded students are placed in normal schools. These students, like other courses, take the Religious Culture and Moral Knowledge Course together with the normal students. However, depending on their learning, they have the right to receive separate training as 1-3 people at-the support training room. The instructional adaptations necessary for the education of these students made by the Guidance and Research Centers are carried out by the teacher who plays the basic role in the education of the students. One of the important elements in the education of these mentally retarded students who need special education is the individualized education program. This program is prepared by the cooperation and joint decision of all stakeholders who may contribute to student’s education. The status of the student to participate in the learning and teaching activities, the amount and the quality of the education to be received in the support education room are made within the framework of this program.One of the most important courses in the education of mentally retarded students who are educated by inclusion is the Religion Culture and Moral Knowledge course. Because this course has the potential to make serious contributions to the socialization of students and to maintain their lives independently. However, there are a limited number of studies investigating the quality of religious education at-the scientific level. Furthermore, it has not been observed that these studies have been quasi-experimental. This study aims to reveal the quality of education for the mentally handicapped students. For this purpose, it aims to determine the contribution of religious education in the support education room to the success of the student depending on the individualized education program. It also makes it possible to make conclusions about how mentally handicapped people use their mental skills to learn religion. Depending on the aim of the study, during the 2015-2016 academic year, primary school 4th grade students and 6 mentally disabled inclusion students were educated. The quasi-experimental study was designed according to the single-subject multiple-start model. The process of the education, in other words, the development of mentally retarded students towards religious learning; were evaluated by Success Test, Teacher Observation Form and Self-Assessment Form based on pre-test, post-test and retention tests.Findings of the study; Faith, worship, the prophet Muhammad, Qur’an and its commentary, are classified according to the fields of morality, religion, and culture. The post-test achievement scores of the students in all learning areas were higher than the pre-test achievement scores. This shows that religious education in the support training room based on individualized education plan contributes positively to the success of the student. The results of the retention test are close to the results of the final test. In addition, it was determined that the students were affected by the society, especially by their peers, structured the religious knowledge when given time, they understood the religious behaviors of the normal individuals, became more emotional, forgot the religious information that is not used in daily life, increased their self-confidence and self-esteem as they succeeded and internalized the values. Based on these results, the following recommendations have been developed.Support Education Rooms should be functionalized and special attention should be given to individual or group-based religious education based on the nature and objectives of the subject in these rooms.In religious education, by taking into account the performances of mentally retarded inclusion students (MHIS), the relevant dimension of religion should be given importance according to their contribution to their normal lives and they should be consistent and patient in this process.Since MHIS has different levels of learning and perception and different developmental characteristics at every stage of life, it should prioritize their proper use of their existing capacities based on their religious education, interests and curiosities.Since MHIS is influenced by the emotion dimension rather than the information dimension of religion, religious education for them should be oriented towards life, which is not academic, literal or doctrinal, but rather their life and feelings.Similar studies with different study group students must be done and the results of the study should be interpreted comparatively. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Their Father’s Library: Books Furnish Not Only a Room, But Also a Tradition ELIZABETH POWERS Although they shared close life dates and became famous in the same years for their epistolary novels, Johann Wolfgang von Goethe (1749–1832) and Fanny Burney (1752–1840) would seem to have been worlds apart literarily. (Goethe had in his Weimar library a copy of Evelina, while Burney was probably not ignorant of the Europe-wide (...) sensation The Sorrows ofYoung Werther.) What might be called their literary apprenticeship, however, was remarkably similar, consisting not of schooling in a traditional institution in which students (and, importantly, most eighteenth-century writers) were drilled in the classical curriculum, but, instead, from wide reading within the confines of their fathers’ libraries. It is true that Goethe and his younger sister Cornelia were supplied at home with a number of tutors and that their progress was monitored by their father, but their acquaintance with literature was fostered within the confines of the family home. Burney had no formal education at all. Indeed, on the appearance of Evelina, her father (according to her diary) remarked : “[S]he has had very little Education but what she has given herself,—less than any of the others!” Burney, however, had the advantage of growing up in a milieu in which books mattered. While the Goethes were eminently respectable, on the mother’s side part of what was the patriciate of the city of Frankfurt, the Burney household in London was bursting with wits and with what can only be called celebrities. The Burneys knew God and the world: David Garrick, Dr. Johnarion 28.1 spring/summer 2020 116 in their father’s library son, Hester Thrale. As Virginia Woolf noted of the famous father, Dr. Charles Burney, he was a musician “who could talk of intellectual things and ask clever people to his house.” Goethe has given plenty of evidence of roaming freely among his father’s books, a collection of 1,700 calfskin-bound volumes. When Burney went to serve at the court of King George III, Queen Charlotte was disappointed at how few books the author of Evelina possessed. (Similarities accumulate: Goethe