BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

The study of anarchism as a philosophical, political, and social movement has burgeoned both in the academy and in the global activist community in recent years. Taking advantage of this boom in anarchist scholarship, Nathan J. Jun and Shane Wahl have compiled twenty-six cutting-edge essays on this timely topic in New Perspectives on Anarchism.

During his celebrated 1922 debate with Bergson, Einstein famously proclaimed: “the time of the philosopher does not exist, there remains only a psychological time that differs from the physicist’s.” Einstein’s dictum, I maintain, has been metabolized by the natural sciences, which typically presuppose, more or less explicitly, the existence of a single, univocal, temporal substratum, ultimately determined by physics. This reductionistic assumption pervades much biological and biomedical practice. The chronological age allotted to individuals is conceived as an objective quantity, allowing (...) one to straightforwardly assign and compare the biological age of organisms. This essay argues that the standard practice of assessing the age and aging of organisms against the backdrop of a physical conception of time is problematic. This becomes especially evident in light of recent discoveries of various levels of senescence underlying the development of individual organisms—a phenomenon known as ‘age mosaicism.’ The bottom line is that the study of age and aging requires a biological conception of time, as opposed to a physical one. Einstein clearly wasn’t wrong about his operationalization of time in relativity theory. Still time may be less monolithic than he surmised. (shrink)

This paper focuses on tacit versus explicit uses of plural performance metrics as a primary methodological characteristic. This characteristic usefully distinguishes two schools of normative analysis and their approaches to normative interpretations of bounded rationality. Both schools of thought make normative claims about bounded rationality by comparing the performance of decision procedures using more than one performance metric. The consistency school makes tacit reference to performance metrics outside its primary axiomatic framework, but lexicographically promotes internal axiomatic consistency as the primary, (...) and in most cases sufficient, normative outcome with which to undertake welfare comparisons. The consistency school's axiomatization program, in both neoclassical and behavioral forms, pre-commits to welfare interpretations that follow a hierarchy of rationalities based on the stringency of restrictions that different axiomatizations impose on choice data. In contrast, the ecological rational.. (shrink)

In The Second Sex, Simone de Beauvoir diagnoses “woman” as the “lost sex,” torn between her individual autonomy and her “feminine destiny.” Becoming a “real woman” in patriarchal societies demands that women lose their authentic, autonomous selves to become the “inessential Other” for Man. To better understand this diagnosis and how women might refind themselves, I rehabilitate the influence of Søren Kierkegaard and his concept of repetition as what must be lost to be found again in Beauvoir’s account of freedom (...) and, specifically, the liberation of women. Beauvoir offers a dual account of repetition, that of mundane repetition and sacrificial repetition, bringing them to bear both on her diagnosis of women’s oppression and her theorization of our liberation. Sacrificial repetition becomes a temporality for freedom—one must be able to repeat or retake their autonomy continuously toward an open future. For this to happen concretely, Beauvoir insists that we must sacrifice the (racist, classist) patriarchal ideals of the “real woman” and “real man” as we retake our autonomy and reconfigure the meaning of sex difference anew. (shrink)

"Explores the nature of time and its implications for questions of politics, ethics, and the self.

In _Secular Grace_ Dana Freibach-Heifetz addresses the crisis of modernity, proposing an ethic of love based on a new philosophical concept of “secular grace" as intersubjective relations.

While ideals of racial purity may be out of fashion, other sorts of purity ideals are increasingly popular in the United States today. The theme of purity is noticeable everywhere, but it is especially prominent in our contemporary fixation on health and hygiene. This may seem totally unrelated to issues of racism and classism, but in fact, the purveyors of purity draw upon the same themes of physical and moral purity that have helped produce white identity and dominance in the (...) US. Historically, this is where the purity rhetoric gets its power. To invoke purity ideals in the US is to mobilize this genealogy of racialized associations. Today's zealous preoccupation with hygiene is part of our living heritage in a racist culture.Just as ideas of race and racial purity were debunked by biologists long before the public would begin to question them, ideals of extreme hygienic purity linger with us, even flourish, despite scientific evidence of their futility and harm. Why are we still so enamored with purity? Because, to some extent, our very self-conceptions are at stake. Other scholars have described how our process of self individuation is based upon exclusion. The unique contribution of a genealogical approach to this issue is that, instead of merely locating the problem in ideologies held by others, it can evoke self-recognition and self-transformation. We will tend to assume the problem lies elsewhere until we learn to recognize ourselves in practices that reproduce cultural ideals. As inheritors of this racist culture, we are all lovers of purity, and we are all responsible for rethinking this value. (shrink)

