Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

Neal Berlin, Ann Arbor City Administrator, Tom Blessing, Assistant City Attorney, plus some Cable Communications Commission (CCC) members are trying to put free speech restrictions into Community Television Network�s policies and remove City Council from the debate. CTN, Ann Arbor�s community access cable TV station, is run by the city but not paid for by tax dollars. It is one of the first public access cable stations in the U.S., founded in 1973.

Recent events concerning Žižek at the Left Forum in New York have revealed much about the state of the Left. It appears that the Left is weaker than ever before and Žižek’s appeal to return to radical roots, yet also break some Leftist taboos, situates the liberal Left as anxious, insecure and reactionary. It also appears that Žižek is deliberately and steadily undertaking what many have accused him of failing to attain – of not going far enough. Here, Žižek is (...) breaking away from being the poster boy for the liberal Left and refining his commitment to communism through critiquing postmodern representations concerning tolerance, hyper-relativism and culturation. (shrink)

Although widely accepted to be the capacity to exercise control in one’s learning, there remains confusion about what exactly this means. Failure to reconcile contradictions has left the field resigned to pluralism, describing ‘versions’ of learner autonomy according to divergent theoretical orientations. However, each version is incomplete, rendering it unreliable as a basis for practice: educational initiatives that seek to foster learner autonomy from one perspective, run the risk of inadvertently undermining it from another. In an attempt to rectify this, (...) I turn to philosophies of personal autonomy, which I analyse in relation to learner autonomy to identify criteria for its achievement, regardless of version. If we acknowledge that learners are ever embodied, emplaced and sociohistorically situated, as we must, learning is a process of identity construction in relation to context. To be in control of this process is to define ourselves in terms of authentic values, the expression of which may require resolve to stay one’s path or resistance to pressure to act otherwise, all of which is contingent on affordances and constraints that are inherent to our embodied, emplaced and sociohistorical constitution. I examine the implications of this theory for practice within educational institutions. (shrink)

In this paper I ask whether in Aristotle's metaphysical system the form of a non-living sensible substance, such as the form of this house, is or is not universal. I argue that his position as it stands is self-contradictory, and then try to give some account of the pressures that led to this central contradiction in Aristotle's metaphysical thought.

Peripersonal space (PPS) is frequently defined as a plastic, pragmatic and goal-directed multisensory buffer that connects the brain-body with its immediate environment. While such characterisations indicate that peripersonal spatiality is profoundly embodied and enactive, comparatively few attempts have aimed to systematically synthesise PPS literature with compatible phenomenological accounts of lived space provided by Heidegger and Merleau-Ponty. Moreover, in traditional cognitive neuroscience, neurophysiological activity is thought to map onto discrete ‘cognitive correlates’. In contemporary 4E approaches to cognition, however, phenomenology-derived notions such (...) as ‘pre-reflective cognition’ and ‘motor-intentionality’ frequently appear, yet their neural correlates may be comparatively difficult to pin down. Pre-reflectively, agents seemingly do not thematise spatial properties as operationalised in key experimental paradigms (e.g., spatial rotation tasks) but are instead inherently spatially embedded within the world. To refine this distinction, I survey how tools co-determine this distinctly spatial ‘world-embeddedness’ using a neurophenomenological methodology (Varela, _Journal of Consciousness Studies, 3_(4), 330–349, 1996 ). Specifically, I conduct two neurophenomenological analyses of tool-perception and tool-use, examining both how distance modulates affordance-perception and how tool-use remaps bodily space via the withdrawal of tools from intentional-objects into co-constituting motor-intentionality itself. I conclude by briefly distinguishing this interpretation of spatial cognition from cognitivist frameworks. Thereafter, I briefly highlight the temporal scaffolding underlying PPS while conceptually grounding my account within Embodied Simulation Theory (Gallese, _Reti, Saperi, Linguaggi_, (1), 31–46, 2018 ). What is at stake is thus both an explicitly embodied-enactive account of bodily space that is qualitative and situational instead of quantitative and positional, as well as a viable, interdisciplinary strategy for unifying pre-reflective cognition with neurophysiological data. (shrink)

This chapter contains sections titled: Character of Claus Christmas Crowd Civic Claus Symbol of Supremacy? Common Claus.

The practice of placing men and women in the same hospital room (mixed gender rooms) has been prohibited in the UK National Health Service for over a decade. However, recent research demonstrates that the practice is common and increasing in a major New Zealand public hospital. Reports and complaints show that the practice also occurs in Australia. We argue that mixed gender rooms violate the fundamental human rights of personal security and dignity. The high rates of cognitive impairment, sensory impairment (...) and frailty in hospital wards exacerbates the risk for these violations and subsequent harm. We argue for the adoption of specific national policies prohibiting mixed gender rooms and public reporting of breaches. Importantly, these guidelines can be adopted without compromising the rights of gender minorities. In the long term, hospitals should be built with single occupancy rooms. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the good maternal body (...) through their breastfeeding behaviors. (shrink)

The present study shows that the Internet functions as a gratifying context for the exchange of knowledge and values related to religious matters among youngsters in the Netherlands; they are in the midst of constructing a religious identity. Systematic content analysis complemented by qualitative research was carried out on Maroc.nl, a discussion forum primarily aimed at Moroccan youth. Inspired by Kemper's definitions of experiencing Islam, the recurrence of six dimensions of religious experience was looked into in 1,354 online messages. The (...) purpose of this study is to gain insight into the nature and the relative visibility of each of these dimensions in the online discussions under study. In addition, a number of context-bound and issue-related characteristics of the message were assessed through qualitative analysis, in an effort to find out what key issues were mainly dealt with, what normative statements were made, and how the informants related to one another. (shrink)