also served at court, as minister in the duchy of Weimar.) But why cart around a load of books? As Burney wrote in her diary: “[M]y Father’s most delightful Library, as I then told her [the Queen], with my free access to it, had made [owning my own books] a thing unnecessary... ” Libraries in the eighteenth and early nineteenth century, whether private or public affairs, were not like contemporary public libraries, catering to a wide array of tastes, but were repositories of what Matthew Arnold termed “the best that is known and thought in the world.” Let’s call it the Western intellectual and cultural heritage. Most respectable homes would possess at a minimum a Bible, while the holdings in private homes, as evident in the library of Goethe’s father, could reach astounding proportions. According to Burney biographer Claire Harman, Fanny’s brother left at his death one of the finest private libraries of the age. Moreover, the antiquity of the works in the venerable libraries scattered across Europe from Dublin to Saint Petersburg, and especially their survival despite centuries of vicissitudes, was testimony to the authoritative nature of the transmission. Anyone who took the Bible in hand, who took lessons from it, adhering, for instance, to the injunctions of the Ten Commandments, was conscious of subscribing to values shared by preceding generations. Literary practitioners, also showing obeisance to authoritative predecessors, followed earlier models, in the process contributing to an evolving literary heritage. There was no purity in this transmission. It was truly promiscuous, but its quasi-biological character, like a mother’s left-handedness in a child, can be seen in the family Elizabeth Powers 117 resemblances among writers of different eras. Just as individuals perpetuate traits of their parents, so literature and the other arts recycled features of artistic predecessors. Writers as diverse in background and language and religion as Ariosto and Milton transmitted the dna, so to speak, of such epical forebears as Homer and Virgil. This sort of family legitimacy was... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Math Anxiety:Making Room to BreatheValerie Allen (bio) and Todd Stambaugh (bio)"Don't do that to me, Professor," the student said, and everybody laughed, for by this late in the semester, the atmosphere was relaxed. The instructor in question had just reached the point in a worked problem when they could move from reasoning about specific numbers to stating a general principle: x≤y≤z, meaning that y—the value we sought—was always going (...) to be greater than or equal to one value (x) and less than or equal to the other (z). The student who had spoken had earned everyone's affection over the weeks, open about their difficulties with math, ready to risk being wrong, and to ask obvious questions that others may have been reluctant to owning. They had hung in there, despite presenting a classic case of math anxiety, a syndrome long recognized in the scholarship of teaching and learning.Among math anxiety's many symptoms, breathing disruption ranks high: hyperventilation (rapid breathing) and hypoventilation (barely or not breathing). When the energy-conserving parasympathetic nervous system is overtaken by the energy-expending sympathetic nervous system, the long exhalations that decelerate the heart rate are replaced by short, panting puffs from the upper lungs. The timed test provides the perfect environment for math anxiety to flourish. Stress diverts cognitive resources needed for procedural execution, so working memory consequently shrinks.Self-rated metrics for math anxiety have been in place for decades (Richardson and Suinn). Relatively trivial interventions can yield nontrivial results: deep breathing exercises and positive affirmations have a beneficial impact, as does writing about one's nerves immediately prior to an exam (Brunyé et al.). More systemic changes require a reorientation in teaching whereby conceptual mistakes are positively rewarded as opportunities for learning; students compose questions instead of answers; students solve problems together rather than perform solo (Boaler).Return now to that opening scenario to watch it become stereotype incarnate: the student was mature, Black, and female; the teacher, younger, white, and male; her comment was triggered by his shift from a specific [End Page 217] set of numbers into symbolic notation. There is robust evidence to demonstrate that certain demographics are consistently underrepresented in the U.S. math community: women and "African-Americans, Hispanics, American Indians, Alaska Natives, and Pacific Islanders," according to the Mathematical Association of America (MAA) ("Resources for Minority"). Routinely feeling that they do not belong, such groups are particularly vulnerable to math anxiety.Several remedies for such disparity suggest themselves: appointing more women and people of color in the profession; one-on-one tutorial assistance; research projects about the students' personal environment; privileging pre-test, low-stakes work over timed tests; assigning group rather than individual work. When all is said and done, however, such strategies "have little to do with mathematics content" (Martin 304). Mathematicians still need to be able to conceptualize, describe, and manipulate abstract objects, and there seems to be a suspicion that, at heart, abstraction is gendered masculine and colored white.It is possible that the rhetorical immediacy and context-dependence of Black English has misguidedly reinforced such a perception. For poet June Jordan, Black English "devolves from a culture that abhors all abstraction" (Jordan 367). Psychiatrist Alvin Poussaint asks, "Is there a way to say metamorphosis in Ebonics?" (O'Malley). Yet, despite Black English's avoidance of nominalization and similar verbosities that afflict academic prose, abstract logical reasoning flourishes in vernacular idiom, as linguist William Labov demonstrated half a century ago. Our aim is not to explain the asymptote in Black English but rather to consider a feature characteristic of those very minority cultures historically underrepresented in math—storytelling—and to ask how it may be foregrounded in mathematics, where it is decisively sidelined. Storytelling has been claimed by every culture and ethnic group at some point as the repository of wisdom, practical skills, religious beliefs, and shared identity and values; but when it gets corralled into the category of "fiction," and when it gets opposed to "fact," a narrowed concept of truth dispatches storytelling to kindergarten and recreational math. Word problems may supply scenarios but offer none of a plot's satisfactions... (shrink)

