Patients’ experience of symptoms does not follow the body–mind divide that characterizes the classification of disease in the health care system. Therefore, understanding patients in their entirety rather than in parts demands a different theoretical approach. Attempts have been made to formulate such approaches but many of these, such as the biopsychosocial model, are still basically dualistic or methodologically reductionist. In primary care, patients often present with diffuse symptoms, making primary care the ideal environment for understanding patients’ undifferentiated symptoms and (...) disease patterns which could readily fit both bodily and mental categories. In this article we discuss theoretical models that have attempted to overcome this challenge: The psychosomatic approach could be called holistic in the sense of taking an anti-dualistic stance. Primary care theorists have formulated integrative views but these have not gained a foothold in primary care medicine. McWhinney introduced a new metaphor, ‘the body–mind’, and Rudebeck advocated cultivating ‘bodily empathy’. These views have much in common with both phenomenological thinking and mentalization, a psychological concept for understanding others. In the process of understanding patients there is a need for the physician to enter an intersubjectivity that aims at understanding the patient’s experiences and sensations without initially jumping to diagnostic conclusions or into a division into mental and physical phenomena. Mentalization theory could form the basis of an approach to a more comprehensive understanding of patients. The success of such an approach is, however, dependent upon structural and organizational conditions that do not counteract it. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew (...) Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

Introduction The starting point is that ethical competence is the basis for ethical healthcare practices and quality of care. Simultaneously, there is a need for research and development from a holistic multi-professional perspective. Aim The aim is to create a proposed model for multi-professional ethical competence grounded in clarified meanings and dimensions of ethical competence studied from a multi-professional healthcare perspective. The research questions are, what is ethical competence from a multi-professional healthcare perspective and what strengthens a multi-professional ethical healthcare (...) practice? Research design The research has a qualitative approach and hermeneutic application research design. Two groups with six participants from clinical practice and two scientific researchers in each group met four times for dialogue. Thematic analysis was used as an analysis method. Ethical considerations The research is approved by the Declaration of Helsinki, the General Data Protection Regulations, and ethical permission was asked from the Norwegian Centre for Research Data (NSD). Results The proposed model for multi-professional ethical competence encompasses a three-dimensional ethical value base that is underpinned by: Ethical attitude – a personal desire to do good; Ethical basis – the best for the patient as a common goal and Ethical culture – common goals and values in the organization. Multi-professional ethical competence is strengthened by: Reflection – to see with new wondering eyes; Time for talk – interdisciplinary teamwork and Leadership – an ethical role model and support. Discussion Ethical competence has a strong link to the core of caring ethics and a deeper personal value base and attitude. Ethical competence involves the whole culture and is seen as a shared value base and a responsibility to do the best for the patient as a multi-professional team and organization. Ethical competence becomes active in healthcare practice by opening up for meaningful multi-professional talks and reflections. (shrink)

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in philosophical literature (...) around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

Table of Contents: Illustrations Acknowledgments Conventions Introduction 3 Ch. 1 Kinds of Natural Philosophy 14 Ch. 2 Methods of Bookishness 49 Ch. 3 Modes of Argument 82 Ch. 4 Bodin’s Philosophy of Nature 116 Ch. 5 Theatrical Metaphors 153 Ch. 6 The Reception of the Theatrum 180 Epilogue: The Legacies of the Theatrum 225 Notes 233 Bibliography 331 Index 369.

Analyzing Oppression asks: why is oppression often sustained over many generations? The book explains how oppression coercively co-opts the oppressed to join their own oppression and argues that all persons have a moral responsibility to resist it. It finally explores the possibility of freedom in a world actively opposing oppression.

Theories of perception have traditionally dismissed the sense of smell as a notoriously variable and highly subjective sense, mainly because it does not easily fit into accounts of perception based on visual experience. So far, philosophical questions about the objects of olfactory perception have started by considering the nature of olfactory experience. However, there is no philosophically neutral or agreed conception of olfactory experience: it all depends on what one thinks odors are. We examine the existing philosophical methodology for addressing (...) our sense of smell: on the one hand appeals to phenomenology that focus on the experiential dimensions of odor perception and on the other approaches that look at odor sources and their material dimensions. We show that neither strategy provides enough information to account for the human sense of smell and argue that the inclusion of the missing dimension of biology, with its concern for the function (or functions) of olfaction, provides the means to develop a satisfactory and empirically informed philosophy of smell. (shrink)

The co-instantiation thesis is pivotal to a significant solution to the problem of causal exclusion. But this thesis has been subject to some powerful objections. In this paper, I argue that these difficulties arise because the thesis lacks the necessary metaphysical framework in which its claims should be interpreted and understood. Once this framework is in place, we see that the co-instantiation thesis can answer its critics. The result is a rehabilitated co-instantiation solution to the troubling problem of causal exclusion. (...) But questions remain concerning the viability of certain of its applications. (shrink)

