With this issue we initiate the policy of expanding the scope of Tulane Studies in Philosophy to include, in addition to the work of members of the department, contributions from philosophers who have earned advanced degrees from Tulane and who are now teaching in other colleges and universities. The Editor THE LOGIC OF OUR LANGUAGE ROBERT L. ARRINGTON Wittgenstein wrote in the Tractatus that "logic is not a body of doctrine, but a mirror-image of the world. " 1 In line (...) with his suggestion that a proposition is a 'picture', Wittgenstein argued that propositions 'show' the logical structure of the real. He was insistent, however, that "the apparent logical form of a proposition need not be its real one. " 2 As a result of this we can misunderstand the structure of fact. Philosophical problems arise just when "the logic of our language is mis understood. " 3 It is common knowledge that much of this view of logic was rejected by Wittgenstein himself in the Philosophical Investi gations. There we are told that language has no ideal or sublime 4 logic which mirrors the structure of the extra-linguistic world. Consequently, inferences from the structure of language to the structure of that extra-linguistic world are invalid. Reality can be 'cut up' in any of a number of ways by language. Wittgenstein adopted a view of philosophy which would render that discipline a non-explanatory, non-critical study of the multiple ways in which language can be used. (shrink)

Induction arrangements are implemented in schools all over the world to support beginning teachers (BTs) (novices) in gradually growing into their profession. The aim of this study is to gain more insight into two key psychological processes involved in the work of a qualified beginning teacher, namely perceived stress and self-efficacy. This unfolding is necessary to find a path of influence to lead the way to meaningful support interventions. Support in the form of induction arrangements is hypothesised to decrease perceived (...) stress and to increase self-efficacy and, thus, decrease stress outcomes. To test our hypotheses 30 BTs and their school-based educators, working in 13 different schools, were surveyed. The analyses revealed that stress causes and stress outcomes are indeed interrelated and that self-efficacy affects this relationship in a mediating way. However, besides decreasing a beginning teachers? perceived lack of learning opportunities, no other influences of induction arrangements were obtained. Implications and suggestions for future research are discussed. (shrink)

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

The purpose of the following discussion is to examine the account of time’s nature and time’s ways that was worked out by Plotinus. For the most part, his philosophy of time is given in treatise iii.7 of the Enneads, entitled “Time and Eternity.” His account of time will be related to the major emphases of his metaphysics and to important views on temporality that were developed by some of his predecessors.

NTRODUCTION intellectual history plainly shows that there is neither a continuing persistence of received ideas nor an unfailing loyalty to a single cluster ...

One of the topics that appears regularly in even the most casual inventories of philosophical problems is the problem of time. Time is such a pervasive, resilient feature of experience that it cannot be ignored. But time is also so vague that almost any analysis or tracking procedure we use to enhance and purify its signals overrides or baffles those signals. We begin a study of the phenomena of temporality and find that our attention is displaced from the temporal continuum (...) to different ways of being seated in it. (shrink)

This Open Access Book is the first to examine disasters from a multidisciplinary perspective. Justification of actions in the face of disasters requires recourse both to conceptual analysis and ethical traditions. Part 1 of the book contains chapters on how disasters are conceptualized in different academic disciplines relevant to disasters. Part 2 has chapters on how ethical issues that arise in relation to disasters can be addressed from a number of fundamental normative approaches in moral and political philosophy. This book (...) sets the stage for more focused normative debates given that no one book can be completely comprehensive. Providing analysis of core concepts, and with real-world relevance, this book should be of interest to disaster scholars and researchers, those working in ethics and political philosophy, as well as policy makers, humanitarian actors and intergovernmental organizations.. (shrink)

Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...) variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once. Results In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. Conclusions This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

