In lieu of an abstract, here is a brief excerpt of the content:“Normalizing” Intersex Didn’t Feel Normal or Honest to Me.Karen A. WalshI am an intersex woman with Complete Androgen Insensitivity Syndrome (CAIS). My 57–year history with this has its own trajectory—mostly driven by medical events, and how I and my parents reacted. Most of my treatment by physicians has not been positive. It didn’t make me “normal” at all. I was born normal and didn’t require medical interventions. And (...) by the way, I’ve never been confused about who or what I am.Truthful disclosure didn’t come to me about my biology and what was done to me as an infant until I was 33, when I forced the issue by removing my medical records from my endocrinologist’s office. I learned that there was never full disclosure to my [End Page 119] parents either, and therefore there was no informed consent for the “corrective” surgeries performed on me as an infant. My parents were only told that their little girl would get cancer and would not have a normal development as a girl unless her “deformed ovaries” were removed, and that they should never discuss these problems with me. Thus, after having presented with an inguinal hernia and having exploratory surgery at age 16 months, my intra–abdominal testes were removed in a second surgery two months later. I was pronounced a “male pseudohermaphrodite,” a diagnosis that was shared neither with my parents nor with me.Years later, I discovered an article my surgeon published in 1960 in the Delaware Medical Journal about me and another intersex person he operated on (whom he labeled a “true hermaphrodite”). The article gives a very detailed pathology report of my gonads, but only two sentences regarding my welfare and the rationale for performing those surgeries. Dr. J. F. Kustrup wrote in this article, “These [two cases] emphasize the need for early diagnosis and treatment in order to avoid the possibility of malignant change and to permit these individuals to follow a normal psychosexual pattern.” And: “Hermaphroditism and pseudohermaphroditism are conditions in which early diagnosis and treatment are essential to avoid malignant degeneration and to allow the child some chance toward normal pyschic [sic] development.” I was grateful to find this article because it revealed the unfounded assumptions underpinning the recommendations for treatment, much of which continues today. Worse even than the sort of social prejudice that shapes treatment is the absence of evidence for what doctors treat as “necessary” interventions. For my syndrome, CAIS, there never was—and still is not—data to support the cancer scare, or the opinion that I’d be confused and not have a normal life.From about the age of four, I can remember being different and being stonewalled by my doctor and prevented by my parents from talking about it. The feelings and fears I tried to express were shushed away, and I could tell that my questions were upsetting everyone. Even if I had wanted to be complicit with their lame diversions and nonsensical explanations, the massive abdominal scars were there as a daily reminder and hinted at a very different story.The Road to Hell is Paved with Good IntentionsGrowing up, I was treated like a fascinoma and a lab rat at a major teaching hospital on the East Coast. All I learned from those doctors as a young kid was what it feels like to be ogled, photographed and probed by a roomful of white–coated male doctors. Dissociation made itself my friend, and helped me to cope through the annual genital and anal exams and probing. I thought I was a freak and I felt completely powerless to protect myself from them and their “care”.At my annual appointment at age 12, with my mom present, three doctors told me I was infertile. Learning that I couldn’t have kids really saddened and shocked me, but there was no opportunity to talk about my feelings—either that day, or any time afterward. I was told to stop crying. I remember them telling me that there was no one else like me and that this was a random genetic anomaly, thereby reinforcing the freakishness... (shrink)

Although prior work on ethical decision-making has examined the direct impact of magnitude of consequences as well as the direct impact of emotions on ethical judgments, the current research examines the interaction of these two constructs. Building on previous research finding disgust to have a varying impact on ethical judgments depending on the specific behavior being evaluated, we investigate how disgust, as well as happiness and sadness, moderates the effect of magnitude of consequences on an individual’s judgments of another person’s (...) unethical behavior. Specifically, we propose and find that because disgust and happiness are both associated with more heuristic-based processing, they both lead to a stronger reliance on the magnitude of consequences when forming ethical judgments. In contrast, because sad and neutral emotional states are associated with more systematic processing, they both result in a weaker reliance on the magnitude of consequences. As such, the effect of magnitude of consequences on judgments of unethical behaviors is stronger when individuals making the judgments are experiencing disgust or happiness versus sadness or a neutral state. This research shows that ethical judgment severity is contingent on individual-level factors, particularly the current emotional state being experienced by the individual, interacting with magnitude of consequences to impact the ethical decision-making process. (shrink)

Previous work suggests that gender attitudes are associated with different individual and organizational factors. At the same time, ethics research suggests that many of these same variables can influence ethical reasoning in companies. In this study, we sought to combine these streams of research to investigate whether individual skepticism of women's employment is related to ethical reasoning in a gender-based ethical situation. The results of the hierarchical regression analysis indicated that skepticism of women's employment was negatively related to the recognition (...) that the gender-based dilemma involved an ethical problem, and that skepticism was also negatively related to judgments that the situation was unethical. These findings imply that companies should advance policies that increase tolerance for women's employment, such as diversity training codes of conduct, and ethics training. (shrink)