Generations of researchers observed a mismatch between headphone and loudspeaker presentation: the sound pressure level at the eardrum generated by a headphone has to be about 6 dB higher compared to the level created by a loudspeaker that elicits the same loudness. While it has been shown that this effect vanishes if the same waveforms are generated at the eardrum in a blind comparison, the origin of the mismatch is still unclear. We present new data on the issue that systematically (...) characterize this mismatch under variation of the stimulus frequency, presentation room, and binaural parameters of the headphone presentation. Subjects adjusted the playback level of a headphone presentation to equal loudness as loudspeaker presentation, and the levels at the eardrum were determined through appropriate transfer function measurements. Identical experiments were conducted at Oldenburg and Aachen with 40 normal-hearing subjects including 14 that passed through both sites. Our data verify a mismatch between loudspeaker and binaural headphone presentation, especially at low frequencies. This mismatch depends on the room acoustics, and on the interaural coherence in both presentation modes. It vanishes for high frequencies and broadband signals if individual differences in the sound transfer to the eardrums are accounted for. Moreover, small acoustic and non-acoustic differences in an anechoic reference environment exert a large effect on the recorded loudness mismatch, whereas not such a large effect of the respective room is observed across moderately reverberant rooms at both sites. Hence, the non-conclusive findings from the literature appear to be related to the experienced disparity between headphone and loudspeaker presentation, where even small differences in room acoustics significantly change the response behavior of the subjects. Moreover, individual factors like loudness summation appear to be only loosely connected to the observed mismatch, i.e., no direct prediction is possible from individual binaural loudness summation to the observed mismatch. These findings – even though not completely explainable by the yet limited amount of parameter variations performed in this study – have consequences for the comparability of experiments using loudspeakers with conditions employing headphones or other ear-level hearing devices. (shrink)

