In the initial wave of the opioid crisis, uninformed prescribing practices and lax oversight were the drivers of opioid addiction and death. Although opioid prescriptions have decreased by 44.4 percent between 2011-2020,1 the number of deaths linked to prescription opioids has decreased only marginally.2 The marked fall in opioid prescribing without a concomitant reduction in opioid-related deaths suggests that an at-risk population continued to receive prescription opioids, whether directly or indirectly, from a medical professional. Currently, illicitly manufactured fentanyl (IMF) is (...) the culprit for the majority of the approximately 81,000 annual opioid-related deaths.3 This finding has been misleadingly used to suggest that prescription opioids for chronic pain are no longer (and never were) a relevant concern,4 while the reality is that their lethal consequences are simply dwarfed by the marked rise in IMF deaths.5. (shrink)

An eighth grade student from Oregon delves into the meaning of art.

Louis Perron Le discours cosmologique actuel permet-il d’affirmer le caractère théophanique du cosmos, au sens où celui-ci pourrait être considéré comme le lieu de la manifestation visible et immédiate de Dieu? Plus généralement : est-il en mesure d’ouvrir un chemin vers la foi? Contrairement à un discours récurrent, l’auteur, s’appuyant sur l’oeuvre de Jean Ladrière, défend la thèse qu’il n’existe pas de voie royale conduisant de la science à la foi. Celle-ci peut cependant recueillir l’image scientifique du monde et lui (...) conférer une signification propre, moyennant un parcours herméneutique s’appuyant sur l’articulation des différents registres de sens et dont la médiation philosophique constitue le passage obligé. (shrink)

The debate surrounding the issue of collective moral responsibility is often steeped in metaphysical issues of agency and personhood. I suggest that we can approach the metaphysical problems surrounding the issue of collective responsibility in a roundabout manner. My approach is reminiscent of that taken by P.F. Strawson in "Freedom and Resentment" (1968). Strawson argues that the participant reactive attitudes - attitudes like resentment, gratitude, forgiveness and so on - provide the justification for holding individuals morally responsible. I argue that (...) the framework of the reactive attitudes extends to collectives and provides the justification for holding collectives morally responsible. (shrink)

In the social sciences and in everyday speech we often talk about groups as if they behaved in the same way as individuals, thinking and acting as a singular being. We say for example that "Google intends to develop an automated car", "the U.S. Government believes that Syria has used chemical weapons on its people", or that "the NRA wants to protect the rights of gun owners". We also often ascribe legal and moral responsibility to groups. But could groups literally (...) intend things? Is there such a thing as a collective mind? If so, should groups be held morally responsible? Such questions are of vital importance to our understanding of the social world. In this lively, engaging introduction Deborah Tollefsen offers a careful survey of contemporary philosophers? answers to these questions, and argues for the unorthodox view that certain groups should, indeed, be treated as agents and deserve to be held morally accountable. Tollefsen explores the nature of belief, action and intention, and shows the reader how a belief in group agency can be reconciled with our understanding of individual agency and accountability. _Groups as Agents_ will be a vital resource for scholars as well as for students of philosophy and the social sciences encountering the topic for the first time. (shrink)