Free speech, its many definitions, and efforts by special interest groups to assure their message is distributed have led to sharp conflict and rising tensions, particularly in universities. For over 10 years, tactics at the University of Massachusetts to assure newspaper content acceptable to special interest groups serve as an example in this article. Women editors seeking guaranteed pages in the university newspaper for women with content unreviewed by regular editors illustrates the rocky path of protest, negotiation, and examination and (...) a resulting confusion and dissatisfaction among all parties. (shrink)

Volume 24, Issue 8, August 2024, Page 43-45.

Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long‐term conditions requires deeper appreciation if nurses are to more effectively support person‐centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant experiences. (...) The major theme emerging from participant interviews was the ‘invisible disequilibrium’ characterised by three subthemes: ‘losing equilibrium’, ‘becoming embattled’ and ‘evolving illness’. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the ‘whole’, as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an ‘invisible disequilibrium’, with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person‐centric care, nursing practice should explore the ‘whole’ of the person's experience, value people’s knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness. (shrink)

-/- Carefully considering the difference in the philosophical potential of page poetry and performance poetry, Karen Simecek argues that it is only by considering them side by side that the unique cognitive value of each can be realised. -/- Focusing on spoken word poetry reveals the importance of voice and embodied words to the differing epistemic rewards of engaging with contemporary works of poetry in both private reading and live performance. This concept of embodied voice progresses a new (...) line of thinking in the cognitivism debate and unlocks the philosophical value of engaging with poetry. Simecek's discussion of performed poetry also advances discussions of affect and experience in contemporary analytic aesthetics which raise new insights and connections within the field. -/- The moral significance of the differing effects of poetry finds comprehensive articulation through a rich philosophical analysis of the thoughts and affects which arise in particular contexts. Simecek concludes that when page poetry is treated as paradigmatic, this enables reflection in the singular, whereas taking poetry in live performance as paradigmatic enables reflection on what is shared and shareable with others. (shrink)

he World Wide Web is not just an electronic display of text and information. To navigate the WWW, readers need to make decisions about how to pursue and translate their decisions into physical actions. The Web is an interface. -/- Because the WWW shares common ground with both papertext writing and with software interfaces, theories and research from interface design, human-computer interaction, and cognitive science can be used to improve web page interfaces and make the design and presentation of (...) information more effective and usable for the reader. -/- One important similarity between writing and interface design is that both emphasize the need for a thorough audience analysis to determine the tasks, goals, and needs of the reader or user. Writers can apply their knowledge of techniques used to focus their writing on the needs of the user, such as reader analysis and reader-response criticisms, to the interface of the WWW document. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Practical Wisdom and Moral Imagination in Sense and SensibilityKaren StohrThere is no single virtue more important to Aristotle's ethical theory than the intellectual virtue of phronesis, or practical wisdom. Yet for all its importance, it is not easy to make sense of this virtue, either in Aristotle's own writings or in virtue ethics more generally. Insofar as Aristotle defines it, he does so opaquely, saying it is "a state (...) grasping the truth, involving reason, concerned with action about things that are good or bad for a human being." 1Practical wisdom is a form of knowledge aimed fundamentally at acting well. It requires both a general understanding of what is worthwhile in human life and the ability to act in ways that reflect that understanding. 2 My goal in this paper is to explore the latter aspect of practical wisdom in its application to ordinary social behavior. The circumstances that will interest me here are often thought to be the domain of manners or decorum, rather than morals proper. Although no one who takes Hume seriously can deny the moral significance of manners, the relationship between one's inner state of character and how that character is expressed in seemingly mundane behavior has received insufficient attention from moral philosophers. 3 In such a task, there can be few better places to begin than with Jane Austen, whose novels reveal the intricacies of ordinary moral behavior with extraordinary acumen.I shall use Austen's Sense and Sensibility to examine the skill associated with knowing how to behave rightly in the sense we associate with propriety or decorum. This skill is essential to pleasant social life, and hence, on the Aristotelian view, to human flourishing. Yet it is often lacking, even among those who have sound moral principles and good hearts. Well-meaning people frequently say or do what is inappropriate. [End Page 378] Consider, for instance, how common it is for kindly disposed people to say to bereaved friends things like, "it's all for the best" or "be thankful for your other healthy children" or "you're young, you'll marry again." The intricacies of offering sympathy are hard to get right, and otherwise good people can unwittingly leave behind disasters in their wakes.The skill of acting well in complex social situations has interesting links to the capacity for moral imagination. Engaging in imaginative identification with others is essential to empathy. 4 Without suggesting that empathy is at the root of all fluid social interactions, I shall argue that certain characteristic failures to act well in that sphere are imaginative failures. In other words, insofar as the exercise of practical wisdom is present in the realm of manners, it requires moral imagination.Failures of moral imagination, however, can take different forms and have different social effects. I shall use two of Austen's characters in Sense and Sensibility—Marianne Dashwood and Mrs. Jennings—to illustrate different ways in which inadequate imaginative capacity can impede the exercise of practical wisdom. The contrast I shall draw is with Elinor Dashwood, to whom I ascribe practical wisdom in full. 5 This contrast is especially interesting because it is not always very sharp: all three characters have fundamentally good moral principles and warm hearts. Yet unlike Elinor, Mrs. Jennings and Marianne routinely fail to act well, and in characteristic ways. Despite the differences in their characters, they have in common an inability to use moral imagination appropriately. The moral errors of Marianne and Mrs. Jennings occur in relatively insignificant circumstances, but the errors themselves point to something deeper about how the virtue of practical wisdom functions in ordinary moral practice.In exploring the link between moral imagination and moral practice, it will help to remember Aristotle's emphasis on the reciprocity between practical wisdom and the moral virtues. Aristotle held that that practical wisdom is necessary for the exercise of the moral virtues and that conversely, the moral virtues are necessary for the exercise of practical wisdom. 6 The justification for the first of these two claims is clearest in the context of Aristotle's doctrine of the mean. Since what counts as a virtuous action depends on features... (shrink)