The performance of music in early modern French and Italian music rooms typically created an aural impression of ‘Intimacy’ and ‘Clarity’ whereby the individual instruments could clearly be perceived spatially. These qualities arise from the close proximity of the audience to the performers and the acoustic characteristics generated by the room geometry. Generally, the rooms were rectangular with high ceilings, between 4 and 8 metres, with volumes between 200 and 1000 cubic metres. Such rooms, when occupied, (...) have moderate reverberance, which helps maintain the individuality of separate voices. The size and volume also give rise to short-delay reflections from the walls and ceiling, which enhance ‘Clarity’, ‘Intimacy’ and ‘Envelopment’. The acoustic characteristics of these rooms will be discussed in terms of current subjective and objective parameters developed for assessing concert venues. (shrink)

Aims and hypothesesIn an environment of absolute silence, researchers have found many of their participants to perceive phantom sounds. With this between-subject experiment, we aimed to elaborate on these research findings, and specifically investigated whether–in line with the fear-avoidance model of tinnitus perception and reactivity–fear or level of perceived threat influences the incidence and perceptual qualities of phantom sound percepts in an anechoic room. We investigated the potential role of individual differences in anxiety, negative affect, noise sensitivity and subclinical (...) hearing loss. We hypothesized that participants who experience a higher level of threat would direct their attention more to the auditory system, leading to the perception of tinnitus-like sounds, which would otherwise be subaudible, and that under conditions of increased threat, narrowing of attention would lead to perceptual distortions.MethodsIn total, N = 78 normal-hearing volunteers participated in this study. In general, the study sample consisted of young, mostly female, university students. Their hearing was evaluated using gold-standard pure tone audiometry and a speech-in-noise self-test, which is a sensitive screening test to identify subclinical hearing loss. Prior to a four-minute stay in an anechoic room, we randomized participants block design-wise in a threat and no-threat condition. Participants in the threat condition were deceived about their hearing and were led to believe that staying in the room would potentially harm their hearing temporarily. Participants were asked whether they perceived sounds during their stay in the room and rated the perceptual qualities of sound percepts. They were also asked to fill-out standardized questionnaires measuring anxiety, affect and noise sensitivity. The internal consistency of the questionnaires used was verified in our study sample and ranged between α = 0.61 and α = 0.90.ResultsIn line with incidence rates reported in the literature, 74% of our participants reported having heard tinnitus-like sounds in the anechoic room. Speech-in-noise identification ability was comparable for both groups of participants. The experimental manipulation of threat was proven to be effective, as indicated by significantly higher scores on a Threat Manipulation Checklist among participants in the threat condition as compared to those in the no-threat condition. Nevertheless, participants in the threat condition were as likely to report tinnitus percepts as participants in the no-threat condition, and tinnitus percepts were not rated as being louder or more unpleasant as a function of level of threat. For participants who did experience tinnitus percepts, a higher level of threat was associated with a higher degree of experienced unpleasantness. These associations were absent in those who did not experience tinnitus. Higher negative affect was only slightly associated with higher ratings of tinnitus unpleasantness.ConclusionWhereas our threat manipulation was successful in elevating the level of fear, it did not contribute to a higher percentage of participants perceiving tinnitus-like sounds in the threat condition. However, higher levels of perceived threat were related to a higher degree of perceived tinnitus unpleasantness. The findings of our study are drawn from a rather homogenous participant pool in terms of age, gender, and educational background, challenging conclusions that are applicable for the general population. Participants generally obtained normophoric scores on independent variables of interest: they were low anxious, low noise-sensitive, and there was little evidence for the presence of subclinical hearing loss. Possibly, there was insufficient variation in scores to find effects. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the Netherlands. We observed a total (...) of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