Inner speech has been shown to vary in form along several dimensions. Along condensation, condensed inner speech forms have been described, that are supposed to be deprived of acoustic, phonological and even syntactic qualities. Expanded forms, on the other extreme, display articulatory and auditory properties. Along dialogality, inner speech can be monologal, when we engage in internal soliloquy, or dialogal, when we recall past conversations or imagine future dialogs involving our own voice as well as that of others addressing us. (...) Along intentionality, it can be intentional (when we deliberately rehearse material in short-term memory) or it can arise unintentionally (during mind wandering). We introduce the ConDialInt model, a neurocognitive predictive control model of inner speech that accounts for its varieties along these three dimensions. ConDialInt spells out the condensation dimension by including inhibitory control at the conceptualization, formulation or articulatory planning stage. It accounts for dialogality, by assuming internal model adaptations and by speculating on neural processes underlying perspective switching. It explains the differences between intentional and spontaneous varieties in terms of monitoring. We present an fMRI study in which we probed varieties of inner speech along dialogality and intentionality, to examine the validity of the neuroanatomical correlates posited in ConDialInt. Condensation was also informally tackled. Our data support the hypothesis that expanded inner speech recruits speech production processes down to articulatory planning, resulting in a predicted signal, the inner voice, with auditory qualities. Along dialogality, covertly using an avatar’s voice resulted in the activation of right hemisphere homologs of the regions involved in internal own-voice soliloquy and in reduced cerebellar activation, consistent with internal model adaptation. Switching from first-person to third-person perspective resulted in activations in precuneus and parietal lobules. Along intentionality, compared with intentional inner speech, mind wandering with inner speech episodes was associated with greater bilateral inferior frontal activation and decreased activation in left temporal regions. This is consistent with the reported subjective evanescence and presumably reflects condensation processes. Our results provide neuroanatomical evidence compatible with predictive control and in favor of the assumptions made in the ConDialInt model. (shrink)

This article provides the first complete edition of the eighteen quodlibetal questions ascribed to Adenulf of Anagni (†1289) with an introductory study concerning the life and works of this author. Although the analysis of the texts reveals a strong dependence of Adenulf on the Summa Halensis, Thomas Aquinas and Gerard of Abbeville and a modest degree of originality, these questions represent an important source for the rising Thomism and the reception of the most prominent 13th-century figures.

Recent discussions of rational deliberation in science present us with two extremes: unbounded optimism and sober pessimism. Helen Longino (1990) sees rational deliberation as the foundation of scientific objectivity. Miriam Solomon (1991) thinks it is overrated. Indeed, she has recently argued (2006) that group deliberation is detrimental to empirical success because it often involves groupthink and the suppression of dissent. But we need not embrace either extreme. To determine the value of rational deliberation we need to look more closely at (...) the practice and practitioners of science. I offer a closer look here by exploring the joint agency of small research teams. Although there are factors that contribute to the suppression of dissent in group contexts, a closer look at the literature on group dynamics suggests that there are ways to mitigate the effects of groupthink. Thus, there is reason to be cautiously optimistic about the value of rational deliberation within certain scientific contexts. (shrink)

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time (...) dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge. (shrink)

L’article se propose de présenter l’éthique philosophique de Jean Ladrière comme une recherche de croisement entre ces deux dimensions constitutives de l’expérience éthique que sont les points de vue universel et existentiel. On couvrira pour ce faire toute l’étendue de la démarche éthique, telle que Ladrière la déploie depuis l’expérience pré-réflexive jusqu’à la détermination effective de l’action en regard d’une situation particulière. Dans cette perspective, l’éthique philosophique apparaît arc-boutée à la fois à l’universalité de la normativité immanente à l’action et (...) à la singularité existentielle d’une destinée unique. (shrink)

The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's concept (...) of governmentality is helpful in understanding the production of the citizen subject, its location within the 'art of government', as well as the ethical and political implications of citizenship in the context of mental health. (shrink)

Although there have been a number of recent discussions about the emotions that we bring with us to our epistemic endeavors, there has been little, if any, discussion of the emotions we bring with us to epistemic appraisal. This paper focuses on a particular set of emotions, the reactive attitudes. As Peter F. Strawson and others have argued, our reactive attitudes reveal something deep about our moral commitments. A similar argument can be made within the domain of epistemology. Our "epistemic (...) reactive attitudes" reveal our epistemic commitments. Reflection on the role they play in our practice of epistemic appraisal can contribute to a number of different debates in contemporary epistemology, including the nature of epistemic norms and epistemic responsibility. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare (...) with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation. (shrink)

There is a small, but growing, number of philosophers who acknowledge the existence of plural subjects – collective agents that act in the world and are the appropriate subject of intentional state ascriptions. Among those who believe in collective agency, there are some who wish to limit the types of intentional state ascriptions that can be made to collectives. According to rejectionists, although groups can accept propositions, they cannot believe them. In this paper I argue that, given the centrality of (...) belief and the similarities between individual belief and collective attitudes, we ought to reject rejectionism. If one believes in collective agency, one must also believe in collective belief. (shrink)

