Narrative ethics taps into an inherent human need to tell our own stories centred on our own moral values and to have those stories heard and acknowledged. However, not everyone’s words are afforded equal power. The use of narrative ethics in bioethical decision-making is problematized by a disparity in whose stories are told, whose stories are heard, and whose stories are believed. Here, I conduct an analysis of narrative ethics through a critical theory lens to show how entrenched patterns of (...) narrative neglect in medicine are harming not only our capacity to make use of narrative ethics but also our capacity to deliver effective healthcare. To illustrate this point, I use three examples where the patient’s gender affects how their stories unfold: autism, weight, and pain management. From these, I argue that the use of narrative ethics without the application of a critical theory lens risks the exacerbation of what Miranda Fricker refers to as “testimonial injustice,” the prima facie harm experienced by individuals whose credibility is undermined by others’ prejudices. Finally, I suggest that narrative ethics can be a powerful tool for mitigating oppressive practices in medicine if we couple it with critical analysis that enables us to understand the power dynamics at play in storytelling. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?

t. 1. Filosofii͡a : samosoznanie cheloveka i obshchestva -- t. 2. Politika i istoriosofii͡a -- t. 3. Politika i diplomatii͡a -- t. 4. Kulʹtura i sovremennostʹ -- t. 5. Zapadnoevropeĭskai͡a filosofii͡a, politika i kulʹtura: problemy i perspektivy.

Although science supplies medicine's “gold standard,” knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always (...) situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice. (shrink)

In Nicolaus Cusanus on Faith and the Intellect: A Case Study in 15th-Century Fides-Ratio Controversy, K.M. Ziebart presents an account of the Cusan epistemology as a fascinating late-medieval attempt to definitively harmonize faith and reason.

Medical ethics, principles, persons, and perspectives is discussed under three headings: History, Theory, and Practice. Under Theory, the author will say something about some different approaches to the study and discussion of ethical issues in medicine—especially those based on principles, persons, or perspectives. Under Practice, the author will discuss how one perspectives based approach, hermeneutics, might help in relation first to everyday ethical issues and then to public controversies. In that context some possible advantages of moving from controversy to conversation (...) will be explored; and that will then be illustrated with reference to a current controversy about the use of human embryos in stem cell therapy research. The paper begins with history, and it begins in the author’s home city of Edinburgh. (shrink)

An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or (...) breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. (shrink)

Immediately after the publication of Darwin's book on the origin of species, Engels, having familiarized himself with it, wrote to Marx on December 12, 1859: "All in all, Darwin, whom I am reading right now, is superb. Teleology had hitherto not yet been destroyed in one of its aspects, and now this has been done. Moreover, hitherto there has never been so sweeping an attempt to prove historical development in nature, especially with such success." Soon Marx enlarged upon the evaluation (...) of Darwinism. In his letter of December 19, 1860, he commented that this theory "provides a foundation in natural history for our views." It is therefore no accident that Engels, in developing the principles of dialectical materialism and problems of the dialectics of nature, interested himself so deeply and comprehensively in the theory of evolution. (shrink)

New plans are continually arising, of which the latest sometimes turns out to be only a resuscitation of the old, nor in the future will there ever be a dearth of even more definitive projects.

Nazariyat, Journal for the History of Islamic Philosophy and Sciences, issued twice a year in English and Turkish (Nazariyat İslam Felsefe ve Bilim Tarihi Araştırmaları Dergisi), is a refereed international journal. It publishes original studies, critical editions of classical texts and book reviews on Islamic philosophy, kalām, theoretical aspects of Sufism and the history of sciences. The goal of Nazariyat is to contribute to the discovery, examination and reinterpretation of the theoretical traditions in the history of Islamic thought, by giving (...) special attention to the post-classical period of it. **ISSN: 2148-8088 E-ISBN: 2547-9415**. (shrink)

This monograph aims to mathematically codify the notion of "moral systems" and define a sensible distance between them. It consists of three parts, aimed at an audience with varying interests and mathematical backgrounds. The first part steers philosophical, formally defining moral systems and several related concepts. The second part studies black box algorithms, including questions of inference and metric construction. The third part explores the technical construction of metrics amongst conditional probability distributions.

Philosophy of history; the idea of the not-being and the history, by K. M. Jamil.--Philosophy of history, by Khwaja Ashkar Husain.--Philosophy of history, by A. H. Kamali.--Philosophy of history, by B. H. Siddiqi.--Philosophy of history: explanation in history, by Kazi A. Kadir.

Investigation into the reality of time can be pursued within the ontological domain or it can also span human thought and natural language. I propose to approach time by correlating three domains of inquiry: metaphysical time, the human concept of time, and temporal reference in natural language, entertaining the possibility of what I call a ‘horizontal reduction’ and ‘vertical reduction’. I present a view of temporalityL/E as epistemic modality, drawing on evidence from the L domain and its correlates in the (...) E and M domains. On this view, the human concept of time is a complex, ‘molecular’ concept and can be broken down into primitive concepts that are modal in nature, featuring as degrees of epistemic commitment to representations of states of affairs. I present evidence from tensed and tenseless languages and point out its compatibility with the view of real time as metaphysical modality. (shrink)

This commentary focuses on two moral values implied by the case study but not specified in the working party's conclusions, namely equitable treatment of the most vulnerable and the value of political government.