This article analyzes the experiences of ecologists who used data they did not collect themselves. Specifically, the author examines the processes by which ecologists understand and assess the quality of the data they reuse, and investigates the role that standard methods of data collection play in these processes. Standardization is one means by which scientific knowledge is transported from local to public spheres. While standards can be helpful, the results show that knowledge of the local context is critical to ecologists' (...) reuse of data. Yet, this information is often left behind as data move from the private to the public world. The knowledge that ecologists acquire through fieldwork enables them to recover the local details that are so critical to their comprehension of data collected by others. Social processes also play a role in ecologists' efforts to judge the quality of data they reuse. (shrink)

Abstract.Telling the tale about South Dakota's recent legislative ban on nearly all abortions gets messy, complicated, and dirty. There are no innocent subjects and no simple plot lines. The story reveals other stories underneath and over the top of the others. Stories counter stories, revealing who is in the know and who does the telling. To “tell the old, old story,” as the song goes, is not as simple as it may seem. Religion and medical science are caught in the (...) politics and cultural wars about abortion. (shrink)

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward. In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

Enduring disparities in choice of college major constitute one of the most significant forms of gender inequality among undergraduate students. The existing literature generally equates major choice with career choice and overlooks possible variation across student populations. This is a significant limitation because gender differences in major choice among liberal arts students, who attend college less for specific career training and more for broader learning objectives, are just as great as among those choosing pre-professional majors. This study addresses this gap (...) by examining how privileged men and women at an elite, liberal arts university select their fields of study. Drawing on in-depth interviews, findings contradict the prevailing assumption of a unitary model of major choice as career choice by revealing a plurality of gendered meanings around choosing a field of study. Majors may play an important part in the construction of an intellectual identity as much as a means of career preparation. How students approach the choice relates to both gender and social background. For privileged students, traditional gendered associations with bodies of knowledge hold salience in their decision making as well as expectations of reproducing future elite family roles. This research also illuminates how gendered processes of choosing fields of study take place in relationship to particular institutional contexts. (shrink)

Michel Foucault’s _History of Sexuality_ has been one of the most influential books of the last two decades. It has had an enormous impact on cultural studies and work across many disciplines on gender, sexuality, and the body. Bringing a new set of questions to this key work, Ann Laura Stoler examines volume one of _History of Sexuality_ in an unexplored light. She asks why there has been such a muted engagement with this work among students of colonialism for whom (...) issues of sexuality and power are so essential. Why is the colonial context absent from Foucault’s history of a European sexual discourse that for him defined the bourgeois self? In _Race and the Education of Desire, _Stoler challenges Foucault’s tunnel vision of the West and his marginalization of empire. She also argues that this first volume of _History of Sexuality_ contains a suggestive if not studied treatment of race. Drawing on Foucault’s little-known 1976 College de France lectures, Stoler addresses his treatment of the relationship between biopower, bourgeois sexuality, and what he identified as “racisms of the state.” In this critical and historically grounded analysis based on cultural theory and her own extensive research in Dutch and French colonial archives, Stoler suggests how Foucault’s insights have in the past constrained—and in the future may help shape—the ways we trace the genealogies of race. _Race and the Education of Desire_ will revise current notions of the connections between European and colonial historiography and between the European bourgeois order and the colonial treatment of sexuality. Arguing that a history of European nineteenth-century sexuality must also be a history of race, it will change the way we think about Foucault. (shrink)

Examines how violence has been conceptually and rhetorically put to use in continental social theory.

Dispositional compatibilists argue that a proper understanding of our abilities vindicates both compatibilism and the principle of Alternate Possibilities (the claim that the ability to do otherwise is required for freedom and moral responsibility). In this paper, I argue that this is mistaken. Both analyses of dispositions and abilities should distinguish between local and global dispositions or abilities. Once this distinction is in place, we see that neither thesis is established by an analysis of abilities.

Education has long been charged with the taskof forming and shaping subjectivity andidentity. However, the prevailing view ofeducation as a project of producing rationalautonomous subjects has been challenged bypostmodern and poststructuralist critiques ofsubstantial subjectivity. In a similar vein,Emmanuel Levinas inverts the traditionalconception of subjectivity, claiming that weare constituted as subjects only in respondingto the other. In other words, subjectivity isderivative of an existentially priorresponsibility to and for the other. Hisconception of ethical responsibility is thusalso a radical departure from the prevailingview (...) of what it means to be a responsible moralagent. In this paper, I use jazz improvisationas a metaphor to focus on three interrelatedaspects of ethical responsibility on Levinas'saccount: passivity, heteronomy, andinescapability. I then point toward some waysin which reframing responsibility andsubjectivity along this line might offer newpossibilities for conceiving subjectivity andmoral agency in education. (shrink)

Despite the fact that ethics consultations are an accepted practice in most healthcare organizations, many clinical ethicists continue to feel marginalized by their institutions. They are often not paid for their time, their programs often have no budget, and institutional leaders are frequently unaware of their activities. One consequence has been their search for concrete ways to evaluate their work in order to prove the importance of their activities to their institutions through demonstrating their efficiency and effectiveness.