In everyday discourse and in the context of social scientific research we often attribute intentional states to groups. Contemporary approaches to group intentionality have either dismissed these attributions as metaphorical or provided an analysis of our attributions in terms of the intentional states of individuals in the group.Insection1, the author argues that these approaches are problematic. In sections 2 and 3, the author defends the view that certain groups are literally intentional agents. In section 4, the author argues that there (...) are significant reasons for social scientists and philosophers of social science to acknowledge the adequacy of macro-level explanations that involve the attribution of intentional states to groups. In section 5, the author considers and responds to some criticisms of the thesis she defends. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews (...) constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity (...) through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

Given the importance of scientific research in shaping our perception of the world, and our senses of what policies will and won’t succeed in altering that world, it is of great practical, political, and moral importance that we carry out scientific research with integrity. The phenomenon of scientific fraud stands in the way of that, as scientists may knowingly enter claims they take to be false into the scientific literature, often knowingly doing so in defiance of norms they profess allegiance (...) to. In this chapter we take a look at some of the causes of scientific fraud, and how it might be manifested in large-scale research teams and situations of anonymous authorship. We find that such cases make trouble for what might seem like intuitive answers to the question “who should be held responsible for this fraud?”, and we argue that in such cases it would be better to hold the entire community responsible for seeing to it that there is less fraud. (shrink)

Objective:To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design:Prospective clinical interventional study.Setting:Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland.Participants:Nine junior physicians in postgraduate training.Intervention:Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results:Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients’ involvement in the (...) decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion:An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

In “Group Testimony” (2007) I argued that the testimony of a group cannot be understood (or at least cannot always be understood) in a summative fashion; as the testimony of some or all of the group members. In some cases, it is the group itself that testifies. I also argued that one could extend standard reductionist accounts of the justification of testimonial belief to the case of testimonial belief formed on the basis of group testimony. In this paper, I explore (...) the issue of group testimony in greater detail by focusing on one putative source of testimony, that of Wikipedia. My aim is to the answer the following questions: Is Wikipedia a source of testimony? And if so, what is the nature of that source? Are we to understand Wikipedia entries as a collection of testimonial statements made by individuals, some subset of individuals, or is Wikipedia itself (the organization or the Wikipedia community) the entity that testifies? If Wikipedia itself is a source of testimony, what resources do we have for assessing the trustworthiness of such an unusual epistemic source? In answering these questions I hope to further elucidate the nature of collective epistemic agency (Tollefsen 2006), of which group testimony is a paradigm example. When a mans Discourse begineth…at some saying of another, of whose ability to know the truth, and of whose honesty in not deceiving, he doubteth not; and then the Discourse is not so much concerning the Thing, as the Person; and the Resolution is called Beleefe, and Faith: Faith in the man. (1651/1991, Ch. 7; p. 48). (shrink)

When restricted to proving $\Sigma _{i}^{q}$ formulas, the quantified propositional proof system $G_{i}^{\ast}$ is closely related to the $\Sigma _{i}^{b}$ theorems of Buss's theory $S_{2}^{i}$ . Namely, $G_{i}^{\ast}$ has polynomial-size proofs of the translations of theorems of $S_{2}^{i}$ , and $S_{2}^{i}$ proves that $G_{i}^{\ast}$ is sound. However, little is known about $G_{i}^{\ast}$ when proving more complex formulas. In this paper, we prove a witnessing theorem for $G_{i}^{\ast}$ similar in style to the KPT witnessing theorem for $T_{2}^{i}$ . This witnessing theorem (...) is then used to show that $S_{2}^{i}$ proves $G_{i}^{\ast}$ is sound with respect to $\Sigma _{i+1}^{q}$ formulas. Note that unless the polynomial-time hierarchy collapses $S_{2}^{i}$ is the weakest theory in the s₂ hierarchy for which this is true. The witnessing theorem is also used to show that $G_{i}^{\ast}$ is p-equivalent to a quantified version of extended-Frege for prenex formulas. This is followed by a proof that Gi p-simulates $G_{i+1}^{\ast}$ with respect to all quantified propositional formulas. We finish by proving that S₂ can be axiomatized by $S_{2}^{1}$ plus axioms stating that the cut-free version of $G_{0}^{\ast}$ is sound. All together this shows that connection between $G_{i}^{\ast}$ and $S_{2}^{i}$ does not extend to more complex formulas. (shrink)