Does individual desert matter for distributive justice? Is it relevant, for purposes of justice, that the pattern of distribution of justice’s “currency” (be it well-being, resources, preference-satisfaction, capabilities, or something else) is aligned in one or another way with the pattern of individual desert? -/- This paper examines the nexus between desert and distributive justice through the lens of individual claims. The concept of claims (specifically “claims across outcomes”) is a fruitful way to flesh out the content (...) of distributive justice so as to be grounded in the separateness of persons. A claim is a relation between a person and a pair of outcomes. If someone is better off in one outcome than a second, she has a claim in favor of the first. If she is equally well off in the two outcomes, she has a null claim between the two. In turn, whether one outcome is more just than a second depends upon the pattern of claims between them. -/- In prior work, I have elaborated the concept of claims across outcomes, and have used it to provide a unified defense of the Pareto and Pigou-Dalton axioms. Adding some further, plausible, axioms, we arrive at prioritarianism. -/- Here, I consider the possibility of desert-modulated claims—whereby the strength of an individual’s claim between two outcomes is determined not only by her well-being levels in the two outcomes, and her well-being difference between them, but also by her desert. This generalization of the notion of claims suggests a new axiom of justice: Priority for the More Deserving, requiring that, as between two individuals at the same well-being level, a given increment in well-being be allocated to the more deserving one. -/- If individual desert is intrapersonally fixed, this new axiom, together with a desert-modulated version of the Pigou-Dalton principle, and the Pareto axioms, yields a desert-modulated prioritarian account of distributive justice. Trouble arises, however, if an individual’s desert level can be different in different outcomes. In this case of intrapersonally variable desert, Priority for the More Deserving can conflict with the Pareto axioms (both Pareto indifference and strong Pareto). -/- This conflict, I believe, is sufficient reason to abandon the proposal to make claim strength a function of individual desert on top of well-being levels and differences. If distributive justice is truly sensitive to each individual’s separate perspective—if the justice ranking of outcomes is built up from the totality of individual rankings—we should embrace the Pareto axioms as axioms of justice and reject Priority for the More Deserving. In short: desert-modulated prioritarianism is a nonstarter. Rawls was right to sever distributive justice from desert. (shrink)

The paper considers and opposes the view that processes are best thought of as continuants, to be differentiated from events mainly by way of the fact that the latter, but not the former, are entities with temporal parts. The motivation for the investigation, though, is not so much the defeat of what is, in any case, a rather implausible claim, as the vindication of some of the ideas and intuitions that the claim is made in order to defend — and (...) the grounding of those ideas and intuitions in a more plausible metaphysics than is provided by the continuant view. It is argued that in addition to a distinction between events and processes there is room and need for a third category, that of the individual process, which can be illuminatingly compared with the idea of a substance. Individual processes indeed share important metaphysical features with substantial continuants, but they do not lack temporal parts. Instead, it is argued that individual processes share with substantial continuants an important property I call ‘modal robustness in virtue of form’. The paper explains what this property is, and further suggests that the category of individual process, thus understood, might be of considerable value to the philosophy of action. (shrink)

. If one is committed to a “Rawlsian” conception of justice, is one not also necessarily committed to a “Christian” personal ethics? MOE explicitly, if one believes that social justice requires the maximinning of material conditions, should one not use one's time and resources as well as one can in order to assist the poorest? The paper offers a very partial answer to these questions by arguing for the following two claims: Contrary to what is implied by some egalitarian critics (...) of Rawls, the idea of a well‐ordered society does not require maximin‐guided choices at the individual level, and hence leaves room for legitimate incentive payments. Despite Rawls's own neglect of this fact, a limited form of patriotism does constitute an individual “natural duty” following from a commitment to maximin social justice. (shrink)

I argue that the social dimension of alienation, as discussed by Williams and Railton, has been underappreciated. The lesson typically drawn from their exchange is that moral theory poses a threat to the internal integrity of the agent, but there is a parallel risk that moral theory will implicitly construe agents as constitutively alienated from one another. I argue that a satisfying account of agency will need to make room for what I call ‘genuine ethical contact’ with others, both as (...) concrete objects in the world external to ourselves and as subjects who can recognize us reciprocally. (shrink)

Debates about the theological implications of recent research in the cognitive and evolutionary study of religion have tended to focus on the question of theism. The question of whether there is any disagreement about the conceptualization of the individual human being has been largely overlooked. In this article, I argue that evolutionary and cognitive accounts of religion typically depend upon a view of cognition that conceptually isolates the mind from its particular social and physical environmental contexts. By embracing this (...) view of the mind, these accounts also unwittingly embrace an abstract individualist view of individual personhood that Christian theologians have explicitly battled against. Taken as a whole, the field leaves sufficient room for supplementary theories that are compatible with theological accounts of the relational individual, but in practice, no effort has been made to engage, or even to accommodate, any other view of individual personhood. (shrink)