Psychoanalysts working in clinical situations are constantly confronted with the struggle between conservative forces and those which enable something new to develop. Continuity and change, stasis and transformation, are the major themes discussed in _The Work of Psychoanalysis_, and address the fundamental question: How does and how can change take place? _The Work of Psychoanalysis_ explores the underlying coherence of the complex linked issues of theory and practice. Drawing on clinical cases from her own experience in the consulting room (...) class='Hi'>Dana Birksted-Breen focuses on what takes place between patient and analyst, giving a picture of the interlocking and overlapping vertices that make up the work needed in psychoanalysis. Some of the key topics covered include: sexuality; aspects of female identity; eating disorders; time; dreams; disturbances in modalities of thought; and terminating psychoanalysis. This book draws different traditions into a coherent theoretical position with consequences for the mode of working analytically. _The Work of Psychoanalysis_ will appeal to psychoanalysts and academics in psychoanalysis, psychotherapists, as well as postgraduate students studying courses in these fields. (shrink)

On the basic concepts of the philosophy of the Vedas.

On musical patterns and meditation towards realization of Nada Brahman.

This article uses Acker's theory of gendered organizations to frame an analysis of the ways in which policies and practices in a men's and a women's prison reflect and reproduce gendered inequalities. The article offers a working definition of one of Acker's key theoretical concepts, the notion of “gendered organizational logic.” Then, using interview data collected from correctional officers in a men's and a women's prison, the article examines the ways in which officer training and assignments, although designed to be (...) nominally generic, assume a male worker and disproportionately benefit male officers working in men's institutions. These findings imply that the perspective could more usefully be conceived as a theory of “masculinized” organizations. (shrink)

This article surveys the history of labor- and middle-class-sponsored efforts to mobilize shopping on behalf of working people from the late nineteenth century through the present. It analyzes the class dynamics of these movements to, first, underscore workers' own ability to mount consumer campaigns and, second, critique middle-class campaigns in the present that can treat workers as unorganized, passive victims. It underscores the potential hierarchical dynamics inherent in consumer-labor campaigns, both between classes and within the labor movement, including dynamics of (...) race, gender, and space. (shrink)

One premise of the underdetermination argument is that entailment of evidence is the only epistemic constraint on theory-choice. I argue that methodological rules can be epistemically significant, both with respect to observables and unobservables. Using an example from the history of medicine—Koch’s 1882 discovery of tuberculosis bacteria—I argue that even anti-realists ought to accept that these rules can break the tie between theories that are allegedly underdetermined. I then distinguish two types of underdetermination and argue that anti-realists, in order to (...) maintain the underdetermination argument, need to do more than show that theories are empirically equivalent: they need to show that a certain kind of underdetermination obtains. (shrink)

The prevailing metaphor for understanding the persistence of gender inequalities in universities is the “chilly climate.” Women faculty sometimes resist descriptions of their workplaces as “chilly” and deny that gender matters even in the face of considerable evidence to the contrary. I draw on interviews with women academics to explore this apparent paradox, and I offer a theoretical synthesis that may help explain it. I build on insights from Ridgeway and Acker to demonstrate that women do experience gender at work, (...) but the contexts in which they experience it have implications for how they understand gender’s importance and whether to respond. Specifically, I find that women are likely to minimize or deny gender’s importance in interactions. When it becomes salient in structures and cultures, women understand it differently. Placing gender in organizational contexts can better inform our understanding of gender inequality at work and can help in crafting more effective efforts to foster gender equity. (shrink)

Christianity has recently undergone historic demographic and cultural shifts: it has expanded significantly in the global south while declining in the west. In an age of World Christianity, these changes bring diversity and competition, and renewed Christian witness. The global context for the faith reveals unavoidable tensions between missional expansion and the call to be one in Christ Jesus. Amid plurality and rapid changes in identity, Christians are challenged to re-appropriate the classic marks of the church – one, holy, catholic, (...) and apostolic. Engagement with all four marks, reframed for the contemporary situation, will help to maintain the creative tension between mission and unity, to connect Christians across geography and generations, and to forge a common vision of salvation in an interconnected world. (shrink)

My talk will be guided by the idea that there are some familiar scientific practices that are epistemically significant. I will argue that we can test for the success of these practices empirically by examining cases in the history of science. Specifically, I will reconstruct one particular episode in the history of medicine – John Snow's reasoning concerning the infectiousness of cholera – and offer this case as a concrete example of the sort of empirical research that needs to be (...) done in order to discover what kinds of methodological practices and rules are actually of epistemic interest. Analysing this case, I will explain how it (and other cases like it) can help us resolve specific cases of underdetermination. After exploring some possible anti-realist responses to this argument, I will conclude that, while the anti-realist is (more or less legitimately) able to construct underdetermination scenarios on a case-by-case basis, he will likely have to abandon the strategy of using algorithms to do so, thus losing the much needed guarantee that there will always be rival cases of the required kind. (shrink)

