Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and (...) Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme (...) design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes. (shrink)

English mass noun phrases & count noun phrases differ only minimally grammatically. The basis for the difference is ascribed to a difference in the features +/-CT. These features serve the morphosyntactic function of determining the available options for the assigment of grammatical number, itself determined by the features +/-PL: +CT places no restriction on the available options, while -CT, in the unmarked case, restricts the available options to -PL. They also serve the semantic function of determining the sort of denotation (...) associated with demonstrative & quantified noun phrases. The feature -CT requires that the associated denotation be the set whose sole member is the greatest aggregate of which the noun phrase or noun is true; the feature +CT requires that the associated denotation be the set whose members are all & only those minimal aggregates of which the noun phrase or noun is true. At the same time, neither mass NPs nor count NPs that are arguments of a predicate have their predicate evaluated with respect to their denotations. Rather, the predicate is evaluated with respect to an aggregation, a set of aggregates constructed from the denotation of the noun phrase that is an argument of the predicate. 3 Tables, 4 Figures, 74 References. AA. (shrink)

Justice, one of the four Beauchamp and Childress prima facie basic principles of biomedical ethics, is explored in two excellent papers in the current issue of the journal. The papers stem from a British Medical Association essay competition on justice and fairness in medical practice and policy. Although the competition was open to all comers, of the 235 entries both the winning paper by Alistair Wardrope1 and the highly commended runner-up by Zoe Fritz and Caitríona Cox2 were written by practising (...) doctors—a welcome indication of the growing importance being accorded to philosophical reflection about medical practice and practices within medicine itself. Both papers are thoroughly thought provoking and represent two very different approaches to the topic. Each deserves a careful read. The competition was a component of a BMA 2019/2020 ‘Presidential project’ on fairness and justice and asked candidates to ‘use ethical reasoning and theory to tackle challenging, practical, contemporary, problems in health care and help provide a solution based on an explained and defended sense of fairness/justice’. In this guest editorial I’d like to explain why, in 2018 on becoming president-elect of the BMA, I chose the theme of justice and fairness in medical ethics for my 2019–2020 Presidential project—and why in a world of massive and ever-increasing and remediable health inequalities biomedical ethics requires greater international and interdisciplinary efforts to try to reach agreement on the need to achieve greater ‘health justice’ and to reach agreement on what that commitment actually means and on what in practice it requires. First, some background. As president I was offered the wonderful opportunity to pursue, with the organisation’s formidable assistance, a ‘project’ consistent with the BMA’s interests and values. As a hybrid of general medical practitioner and philosopher/medical ethicist, and as a firm defender of the Beauchamp …. (shrink)

Our aim is to put into consideration the topics of “semantics”, “types”, “lifeworld” and “intersubjectivity” following the social theories of Alfred Schutz and Niklas Luhmann. First of all, and inversely to Luhmann’s perspective which receives the schutzian theory comparing equal types and semantics, we will show that types are inherent to subjectivity. Secondly, and consequently, we state that the social systems theory in the analysis of the “lifeworld”, does not pay attention to the past character of its constitution. Last, but (...) not least, we will point out that all these aspects are framed in a critique of the phenomenological notion of intersubjectivity, which from the luhmannian point of view, ignores the autonomy of consciousness, as well as the emergent character of the social. (shrink)

Por mucho tiempo, las teorías del mestizaje han sido utilizadas para analizar e interpretar la hibridez de las identidades y culturas latinoamericanas, pero el mestizaje –al igual que sus críticas– no es un concepto adecuado en el caso de los espacios sociales, culturales y políticos que ocupan en los Estados Unidos las comunidades latinas y sus producciones musicales. A través del análisis de las profundas líneas de falla que existen en la intersección de los conceptos latinoamericanos de mestizaje y los (...) conceptos bipolares estadounidenses sobre raza e identidad racial, este ensayo dilucida el impacto concreto y material que estas discrepancias conceptuales tienen en las comunidades latinas estadounidenses y en sus prácticas musicales. (shrink)

An expanded conceptualization of the dialogal research methodology was used to gain a deeper understanding of the dyadic experience of Being a couple. Twenty-two committed couples from a variety of backgrounds were interviewed, responding to the question: “What does it mean to ‘Be’ a couple?” The interviews were videotaped, allowing the researchers to engage with both verbal and nonverbal interpersonal expression. The authors describe the dialogal process used, and identify and discuss three core themes expressed by the couples regarding the (...) meaning of being a couple: commitment, morphogenesis, and transcending paradox through witness. (shrink)