The Paper Begins by introducing the Siren “psychogenic inference”. It then deals with the impact of this inference on the navigation of medical and psychiatric seafarers. The next two parts are more theoretical; the first deals with the entrenchment of the psychogenic inference in some central terms used in discussing medically unexplained symptoms (MUS). The second uncovers the damaging influence of the psychogenic inference on the navigational charts—on the somatoform disorder sections of the two major classifications used internationally, namely the (...) Diagnostic and Statistical Manual, 4th edition Text revision (DSM-IV-TR; American Psychiatric Association [APA] 1994), produced by the APA and of the International .. (shrink)

The child protection system in France has gradually changed along the lines of the laws enacted in 2002 and 2007 that reasserted the importance of the role played by the parents. Far from condemning the family, it henceforth seeks to provide it with accompaniment so as to ensure the child’s future reintegration. Grounded in psychoanalytical group and family theories, the article investigates the psychic function of the institution and (with case studies to support it) discusses what has to be done (...) to make arrangements within the therapeutic framework for families to make progress and maintain ties despite the absence of direct relations. For it is only after a real period of separation that work on the young person’s psychic group experience will enable the family to move forward. (shrink)

This article allies the 1997 PlayStation video game Final Fantasy VII with Slavoj Žižek’s writings on ecology to critique the area of legal philosophy known as ‘earth jurisprudence’. Earth jurisprudents argue that law bears a large part of the responsibility for humanity’s exploitation of the environment, as law helps to bar nature from subjectivity. However, as Žižek warns—and as FFVII illustrates—the desire for meaning incites people to manufacture a harmonious vision of nature that obscures the chaotic forces at work in (...) the environment and ultimately absolves humanity of responsibility towards the world. Therefore, earth jurisprudence’s program of using legal rights to limit human intervention should be rejected in favour of an approach that enables people to take an active role in addressing the ecological crisis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who Tells the StoryCindy BitterThirty years later, I do not remember her name, but I definitely remember her face, and this is how I remember her story.She came into the office for her flu shot. She was in her 70s and had a mild case of COPD attributed [End Page 87] to years of exposure to pesticides on the family farm. She said she was trying to stay healthy, (...) as the grandkids were due for a visit, and everyone had gotten a cold after Thanksgiving the year before. I was a sub-intern doing a required rural medicine rotation and diligently did an exam, finding asymptomatic new-onset atrial fibrillation of uncertain duration. We admitted her to the hospital and started anticoagulation. My attending also ordered a calcium channel blocker to slow her pulse, which was running 90–100 while she was at rest. The attending insisted that it would convert her back to sinus rhythm. The nurses were not experienced with the medication and were uncomfortable giving it. I was pretty sure the calcium channel blocker was not indicated, and a quick check of my pocket manual confirmed the drug would lower her heart rate and maybe her blood pressure but that it would not fix the abnormal rhythm. I refused to administer it. The attending came in, pushed the medication, and returned home. A few minutes later, the patient was struggling to speak. Her pulse fell to in the 30s, and her blood pressure had dropped dangerously low. I asked for the crash cart and calcium, and my attending, then started CPR when she lost her pulse. Half an hour later, my attending called her time of death.Hers was not the first death I'd witnessed, but it was the first time I felt like my patient would have been better off without our interventions. As a medical student hundreds of miles from the main hospital campus, I felt powerless to contradict the attending, and did not know where to turn for support in the moment. I rationalized it by saying that I had not actively contributed to her death by pushing the medication, but I held myself morally culpable for doing the exam and finding an asymptomatic abnormality that started her down that path. I felt I should have known the pathophysiology and medication side effects better, or been more assertive, or called for help.One could argue whether I was suffering from a grief reaction or falling into depression, but I questioned my calling to medicine and seriously considered leaving the field. But I was quite certain that I did not want another patient to be put at risk, or a student to feel cornered into taking actions against their better judgment. After returning to the main hospital, I met with the clerkship director and helped develop a pathway for students to raise safety concerns in real-time. Now I recognize the feeling I experienced as moral injury, but we weren't using that term at the time, or talking about Six Sigma safety, or stopping the line.Ultimately, I continued through medical school and trained as an emergency physician. My prior reverence for my attendings moderated to a healthier respect that had to be earned. I read voraciously, trying to prepare myself for unexpected situations. I became an advocate for patient safety and was an early adopter of shared decision-making. I strive to be a physician who welcomes questions and respects the concerns of all team members. Many of the principles that ground my career in medicine grew out of my exposure to this patient.It was always my least favorite of the tropes common to television medical dramas—the circumstances of the patient-of-the-week illuminated some aspect of our main characters' lives, providing a very important life lesson. I felt it positioned patients to be in service of the physician's aims, using patients as a means to our ends, when we should be using our knowledge and experience to further the patient's goals. Very un-Kantian, in addition to transgressing against multiple other philosophers and medical ethicists. As medicine learns more about the power of... (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)

Recent events concerning Žižek at the Left Forum in New York have revealed much about the state of the Left. It appears that the Left is weaker than ever before and Žižek’s appeal to return to radical roots, yet also break some Leftist taboos, situates the liberal Left as anxious, insecure and reactionary. It also appears that Žižek is deliberately and steadily undertaking what many have accused him of failing to attain – of not going far enough. Here, Žižek is (...) breaking away from being the poster boy for the liberal Left and refining his commitment to communism through critiquing postmodern representations concerning tolerance, hyper-relativism and culturation. (shrink)