This article takes issue with interpretations of Foucault’s thought that understand power and resistance as forces working in opposition to one another to fix and dissolve or construct and deconstruct social identities. Starting from the theme of dispersion presented in The Archaeology of Knowledge, it maintains that, for Foucault, power works only in a dispersive manner and that identities are not so much substantialities produced by power as simulacra that appear on the surface of a very different dynamic. Resistance, in (...) turn, is not a force opposed to power but rather a consequence of the disjunctive nature of power relations themselves. Using this reconceived dynamic of power and resistance, the article revisits Foucault’s understanding of disciplinary society and the micropolitics of the care of the self, and argues that, although Foucault has been deployed in political theory to show that identities are both necessary and problematic, his work in fact points to a politics and ethics that strives to dispense with this necessity altogether. (shrink)

Research on “improper” linear models has shown that predetermined weighting schemes for the linear model, such as equally weighting all predictors, can be surprisingly accurate on cross-validation. We review recent advances that can characterize the optimal choice of an improper linear model. We extend this research to the understanding of fast and frugal heuristics, particularly to the ecologically rational goal of understanding in which task environments given heuristics are optimal. We demonstrate how to test this model using the Recognition Heuristic (...) and Take the Best heuristic, show how the model reconciles with the ecological rationality program, and discuss how our prescriptive, computational approach could be approximated by simpler mental rules that might be more descriptive. Echoing the arguments of van Rooij et al., we stress the virtue of having a computationally tractable model of strategy selection, even if one proposes that cognizers use a simpler heuristic process to approximate it. (shrink)

This paper will articulate an underappreciated side of the psychoanalytical Deleuze: his relation to Melanie Klein, particularly as it appears in The Logic of Sense. Deleuze's engagement with Klein largely follows his familiar strategy of re-reading a thinker off of a twist in one or two of that thinker's key concepts. With Klein, this twist involves re-reading her story of psychic development on the basis of disjunction rather than negation, so that the psychic surface that emerges generates a persistent non-correspondence (...) between self and other and between concept and thing. Deleuze thereby makes Klein a central figure in his ontology of sense and his analysis of how the physical surface of bodies generates a metaphysical surface of thought. However, Deleuze's ultimate turn is a Nietzschean one towards overcoming, the thought of eternal return, and the demolition of the Oedipal Law. As this final turn makes clear, even in his early writings that engaged more directly and affirmatively with psychoanalytical thought, Deleuze was already on an anti-Oedipal path. (shrink)