Over the past decades, great strides have been made to professionalize and increase access to transgender medicine. As the evidence base grows and conceptualizations regarding gender dysphoria/gender incongruence evolve, so too do ideas regarding what constitutes good treatment and decision-making in transgender healthcare. Against this background, differing care models arose, including the ‘Standards of Care’ and the so-called ‘Informed Consent Model’. In these care models, ethical notions and principles such as ‘decision-making’ and ‘autonomy’ are often referred to, but left unsubstantiated. (...) This not only transpires into the consultation room where stakeholders are confronted with many different ethical challenges in decision-making, but also hampers a more explicit discussion of what good decision-making in transgender medicine should be comprised of. The aim of this paper is to make explicit the conceptual and normative assumptions regarding decision-making and client autonomy underpinning the ‘Standards of Care’ and ‘Informed Consent Model’ currently used in transgender care. Furthermore, we illustrate how this elucidation aids in better understanding stakeholders’ ethical challenges related to decision-making. Our ethical analysis lays bare how distinct normative ambiguities in both care models influence decision-making in practice and how foregrounding one normative model for decision-making is no moral panacea. We suggest that the first steps towards good decision-making in gender-affirming medical care are the acknowledgement of its inherent normative and moral dimensions and a shared, dialogical approach towards the decision-making process. (shrink)

Dans des études diachroniques et synchroniques récentes, on constate une convergence vers l’idée que l’analyse de des fonctionnant comme article (« article-like » des, désormais desal) ne doit pas être fondée sur une relation avec les partitifs. Cette contribution reprend ce débat et montrera que les approches proposées pour contourner une analyse partitive de desal entraînent pourtant un certain nombre de défis. L’identification de ces défis nous mène à élargir notre perspective vers les partitifs nus (c’est-à-dire des structures partitives sans (...) déterminant « upstairs », p. ex. de ces N) en français, italien et néerlandais. Surtout cette dernière langue est particulièrement intéressante, vu que les partitifs nus ne s’y sont pas fossilisés. Sur la base de ces données, nous proposerons une analyse de desal comme faisant partie de la famille des partitifs nus. Cette approche partitive de desa, qui rend compte de faits synchroniques et diachroniques, s’avère théoriquement plus élégante et a une couverture empirique plus large. (shrink)

The most important issue remains: Whether attorneys should serve on HECs? Will they tend to inhibit the development of other discussions, ethical discussions, regarding the issues brought before the HEC? D. Niemira (17, p. 982) suggests that what a hospital needs is not necessarily an attorney to help in their ethical deliberations, but an ethicist. This suggestion should receive further analysis. What types of ethical deliberations to which attorneys have not been exposed in their legal training are important given the (...) broader attorney-role (beyond giving legal opinion) in HEC discussions?The pro-active attorney faces many challenges, both in the current setting (as cases are brought to the HEC) and as future questions are raised (due to innovations in medical technology). These questions remain unclarified by the courts. The nature of the attorney's role is ever challenging; he or she remains in a key position that is currently needed (regarding the uncharted areas of HEC decisionmaking) and important for the future (as new cases emerge and require extensive deliberations). (shrink)

If we are looking for an Ur-explanation for the persistence of the Ur-myth, or any other myth, in our literature, could we not more directly find it in the structure of a mind which does not have to remember in order to imitate? The occasion of both myth and literature is the social life of the species which, in Starobinski's sense, is a history of continual eviction; but as regards the apparatus of thought by which this social life is reflected (...) in art it is more a history of assimilation and repetition. "The work of the brain," to cite a recent article in Scientific American, "is to create a model of a possible world rather than to record and transmit to the mind a world that is metaphysically true…Different worlds are presumably constructed by similar species."1 And, presumably, similar worlds are constructed by similar species. Weisinger hints briefly at something like this in his essay "The Mythic Origins of the Creative Process," but one has the clear impression, as his title suggests, that he would like to have the [myth/ritual] cart before the creative horse.2 However much this may satisfy our longing to crown our literature, if not creativity itself, with a mythic genealogy, it seems a wistful hypothesis. One might just as well look upon the remains of early man's shelters, marvel that they too had roofs, just like ours, and conclude that therefore our roofs have their origin in theirs.· 1. Harry J. Jerison, "Paleoneurology and the Evolution of Mind," Scientific American, January 1976, p. 99.· 2. Herbert Weisinger, The Agony and the Triumph: Papers on the Use and Abuse of Myth , p. 250.Bert O. States, professor of dramatic arts at the University of California at Santa Barbara, is the author of Irony and Drama: A Poetics and The Shape of Paradox: An Essay on "Waiting for Godot.". (shrink)