Clinical musings on the nature of reality and "known experience." Therapists must rely on their clients' reporting of experience in order to assess, treat, and offer help. Yet we all experience the world through various filters of one sort or another, and our experiences are transformed through several nonconscious processes before reaching our conscious awareness. Science, philosophy, and wisdom traditions share the belief that our awareness is very restricted. How, then, can anyone accurately report their experience, let alone get help (...) with it? Neuropsychologist Aldrich Chan examines how our experience of reality is assembled and shaped by biological, psychological, sociocultural, and existential processes. Each chapter explores processes within these domains that may act as "veils." Topics in the book include: the default mode network, cognitive distortions, decision-making heuristics, the interconnected mind, memory, and cultural concepts of distress. By understanding the ways in which reality can be distorted, clinicians can more effectively help their clients reach their personal psychotherapeutic goals. (shrink)

This article introduces a process-oriented approach for improving present moment conceptualization in psychotherapy that is in alignment with neuroscience: the Temporospatial movements of mind model. We elaborate on seven temporal movements that describe the moment-to-moment morphogenesis of emotional feelings and thoughts from inception to maturity. Temporal refers to the passage of time through which feelings and thoughts develop, and electromagnetic activity, that among other responsibilities, bind information across time. Spatial dynamics extend from an undifferentiated to three dimensional experiences of emotional (...) and cognitive processes. Neurophysiologically, spatial refers to structures within the brain and their varying interactions with one another. This article culminates in the development of an atheoretical temporospatial grid that may help clinicians conceptualize where patients are in their cognitive and emotional development to further guide technique. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Many are calling for concrete mechanisms of oversight for health research involving artificial intelligence (AI). In response, institutional review boards (IRBs) are being turned to as a familiar model of governance. Here, we examine the IRB model as a form of ethics oversight for health research that uses AI. We consider the model's origins, analyze the challenges IRBs are facing in the contexts of both industry and academia, and offer concrete recommendations for how these committees might be adapted in order (...) to provide an effective mechanism of oversight for health‐related AI research. (shrink)

Media guidelines on safe suicide-related reporting are within the suicide prevention armamentarium. However, implementation issues beleaguer real-world practice. This study evaluated the perspectives of the Malaysian media community, persons with lived experience of suicidal behavior, and mental health professionals on suicide-related reporting in terms of the impact, strategies, challenges, and the implementation of guidelines on safe reporting. Three focus group discussions of purposively sampled Malaysian media practitioners, PLE, and MHP were audio-recorded, transcribed, coded and thematically analyzed. Inclusion criteria were: English (...) fluency, no clinical depression or suicidal ideation, no recent previous suicide attempts or suicide bereavement. Three major themes emerged: Unsafe Reporting; Impact; and Safe Reporting. Most described current reporting as unsafe by being potentially triggering to media users and may contribute to contagion effect. Positive impacts identified included raised awareness toward suicide and its prevention. Unsafe reporting was attributed to inadequate awareness, knowledge, and guidance, lack of empathy and accountability, job-related factors, popularity-seeking, lack of monitoring and governance, and information source with unsafe content. Majority agreed on how suicide stories should be framed to produce a safe report. The media community diverged on how detailed a suicide story should be. Safe reporting challenges included difficulties in balancing beneficial versus harmful details, social media ubiquity and its citizen reporters. Participants suggested these safe reporting strategies: stakeholder engagement, educational approaches, improving governance and surveillance, and guidelines revision. Most acknowledged the relevance of guidelines but were unaware of the existence of local guidelines. Implementation challenges included the dilemma in balancing media industry needs vis-à-vis safe reporting requirements, stakeholder engagement difficulties and social media regulation. There is poor awareness regarding safe suicide-related reporting across all groups. PLE and MHP were negatively impacted by current unsafe messaging which aggravated trauma and grief reactions. Postvention support gaps for mental health professionals were highlighted. Safe reporting promotion strategies should include stakeholder engagement to increase awareness on minimizing Werther and maximizing Papageno effects. Strategic re-examination and dissemination of local media guidelines to address new media issues, and effective surveillance mechanisms, are crucial in sustainable improvement of safe reporting practices. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Darwin himself suggested the idea of generalizing the core Darwinian principles to cover the evolution of social entities. Also in the nineteenth century, influential social scientists proposed their extension to political society and economic institutions. Nevertheless, misunderstanding and misrepresentation have hindered the realization of the powerful potential in this longstanding idea. Some critics confuse generalization with analogy. Others mistakenly presume that generalizing Darwinism necessarily involves biological reductionism. This essay outlines the types of phenomena to which a generalized Darwinism applies, and (...) upholds that there is no reason to exclude social or economic entities. (shrink)