ABSTRACTIn this paper, I discuss my personal experience of the issues that can arise when adopting critical realism in academic contexts dominated by irrealist methodological approaches. I draw inspiration for my analysis from the concept of Gramscian hegemony and the concept of ‘authenticity’. These concepts are related because hegemonic processes prevent individuals from freely expressing themselves. In my case, academic hegemony has resulted in social pressure to sacrifice my authentic critical realist self in order to achieve academic success. I also (...) discuss groupthink dynamics, suggesting that they are a mechanism by which hegemony – and denial of individual authenticity – can be achieved. This paper is meant to be a theoretical and reflexive discussion, which could be the starting point for empirical studies investigating the situation of a critical realist in a hegemonic academic context. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)

Introduction: Dignified care is one of the moral responsibilities of professional caregivers. However, in many cases the dignity of hospitalized patients, especially women in the delivery room, is not maintained. Dignity is an abstract concept and there has been no previous research exploring the dignity of pregnant women in the delivery room in Iran. Objectives: The objective of this study is to define and explain the concept of dignity for pregnant women in the delivery room from the perspectives of professional (...) caregivers. Research design: This is qualitative research. The data were collected through in-depth semi-structured individual interviews. The conventional content analysis method was used to analyze the data. In qualitative content analysis, participant narrative is examined in-depth and sorted into categories and themes. Participants and research context: Potential participants who met the entrance criteria for this study were approached between July 2016 and February 2017. In all, 20 professional caregivers working in the delivery room setting within Iranian general hospitals were invited to participate in the study. The sampling was done through targeted sampling until saturation was achieved. Ethical considerations: The research ethics committee of the Shiraz University of Medical Sciences has approved the study’s protocol and all commonly recognized ethical principles were followed throughout the study. Findings: The findings of this study were presented in three main themes, including “privacy,” “respecting patients’ preferences,” and “comprehensive attention” and eight categories. Discussions and conclusion: Women in the delivery room need to be taken care of in an environment where healthcare staff promote the preservation of dignity through maintaining privacy, by providing attentive care and through ensuring that patient preferences regarding care and treatment are respected. In such an environment, the dignity of these women would be maintained and desirable outcomes achieved. (shrink)

In this paper we first briefly review Bell's (1964, 1966) Theorem to see how it invalidates any deterministic "hidden variable" account of the apparent indeterminacy of quantum mechanics (QM). Then we show that quantum uncertainty, at the level of DNA mutations, can "percolate" up to have major populational effects. Interesting as this point may be it does not show any autonomous indeterminism of the evolutionary process. In the next two sections we investigate drift and natural selection as the locus of (...) autonomous biological indeterminacy. Here we conclude that the population-level indeterminacy of natural selection and drift are ultimately based on the assumption of a fundamental indeterminacy at the level of the lives and deaths of individual organisms. The following section examines this assumption and defends it from the determinists' attack. Then we show that, even if one rejects the assumption, there is still an important reason why one might think evolutionary theory (ET) is autonomously indeterministic. In the concluding section we contrast the arguments we have mounted against a deterministic hidden variable account of ET with the proof of the impossibility of such an account of QM. (shrink)

This study investigates the relationships between religious fundamentalism, collective identity, and individuality. The questions addressed in this research are: Who is joining fundamentalist student organizations? Why and how are they doing so? And, how do these organizations maintain their collective identity in the face of ever-growing individualism? To gain an adequate understanding of the fundamentalist characteristics of such organizations, we first explored the existing theoretical literature. Then, we performed a qualitative case study of two student organizations at the University of (...) Guilan: the Basij and Welayat Lovers. Our findings indicate that although these organizations strongly tend to define and impose a unified collective identity on their members, some important social trends, such as the expansion of secularist higher education and rising levels of students' knowledge, skills, and their reinforced individuality, leave little room for the growth of a fundamentalist collective identity. (shrink)

There is a straightforward view of perception that has not received adequate consideration because it requires us to rethink basic assumptions about the objects of perception. In this paper, I develop a novel account of these objects—the sensible qualities—which makes room for the straightforward view. I defend two primary claims. First, I argue that qualities like color and shape are “ontologically flexible” kinds. That is, their real definitions allow for both physical objects and mental entities to be colored or shaped. (...) Second, a single instance of these qualities can be attributed to more than one entity. Just as we attribute the same instance of a material property to a statue and to the clay that constitutes it, single instances of sensible qualities should be attributed both to the physical objects perceived and to the perceptual states that have those instances as their objects. (shrink)