La relación entre filosofía y teatro ocupa un lugar interesante y no siempre explorado en la filosofía de Gilles Deleuze. En el presente artículo exponemos la noción de teatro tal como aparece en la obra del autor vinculada al problema de una nueva imagen del pensamiento. Consideramos que el uso metodológico del teatro se encuentra diseminado a lo largo de todo su itinerario filosófico. Lo teatral funciona como una matriz de análisis que permite distinguir las fuerzas que dramatizan un concepto, (...) y esto se inscribe en el marco de una crítica a la representación en la filosofía de Deleuze. (shrink)

Ils sont suisse, canadien, belge, roumain ou encore français et se sont réunis à Montréal pour se pencher sur la notion de «limite» dans les travaux de Jean Ladrière. On le sait, l'oeuvre de Jean Ladrière se déploie, avec génie et originalité, dans bien des domaines: la physique, les mathématiques, la logique, les sciences du langage, la philosophie et la théologie. Les textes réunis dans ce volume tentent de penser les «articulations du sens» de cette notion de «limite», en prenant (...) la mesure des questionnements les plus contemporains, que ceux-ci émanent de perspectives scientiques, politiques, éthiques ou encore pratiques. (shrink)

"Teaching after all is about knowing children well" -- from A Letter to Teachers "Perrone has given us a gift, a book worth reading over many times, an important reflection on his many years of close observation of schools and school people, parents, teachers, children, and their communities." -- Deborah W. Meier, principal, Central Park East Secondary School Simple, elegant and full of common sense, these reflections on the art of teaching address the deepest concerns teachers have for their (...) work with children and young people. (shrink)

Contemporary analytic epistemology exhibits an individualistic bias. The standard analyses of knowledge found in current epistemological discussions assume that the only epistemic agents worthy of philosophical consideration are individual cognizers. The idea that collectives could be genuine knowers has received little, if any, serious consideration. This individualistic bias seems to be motivated by the view that epistemology is about things that go on inside the head. In this paper I challenge this type of epistemic individualism by arguing that certain groups (...) are intentional agents and that cognition occurs at the level of groups. In section I, I extend a plausible and well-defended account of individual intentionality to organizations. In section II, I appeal to research on distributed cognition in order to challenge the view that cognition occurs exclusively in the individual mind-brain. Having established that groups can be believers and cognizers, I turn to the issue of the justification of group belief. In section III, consider whether a reliabilist account of justification can be extended to groups. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

This paper focuses on the specific topic of oniric and prophetic praenotio, which Pomponazzi discussed in his main works. Pomponazzi aims at proving that dreams and prophecies are not inspired by Christian God, angels or demons, but are natural phaenomena, depending on divine, impersonal providence (fatum), which guarantees through astral movement the eternal preservation of human species.

Despite changes to research and practice, that, to some degree, acknowledge that people are shaped by their contexts, the treatment of mental illness remains largely focused on interventions that take place at the level of the individual. Conceptualizing mental illness as something that resides in individuals can lead to reliance on neurobiological and psychotherapeutic solutions, and away from conversations about not only contextual causes of mental distress, but also sociopolitical solutions to mental distress. Further, it can lead to the use (...) of mental health interventions that focus on the biology of an individual without a consideration for how those interventions themselves may have psychological, social, or political consequences that act to shape an individual's identity, agency, and relationship to their community. This paper examines one medicolegal intervention, the community treatment order, using the philosophical work of Grosz and Foucault to consider how this intervention affects the experience and construction of identity, and the impact of this on an individual's sense of agential membership in a community. This discussion aims to increase understanding of the individual and social implications of interventions for mental illness, and provide a conceptualization of the relationship between identity, agency, and ethics which can inform critical research and nursing practice more broadly. (shrink)