We already have a distinction between the intension and extension of terms. This is not simply the distinction that is operative in philosophy of mind, body, and action. There, the concern is with things, and with a physicalistic or a mentalistic account of them. The physicalist says he supports an ‘extensional’ analysis of things, the mentalist an ‘intensional’. So, the physicalist says that, in the end, only ‘the extensional language of physical science’ will do in ontology. But, associating this physical-mental (...) dichotomy with the intension-extension distinction as applied to terms is misleading. The ontological issue is obscured by the association. An ontologist wants, like Spinoza or Berkeley, to know whetherthingsare extended or not, and in what respects. This question makes central the concept of space, or more generally of ‘field’, ‘domain’. Unfortunately, the same word ‘extension’ is used also for the spread or location of athingin space. To dissociate the extension of a term, a logical notion, from the ontological notion of the spatial status of a thing, I introduce the new word ‘extention’. This coinage correlates, not with the ‘intension’ of terms—the logical correlate of ‘extension’—but with ‘intention’, a word that fortunately already has common currency, and reeks with connotations that have logical ties with ‘consciousness’. So, from here on, we have two dichotomies: intension-extension applying to terms, and intention-extention applying to things. Since terms are things, both sorts of considerations are relevant to them, the logical one and the ontological. Only the latter applies to, say, stones or persons, since these are not linguistic terms. (shrink)

This Source Book is devoted to the purpose of providing such a basis for genuine understanding of Chinese thought (and thereby of Chinese life and culture, ...

What is belief? "Beliefs aim at truth" is the commonly accepted starting point for philosophers who want to give an adequate account of this fundamental state of mind, but it raises as many questions as it answers. For example, in what sense can beliefs be said to have an aim of their own? If belief aims at truth, does it mean that reasons to believe must also be based on truth? Must beliefs be formed on the basis of evidence alone? (...) Is truth the constitutive norm of belief? Does aiming at truth bring in a normative dimension to the nature of belief? How can the aim of truth guide the formation of our beliefs? In what ways do partial beliefs aim at truth? Is truth the aim of epistemic justification? Last but not least, is it knowledge rather than truth which is the fundamental aim of belief? In recent years, pursuing these questions has proved extremely fertile for our understanding of a wide range of current issues in philosophy of mind and action, epistemology, and meta-ethics. The Aim of Belief is the first book to be devoted to this fast-growing topic. It brings together eleven newly commissioned essays by leading authors on the aim of belief. Contributors: Jonathan Adler, Krister Bykvist, Timothy Chan, Pascal Engel, Kathrin Glüer, Anandi Hattiangadi, Michael Hicks, Paul Horwich, David Papineau, Andrew Reisner, Asbjørn Steglich-Petersen, Ralph Wedgwood, Åsa Wikforss, Daniel Whiting. (shrink)

Since the very beginning, Confucianism has been troubled by a serious gap between its political ideals and the reality of societal circumstances. Contemporary Confucians must develop a viable method of governance that can retain the spirit of the Confucian ideal while tackling problems arising from nonideal modern situations. The best way to meet this challenge, Joseph Chan argues, is to adopt liberal democratic institutions that are shaped by the Confucian conception of the good rather than the liberal conception of (...) the right.Confucian Perfectionism examines and reconstructs both Confucian political thought and liberal democratic institutions, blending them to form a new Confucian political philosophy. Chan decouples liberal democratic institutions from their popular liberal philosophical foundations in fundamental moral rights, such as popular sovereignty, political equality, and individual sovereignty. Instead, he grounds them on Confucian principles and redefines their roles and functions, thus mixing Confucianism with liberal democratic institutions in a way that strengthens both. Then he explores the implications of this new yet traditional political philosophy for fundamental issues in modern politics, including authority, democracy, human rights, civil liberties, and social justice.Confucian Perfectionism critically reconfigures the Confucian political philosophy of the classical period for the contemporary era. (shrink)

This article defends as correct and as faithful to Aquinas’s thought the tenets of “descriptivism” (sometimes called “naturalism”) in the context of criticisms that Patrick Lee has made in “Is Thomas’s Natural Law Theory Naturalist?” (American Catholic Philosophical Quarterly 71:4 [1997]: 567–87). “Revisiting Aquinas” argues that evaluative utterances are descriptive; so even if human goods were immediately known by practical reason (a position nonetheless rejected), their understanding would be a descriptive one, which moral objectivity requires. The arising of the prescriptivity (...) of precepts in relation to practical reason is then treated. The descriptivism articulated in this paper supports Lee’s emphasis on the primacy of love and choice; it further stresses that submission to an understood order of objective goods is essential to willing well. (shrink)