Background Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. Aim To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. Research design Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Participants and research context Eleven experienced perioperative/operating room nurses (...) working in an operating unit at a Norwegian university hospital. Ethical considerations Approval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer. Findings Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. Discussion Defending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner. Conclusion Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team. (shrink)

Definition of the problem Assistive technologies, including “smart” instruments and artificial intelligence (AI), are increasingly arriving in older adults’ living spaces. Various research has explored risks (“surveillance technology”) and potentials (“independent living”) to people’s self-determination from technology itself and from the increasing complexity of sociotechnical interactions. However, the point at which self-determination of the individual is overridden by external influences has not yet been sufficiently studied. This article aims to shed light on this point of transition and its implications. (...) Arguments The identification of this “tipping point” could contribute to analysis of familiar issues of conflict between the ethical principles of beneficence and respect for autonomy. When using technology in the living spaces of older adults, relationships, among other factors, may play a crucial role in older adult’s self-determination. We find the tipping point to occur subjectively and variably. To this end, the article combines theoretical ethical considerations with two examples from a qualitative study illustrating the perspective of older adults aged 65–85 years. Conclusion The study of the tipping point underscores the importance of perceiving an older person’s perspective. Particularly at the tipping point, this might be the only way to effectively identify whether the individual concerned perceives their self-determination as externally overridden. In conceptualizing the tipping point itself as well as its variability, we might create the basis for a normative call to shift the tipping point to promote self-determination and prevent overriding the will of older adults. We highlight individual, relational, and societal implications of our findings. (shrink)

ABSTRACTThe eyes are extremely important for communication. The muscles around the eyes express emotional states and the size of the pupil signals whether a person is aroused and alert or bored and fatigued. Pupil size is an overlooked social signal, yet is readily picked up by observers. Observers mirror their own pupil sizes in response, which can influence social impressions. In a landmark study by Hess [1975. The role of pupil size in communication. Scientific American, 233, 110–119] it was shown (...) that individuals with large pupils are perceived more positively than individuals with small pupils. In that behavioral study, participants were asked to draw pupils in line drawings of faces with empty irises and they drew large pupils in the happy face, and small ones in the angry face. The current study tested 579 participants and extended this work by showing that this association between large pupils and a positive impression develops over age and is absent in... (shrink)

We propose a cognitive-dissonance model of norm compliance to identify conditions for selfishly biased information acquisition. The model distinguishes between: (i) objective norm compliers, for whom the right action is a function of the state of the world; (ii) subjective norm compliers, for whom it is a function of their belief. The former seek as much information as possible; the latter acquire only information that lowers, in expected terms, normative demands. The source of ‘moral wiggle room’ is not belief manipulation, (...) but the coarseness of normative prescriptions under conditions of uncertainty. In a novel experimental setup, we find evidence for such strategic information uptake. Our results suggest that attempts to change behavior by subjecting individuals to norms can lead to biased information acquisition instead of compliance. (shrink)

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable (...) medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (shrink)

We identify two senses of ‘pragmatics’ and related terms that give rise to two different methods of propositional individuation. The first one is the contextualist approach that essentially acknowledges contextual information to take part in the determination of what is said by the utterance of a sentence. In this sense, Pragmatics relies on the Principle of Compositionality and interprets propositions as structured entities. It epitomises the Building-block Model of Propositional Individuation. The general approach that makes what the agents do the (...) grounding level of philosophical and linguistic analysis characterizes the second sense, Pragmatism. It finds its clearest expression in Peirce’s Pragmatist Maxim, and it relies on the Fregean Principle of Context, and supports a view of propositions as unstructured entities. This is the Organic Model of Propositional Individuation. There is a test, the Analytic Equivalence Test, that tells apart the two models. According to it, the answer to the question whether a theory makes room for different but analytically equivalent propositions determines the model the theory belongs in. A positive answer classifies the theory as belonging to the building-block model; a negative answer allocates the theory within the organic model. (shrink)