The externality of the inside: body images of pregnancyThis paper draws on literature, empirical data and a range of theoretical perspectives on the maternal body to examine understandings of the relationship between a pregnant woman and her foetus, with a particular focus on the body images used by women to represent this relationship. Psychoanalytic and nursing accounts of the relationship between mother and foetus have often described a symbiotic ‘oneness’ or unity during pregnancy. Such accounts, however, stress the temporary nature (...) of this unity and identify a series of ‘stages’ of separation or ‘polarisation’ between mother and foetus during pregnancy. In contrast, many of the 25 women who participated in our interview study of new motherhood described a confusion of the boundary between self and foetus. For many women the experience of pregnancy and the relationship with the unborn baby was ambiguous and uncertain. Importantly, none of these women described her relationship with the foetus as a series of developmental stages, but rather saw it as fluctuating throughout pregnancy. These findings are more consistent with the work of feminist theorists who describe pregnancy as a dynamic and fluid merging of the inside and the outside of the body/self. (shrink)

The concept of innateness is central to Descartes's epistemology; the Meditations display a new, non-Aristotelian method of acquiring knowledge by attending properly to our innate ideas. Yet understanding Descartes's conception of innate ideas is not an easy task, and some commentators have concluded that Descartes held several distinct and unrelated conceptions of innateness. In Descartes on Innate Ideas, Deborah Boyle argues that Descartes's remarks on innate ideas in fact form a unified account. Addressing the further question of how Descartes (...) thinks innate ideas are known, the author shows that, for Descartes, thinkers have implicit knowledge of their innate ideas. Thus she shows that the actual perception of these innate ideas is, for Descartes, a matter of making them explicit, turning the intellect away from sense-perceptions and toward pure thought. The author also provides a new interpretation of the Cartesian "natural light," an important mental faculty in Descartes's epistemology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 78-98 [Access article in PDF] Aesthetic Understanding as Informed Experience:The Role of Knowledge in Our Art Viewing Experiences Richard Lachapelle, Deborah Murray, and Sandy Neim [Figures] Thinking calls for images, and images contain thought. Therefore, the visual arts are a homeground of visual thinking. 1A common misconception about the nature of art and of aesthetic appreciation is that these activities are (...) essentially a question of "feeling," as if tuning in to the right feeling will automatically lead to a full understanding of the work of art. Another widespread misunderstanding essentially reduces art viewing to a simple question of perception, as if looking long and hard isalways enough to apprehend the work of art's message. Fortunately, a growing body of research into adults' art viewing experiences is debunking these widely held beliefs as oversimplifications of the art viewing process. We can now assert, with a good degree of certainty, that our art viewing experiences solicit four key areas: the affective, perceptual, communicative, and cognitive dimensions of human experiencing. 2 Therefore, we would be hard-pressed not to agree with Rudolph Arnheim's reflections, presented above, on the important role of thought in shaping our artistic and aesthetic experiences.While acknowledging at the outset the essential roles of affect, perception, and communication in our art viewing experiences, this paper focuses more specifically on aspects of the intellectual dimension of this experience. First, we will present and discuss a model that we have developed over the last several years. This model identifies the kinds of knowledge and learning involved in art viewing activities. Second, we will present the results of an empirical study conducted to provide support for the model. Finally we will briefly discuss the model's usefulness for the purposes of aesthetic education. [End Page 78] The Model of Aesthetic Understanding as Informed Experience The Model of Aesthetic Understanding as Informed Experience provides an explanation of the process of understanding and appreciating a work of art from an educational perspective: it identifies the types of knowledge involved and it also pinpoints the kinds of learning at each stage in the process leading to an understanding of the aesthetic object.In this model, the process of viewing and understanding a work of art is visualized as a two-phased type of informed experience. Through a process of experiential learning, the viewer first encounters the work of art and formulates an initial interpretation. Then, through a process involving theoretical learning, the viewer compares his or her first interpretation with a related body of external, scientific information. This second step in the learning process leads to a reconstruction of knowledge about the work of art. Tandem use of the two processes assists the viewer in furthering his or her understanding of the art object; it also promotes growth in his or her art viewing skills. In the course of each new encounter with an aesthetic object, the interplay of experiential and theoretical learning leads to additional development of the viewer's background knowledge in art, resulting in better preparedness to successfully engage the next work of art. 4 Theoretical Foundations of the Model Three different theories informed the development of the model. 5 By using anecdotal evidence obtained from a group of fifty-two museum professionals, Mihaly Csikszentmihalyi and Rick E.Robinson were able to identify the four major dimensions of aesthetic experience: intellect, communication, perception, and emotion. Each one of these dimensions constitutes, to some extent, a challenge that the work of art addresses to the viewer. According to these researchers, the intellectual dimension of aesthetic experience consists of all aspects of the viewer's attempts to use knowledge in order to find meaning in the work of art (TAS, 27-71). Csikszentmihalyi and Robinson also propose a model that describes the aesthetic encounter in terms of an interaction between the viewer, the work of art, and the artist. To this encounter, the viewer brings his skills in aesthetic appreciation; these may be... (shrink)