This volume contains essays on an array of topics originally presented orally by a master teacher and scholar. With characteristic rhetorical elegance, Msgr. Synan, late professor at the Pontifical Institute in Toronto, delivered these papers in a variety of settings on issues relating to his specialty of mediaeval Christian philosophy and to his interest in Jewish-Christian dialogue, on the theology of sanctity and of death, and on morally significant historical events. Medieval figures represented here include Aquinas, Augustine, Abelard, and Godfrey (...) of St. Victor; some topics treated are war and peace, philosophical innovations, ecclesiology, evil, goliardic verse, law and abortion, Church councils and Jews in the Middle Ages, and convictions uniting Jews and Christians. This book also contains representative sermons–including a Month’s Mind for Etienne Gilson, an introduction detailing Synan’s background and professional contributions, an updated bibliography of his published works, and an extensive index. Especially appealing to those who knew Synan are three posthumous tributes and thirteen photographs from throughout his life. The selections in this volume are scholarly but non-technical, intended for anyone moved to seek elucidation of the topics discussed. (shrink)

Comparative study of religions and philosophies, in spite of its significance and urgency, has been neither fully appreciated nor developed in the study of religion or philosophy. Comparative study, historically speaking, is still young and complex in its approach. Religious Studies as an intellectual discipline has traditionally concentrated on the investigation of a single tradition, enabling a student to become an ‘expert’ in that particular tradition. The world in which we live, however, no longer allows us to be content with (...) the idea, the value, the way of thinking in our own tradition alone. In short, we no longer live in a ‘provincial’ age but in a ‘global’ age. (shrink)

Two groups of scientists have just announced what is being described as a leap forward in human stem cell research.1–3 Both have found ways of producing what are being called “induced pluripotent cells” , stem cells that they hope will demonstrate the same key properties of regeneration and unrestricted differentiation that human embryonic stem cells possess, but which are derived from skin cells not from embryos. In simple terms, these scientists have succeeded in reprogramming skin cells to behave like hESCs.Stem (...) cell research has been hailed as one of the most important and exciting areas of science, because it is believed that these types of cells will not only play an important part in regenerative medicine, but also yield valuable scientific information. These latest developments in cell reprogramming represent a milestone for stem cell science. No longer does the paradigm of irreversible cell specialisation hold true; instead, almost any type of cell might have the potential to become any other.The advent of techniques for producing these iPCs has also been hailed as an ethical breakthrough. Up until now, the production of hESCs has required a process which involves the destruction of embryos. Many of these embryos are available as by-products of IVF; but in addition, the process of somatic cell nuclear transfer to produce cloned embryonic stem cells requires a supply of human oocytes, which must currently be harvested from female donors at no insignificant cost. In a nutshell, iPCs seem to enable us to produce “embryo-free” human pluripotent stem cells, and in a “gender-neutral” way—that is, without the need for human oocytes.The response from the scientific community, ethical commentators and the public has, however, reflected an inherent confusion over the ethical significance of this research. The anti-embryo …. (shrink)

Questions about sincerity play a central role in our lives. But what makes an assertion insincere? In this paper we argue that the answer to this question is not as straightforward as it has sometimes been taken to be. Until recently the dominant answer has been that a speaker makes an insincere assertion if and only if he does not believe the proposition asserted. There are, however, persuasive counterexamples to this simple account. It has been proposed instead that an insincere (...) assertion that p is one made by a speaker who (a) does not express his belief that p; or (b) does not believe that he believes that p; (c) does not assent to p; or (d) does not express any of these cognitive states. We show that these .. (shrink)

The Iran-United States Claims Tribunal is the most important source of international arbitral decisions for at least the past half century, and its decisions have contributed significantly to the development of international law and the law of international commercial transactions. Judge Aldrich, who is the only member of the Tribunal to have served since its inception in 1981, has written what will be recognised as the definitive book about the jurisprudence of the Tribunal. The book seeks to preserve and (...) to make accessible the substantial body of Awards and Decisions rendered by the Tribunal during the years since it was established in. Its hundreds of Awards and Decisions may be individually consulted but hitherto there has been no detailed analytical guide through the vast published work of the Tribunal. This important new book provides a two-fold service. First, it quotes from the most significant Awards and Decisions at sufficient length so that both their substance and the reasoning of the Tribunal can be understood from access to the present volume alone. Second, it organizes and summarizes the decisions to facilitate finding complete texts relevant to any particular issue. (shrink)