What is arguably the central criticism of Hegel’s philosophical system by the Continental tradition, a criticism which represents a unifying thread in the diverse work of Schelling, Feuerbach, Kierkegaard, Nietzsche and Adorno, is that Hegel fails to adequately do justice to the notion of individuality. My aim in this paper is to counter the claim that Hegel’s idea of the concrete universal fails to properly explain the real uniqueness of individuals. In what follows, I argue that whilst the Continental critique (...) (as it is particularly expressed by Adorno) is prima facie attractive, it is ultimately misguided. This is because the critics of Hegel fail to correctly understand (i) his principal argument in Sense-Certainty; (ii) crucial features of his logico-metaphysics; and (iii) his notion of wholeness. I contend that carefully explicating these important parts of the Hegelian system not only shows that Hegel’s metaphysical commitments are not those which do not leave meaningful room for or make adequate sense of individuality, but that they also reveal a sophisticated treatment of the interdependency between the categories of individuality, particularity and universality in a way which conceives of individuality robustly. (shrink)

Political ethics, a subfield of applied ethics, is concerned with normative questions about voters, politicians, lobbyists, and other individual political agents. Compared with other fields in applied ethics political ethics has not developed into an area of intense interest in academic philosophy. Debates over the main questions in political ethics occur in mainstream news, on social media, in living rooms and neighborhood bars, etc., but for the most part have not bled over into the pages of philosophy journals (...) and books. This volume aims to fill this gap in the philosophical literature. It contains seventeen original papers by a diverse range of leading scholars on central questions in political ethics. (shrink)

Recently some philosophers have emphasized a potentially irreconcilable conceptual antagonism between the statistical characterization of natural selection and the standard scientific discussion of natural selection in terms of forces and causes. Other philosophers have developed an account of the causal character of selectionist statements represented in terms of counterfactuals. I examine the compatibility between such statisticalism and counterfactually based causal accounts of natural selection by distinguishing two distinct statisticalist claims: firstly the suggested impossibility for natural selection to be a cause (...) acting upon populations and secondly the conceptualization that all evolutionary causes occur at the level of interactions between individual organisms. I argue that deriving the latter from the former involves supplementary assumptions concerning precisely what causation is. I critically examine two of these assumptions purportedly preventing natural selection being regarded as a cause: the locality claim and the modularity claim. I conclude that justifying the strongest version of statisticalism—i.e. evolutionary causation only occurs at the level of individual interactions between organisms—would require further metaphysical arguments that are likely to be deemed highly problematic. Additionally, I argue that such a metaphysical position would be considered incongruous with both our scientific and ordinary use of the concepts of causality and explanation as employed within our everyday epistemological framework. (shrink)

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

There is large, imposing-looking box in a wing of University College, London, that contains the lifelike remains of the English philosopher, Jeremy Bentham. Bentham requested that upon his death, which occurred in 1832, his body should first be used for purposes of a medical lecture and then be place on display. His request was entirely utilitarian in character. For as a famous individual, Bentham could argue that it made less sense to be buried and then have a statue constructed (...) of his likeness than to eliminate the burial by having himself made into a statue. He called the latter an auto-icon. (shrink)

This paper presents the interpersonal variability of harm challenge to Jerome Wakefield’s harmful-dysfunction account (HDA) of disorder. This challenge stems from the seeming fact that what promotes well-being or is harmful to someone varies much more across individuals than what is intuitively healthy or disordered. This makes it at least prima facie difficult to see how judgments about health and disorder could, as harm-requiring accounts of disorder like the HDA maintain, be based on, or closely linked to, judgments about well-being (...) and harm. This interpersonal variability of harm challenge is made salient by the difficulty faced by harm-requiring accounts of disorder in dealing satisfactorily with cases of intuitively disordered conditions that seem harmless because they do not deprive the individuals that they affect of anything that they value (e.g., desired infertility). I argue that this challenge is made more serious for the HDA by some clarifications Wakefield has recently made on harm. In recent publications, Wakefield dissociates himself from the sheer cultural-relativist view of harm attributed to him by some critics based on his linkage of harm to social values, and adopts a more qualified social-values-based view of harm that leaves room for criticism of the values endorsed by members of a cultural group at a given time. I show how Wakefield’s qualified view makes it more difficult for the HDA to deal with the interpersonal variability of harm challenge, at least when applied to a Western cultural context where a high value is placed on autonomy and individual choice. (shrink)