This paper, based on a talk given at a conference on compassion in health care held at the Royal Society of Medicine in November 2012, argues that the ethical requirement for humanity in health care is obvious and needs little ethical analysis – the problem is to get the results of ethical reflection, ordinary humanity and everyday common sense, into everyday behaviour. The author offers some suggestions that might help to achieve this aim and bring back the human face of (...) health and social care. These suggestions concern organisational structural changes (including `humanity objectives' in appraisal and reward schemes); individual attitudes (including self assessment of their own humanity in their work by all health and social care workers – `does my own practice manifest a human face?'); and a possible research agenda (and a concomitant effort to remind all health care research funders that `humanity is an integral component of medical, health and care research'. And the author proposes a standing high level `humanity task force' to implement and oversee Health Education England's recent `humanity mandate'. (shrink)

The preceding symposium articles speculate on the psychosocial dynamics of discrimination as reverberating with grief, mourning, melancholia, and denial. They invite a psychoanalytic paradox on the fate of inchoate loss and its complex relation to oppression and depression: constellations of attachment to loss met with its social and psychical disavowal render inexpressible to the other the work of mourning and drive its myriad expressions. A different way of putting the dilemma is that grief calls upon symbolic equation and the pain (...) of symbolization. Deborah Britzman's coda reads the psychoanalyst Melanie Klein's consideration of depression as the origin of the human condition with Paulo Freire's call to educators for a radical humanization to release oppression. Between Freire's Pedagogy of the Oppressed and Klein's Love, Guilt, and Reparation, the coda traces a signifying loss that attests to the entwined roots of the self/other matrix with attention to the needed fluctuations within interiority and exteriority, loss and the depressive position, illness and health, and psychoanalysis with pedagogy. (shrink)

In the svārthānumāna chapter of his Pramāṇavārttika, the Buddhist philosopher Dharmakīrti presented a defense of his claim that legitimate inference must rest on a metaphysical basis if it is to be immune from the risks ordinarily involved in inducing general principles from a finite number of observations. Even if one repeatedly observes that x occurs with y and never observes y in the absence of x, there is no guarantee, on the basis of observation alone, that one will never observe (...) y in the absence of x at some point in the future. To provide such a guarantee, claims Dharmakīrti, one must know that there is a causal connection between x and y such that there is no possibility of y occurring in the absence of x. In the course of defending this central claim, Dharmakīrti ponders how one can know that there is a causal relationship of the kind necessary to guarantee a proposition of the form “Every y occurs with an x.” He also dismisses an interpretation of his predecessor Dignāga whereby Dignāga would be claiming non-observation of y in the absence of x is sufficient to warrant to the claim that no y occurs without x. The present article consists of a translation of kārikās 11–38 of Pramānavārttikam, svārthānumānaparicchedaḥ along with Dharmakīrti’s own prose commentary. The translators have also provided an English commentary, which includes a detailed introduction to the central issues in the translated text and their history in the literature before Dharmakīrti. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two (...) London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

By performing an abduction of Bateson and Peirce, we come to understand the logic of the sacred as a semiotic and phenomenological communicative phenomenon. First, I compare and contrast their ideas concerning ontology, epistemology, and logic. Next, I articulate how both theorists construct their epistemologies within a triadic frame of relations that successfully accounts for a communicative logic that activates the integration of body and Mind. Finally, I bring Bateson’s triadic relations of aesthetics,consciousness (mental process), and the sacred in line (...) with Peirce’s existential semiotic categories of Firstness, Secondness, and Thirdness. We discover the sacred is constituted within a communicative logic that is abductive. As such, I argue that Bateson’s epistemology of the sacred becomes more accessible as a postmodern philosophy when viewed as a condition of phenomenological semiosis. (shrink)