This paper argues that Nietzsche presents an ontology of excess that, by problematizing the logic of identity, can positively contribute to democratic theory and practice. This ontology is missed by a wide range of interpreters who try to depoliticize Nietzsche's thought, align it with the agonisms of contemporary mass democracy, or re-align it with an aristocratic politics of fixed hierarchy. While Nietzsche himself may not extend this ontology onto the political domain, the writings of Foucault, and Deleuze and Guattari demonstrate (...) how it can provide greater appreciation of the subtleties and complexities of power relations that operate at a micropolitical level. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Atonement, Justice, and Peace: The Message of the Cross and the Mission of the Church by Darrin W. Snyder Belousek, and: Restorative Justice: Theories and Practices of Moral Imagination by Amy LevadDana ScopatzReview of Atonement, Justice, and Peace: The Message of the Cross and the Mission of the Church DARRIN W. SNYDER BELOUSEK Grand Rapids, MI: Eerdmans, 2012. 668 pp. $55.00Review of Restorative Justice: Theories and Practices of (...) Moral Imagination AMY LEVAD El Paso, TX: LFB Scholarly Publishing, 2012. 300 pp. $80.00In Atonement, Justice, and Peace and Restorative Justice, the authors advocate for a restorative conception of justice, which they oppose to the “normal” retributive concept. Amy Levad draws on Aristotle and the virtue ethics tradition to write about “moral imagination” and restorative justice. Darrin Belousek uses Thomas Kuhn’s language to write about a “paradigm shift” in our understanding of theological themes relevant to restorative justice. Both contrast the restorative imagination or paradigm with a retributive one, although Levad also contrasts restoration with rehabilitation. Levad limits her study to restorative justice as [End Page 214] practiced in the criminal justice system, while Belousek expands his work to consider the Bible, theology, and multiple issues in society and in the church.Levad begins her book by discussing Aristotle’s idea of justice as equity, which she points out requires more discernment from judicial decision makers than it requires the algorithmic application of laws. In order for them to enact justice as equity, she argues, decision makers need a “vivid and expansive” moral imagination. Toward this end, she brings together two traditions: Aristotelian virtue ethics and modern literature on moral imagination. At the heart of her work is an ethnographic study intended to determine whether there are practices of restorative justice that can foster such a vivid and expansive moral imagination. After observing and interviewing participants in restorative justice programs in Colorado, Levad examined the narratives, metaphors, and symbols they used in order to determine whether and how they demonstrated a distinctively restorative moral imagination. Because the scope of her study was limited, and because she had difficulty getting a wide spectrum of roles involved in restorative justice to participate in the study, Levad’s results are more suggestive than conclusive. She acknowledges that we cannot generalize from them; although she draws on research methods from sociology and criminology, her findings do not meet their standards of evidence. Thus, the book’s greatest value lies in the recommendations it makes for further study. Empirical studies of the effectiveness of restorative justice practices have tended to focus on either reducing recidivism or the satisfaction of participants with the process. Levad brings to the fore two questions that have so far not been explored in previous research. First, how do restorative justice practices affect the moral imagination? And second, what effect might those practices have on ethical discernment? Her book takes some hopeful initial steps in addressing those questions.Although Levad writes as a Christian ethicist, she did not explicitly incorporate theological reflection into her study of state-sponsored programs. Belousek, by contrast, takes on an explicitly theological project of evaluating how interpretations of the significance of the cross of Jesus interact with such things as support for capital punishment, just war, and market economics. Since Belousek’s book is wide-ranging, this review will concentrate on the task it has in common with Levad’s book: that of reconceptualizing justice.In a fashion parallel to Levad’s use of Aristotle’s notion of justice as equity, which sometimes departs from strict legal justice, Belousek cites Paul’s vision of God’s justice “irrespective of” or “apart from” the law (372). Belousek begins by linking penal-substitutionary atonement theory to capital punishment, just war, and exchange economy in a single “paradigm,” arguing that they are all under-girded by what he calls the “Retributive Principle” (28). He then challenges this paradigm’s appropriateness for Christianity on biblical and doctrinal grounds. After examining arguments in favor of penal-substitutionary atonement in detail—drawing on the works of J. I. Packer and Thomas Schreiner, among [End Page 215] others—he turns to the scriptures cited in support... (shrink)

This Encyclopedia offers a fresh, integrated and creative perspective on the formation and foundations of philosophy and science in European modernity. Combining careful contextual reconstruction with arguments from traditional philosophy, the book examines methodological dimensions, breaks down traditional oppositions such as rationalism vs. empiricism, calls attention to gender issues, to ‘insiders and outsiders’, minor figures in philosophy, and underground movements, among many other topics. In addition, and in line with important recent transformations in the fields of history of science and (...) early modern philosophy, the volume recognizes the specificity and significance of early modern science and discusses important developments including issues of historiography (such as historical epistemology), the interplay between the material culture and modes of knowledge, expert knowledge and craft knowledge. This book stands at the crossroads of different disciplines and combines their approaches – particularly the history of science, the history of philosophy, contemporary philosophy of science, and intellectual and cultural history. It brings together over 100 philosophers, historians of science, historians of mathematics, and medicine offering a comprehensive view of early modern philosophy and the sciences. It combines and discusses recent results from two very active fields: early modern philosophy and the history of (early modern) science. (shrink)

The philosophy of education began, in the work of Plato, with two normative questions: What should humans be taught? And by what method should they be taught it? Those simple questions have been obscured by ever-increasing complexity in educational philosophy. The philosophy of education may currently include too much, and so this review of four general texts uses this criterion of a book’s merit: the ability to retain what is most obviously philosophical and eliminate what is not. On that criterion, (...) two of the books, one by Nel Noddings and another by Randall Curren, are especially noteworthy in their value for students and teachers of educational philosophy. (shrink)

The purpose of this research was to explore the relationship between university students’ perceptions of the overall quality of instruction they experienced since COVID-19 and their academic well-being. This relationship was examined in the context of a moderated moderation with students’ household income and the cultural value of power distance, which measures the extent to which less powerful members of an organization expect and accept that power is unequally distributed. Two countries with societally moderate levels of PD were assessed. Moderated (...) moderations between PQI, income, and PD were found for the academic well-being of students from both the United States and South Africa. The patterns of interactions were in some ways similar and other ways different, highlighting the complexity of how students may react to potential stressors in their academic environment. Potential explanations and implications of these results are discussed. (shrink)

In recent years, the Minnesota Attorney General’s Office and the Minnesota Department of Health have cultivated a productive partnership to strengthen the state’s multidisciplinary response to overlapping health equity and social justice issues. This article describes shared efforts in three areas: post-conviction justice, drug overdose, and human trafficking/exploitation.