This paper offers a case study based on qualitative research in the burley tobacco region of central Kentucky, where farmers are urged to diversify away from tobacco production. “Replacing” tobacco is difficult for economic and material reasons, but also because raising tobacco is commensurate with a locally valued way of doing masculinity. The focus is on these two questions: How can the doing of work associated with tobacco production and marketing be understood as also doing a particular masculinity? What does (...) an understanding of farm work as a simultaneous doing of gender illuminate about the challenges of diversification away from tobacco? Asking tobacco farmers to “grow something else” is also asking them to do gender differently, suggesting that the transition away from tobacco must be understood as a gendered transition. This research, focused primarily on male farmers who continue to raise tobacco, suggests the need for gendered research with women and men who have moved away from tobacco to other crops. (shrink)

Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.

Some have argued that our intuitive reactions to a number of cases of moral responsibility can only be preserved at the expense of a unified account of moral responsibility for acts and omissions. I argue against this conclusion, proposing that a plausible condition on responsibility, the Causal Condition can, when properly elaborated, justify the relevant intuitive data.

'The church in danger' : latitudinarians, Socinians, and Hobbists -- Animal spirits and living fibres -- Mortalists and materialists -- Journalism, exile, and clandestinity -- Mid-eighteenth-century materialism -- Epilogue : some consequences.

In this paper, I offer an analysis of prospective responsibilities. I begin by surveying recent accounts of prospective responsibilities and positioning my view within that literature. Then I offer a more detailed analysis of a shared component of these accounts, namely the claim that S is prospectively responsible for φ only if S has to ‘see to it that φ'.

This is a ground-breaking study of the way educated people were trained to think in Renaissance Europe. As Ann Moss demonstrates, the commonplace-book of quotations which every schoolboy of the period was taught to use opens a window on to the manner in which attitudes were structured, a moral consensus was established, and styles of writing evolved. Printed Commonplace-Books and the Structuring of Renaissance Thought is much more than an account of humanist classroom practice: it is a major work of (...) cultural history. (shrink)

Rape, claims Ann J. Cahill, affects not only those women who are raped, but all women who experience their bodies as rapable and adjust their actions and self-images accordingly. Rethinking Rape counters legal and feminist definitions of rape as mere assault and decisively emphasizes the centrality of the body and sexuality in a crime which plays a crucial role in the continuing oppression of women.

Although intersectional analyses of gender have been widely adopted by feminist theorists in many disciplines, controversy remains over their character, limitations, and implications. I support intersectionality, cautioning against asking too much of it. It provides standards for the uses of methods or frameworks rather than theories of power, oppression, agency, or identity. I want feminist philosophers to incorporate intersectional analyses more fully into our work so that our theories can, in fact, have the pluralistic and inclusive character to which we (...) give lip service. To this end, I advocate an intersectional family resemblance strategy that does not create philosophical problems for feminists. I test my approach against María Lugones's argument in “Heterosexualism and the Colonial/Modern Gender System” (Lugones 2007) to determine, in particular, whether we can successfully resist a move to create multiple genders for women. If we can successfully resist this move, then we can answer the objection that intersectionality fragments women both theoretically and politically. I also argue that my approach avoids Lugones's critique of forms of intersectionality that fall within “the logic of purity.”. (shrink)

This paper provides an overview of twenty years of feminist philosophy in Northamerica. The professionalization of feminist theory that has occurred through the mainstreaming of feminist philosophy creates a danger of a gap between theory and practice that creates the danger of co-optation. Three stages of feminist philosophizing are outlined, including the radical critique, gender difference and difference/post-modernist stages. The last stage, it is argued, leads to an conceptual impasse about feminist strategies for social change.

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

The A-Theory of time has long struggled with the results of special relativity. One proposed solution is to stipulate the existence of a physically or metaphysically privileged frame which defines the global present for all observers. Recently this proposal has cropped up in literature on spatially closed universes (SCUs) which seem to naturally instantiate such structures. This paper examines the privileged frame proposal through the lens of SCUs, arguing that even in these space-times which seem overwhelmingly friendly to A-theoretic accounts (...) the theory face insurmountable challenges. (shrink)

At the UN, important projects laying down transnational corporations' (TNCs) human rights responsibilities have been launched without ever clarifying the relevant theoretical foundations. One of the consequences is that the human rights principles in projects like the 2000 UN Global Compact and the 2003 Norms on the Responsibilities of Transnational Corporations and Other Business Enterprises with Regard to Human Rights can be understood in different ways, which should not cause surprise given that their authors come from diverse backgrounds, including economics (...) and public policy. An examination of these projects and the views of their authors reveals that, although they are superficially linked to international human rights law, they go well beyond it and attempt to deal with corporate social responsibility issues in ways that elude neat classification as fitting neatly in either legal or non-legal categories. Too little attention has been paid to how in the course of developing these projects the legal and ethical dimensions have become entwined and how lines have gotten blurred. Meanwhile, there has been recognition that these UN projects have emerged simply as ad hoc responses to practical concerns about the sustainability of globalization. The lack of any foundational theory or normative framework should be addressed; it is time to bring together specialists from different fields concerned with the human rights responsibilities of corporations to see if it is possible to define a coherent overarching theory for these UN projects. (shrink)