This article will introduce readers to current debates in the philosophy of poetry. This includes discussion of the need for a philosophy of poetry as distinct from a philosophy of literature, the (in)compatibility of poetry and philosophy, poetic meaning and interpretation, and poetry in relation to affect, emotion and expressiveness, which opens up discussion of wider forms of poetry from spoken word to signlanguage poetry. The article ends with suggestions for future directions of research in the philosophy of poetry. I (...) argue that as the philosophy of poetry is gaining interest, the previous debates that presuppose an understanding of poetry as taking form on the page and as having fixed aboutness ought to be abandoned in favour of an understanding of a poem in the affective space, with issues of reception, interpretation, distribution, and performance in play. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics & the Environment 7.2 (2002) 39-59 [Access article in PDF] Response to My Critics Karen J. Warren Introduction In the Preface to my book, Ecofeminist Philosophy: A Western Perspective on What It Is and Why It Matters, 1 I describe as both "exciting and taxing" the process of writing the book over more than one decade (Warren, x). It was exciting because I was contributing to the (...) still nascent field of ecofeminist philosophy; it was taxing because I often found it difficult to know what I wanted to say about ecofeminism as a philosophical position. The book that emerged is my attempt to say, in my own voice and in a language and style amenable to a reflective lay audience, what I understand ecofeminist philosophy to be and why I think it matters.Ecofeminist Philosophy is premised on the conviction that ecofeminist philosophy has liberating potential to generate insights and recommendations for any theory, practice, or policy that is feminist, ecofeminist, or environmental. The version of ecofeminist philosophy I defend focuses on a variety of contingent interconnections—historical, empirical, socioeconomic, conceptual, linguistic, symbolic and literary, spiritual and religious, epistemological, metaphysical, political, ethical, and theoretical—among the dominations of women, other subordinated humans, nonhuman animals, and nature. It locates the commonalities of mutually reinforcing "isms of domination" (e.g., sexism, racism, classism, heterosexism, ageism, colonialism, [End Page 39] ethnocentrism, speciesism and "naturism," or the unjustified domination of nonhuman nature) in oppressive conceptual frameworks, institutions, and practices mediated and justified by a "logic of domination." Connecting these isms of domination to pressing contemporary feminist and environmental issues, I argue for a version of ecofeminist philosophy that provides both critical analyses of and creative solutions to the intersecting practices, policies, and structures of unjustified ("isms" of) domination.From my perspective, the book is bold and daring. It advocates positions (e.g., regarding spirituality) typically eschewed by feminist and ecofeminist philosophers. It takes positions (e.g., on moral vegetarianism) that are at odds with much mainstream ecofeminist literature on nonhuman animals (particularly ecofeminist animal rights literature). It defends unfamiliar or unpopular philosophical positions (e.g., on the moral considerability of nonhuman animals and nature, on the nature of social justice, on ethics as "care-sensitive," and on theory as theory-in-process). It provides an account of ecofeminist philosophy that is grounded in good science, though not in canonical ideals of objectivity and rationality. It uses cross-cultural empirical, historical, social, and cultural data to motivate and test the theoretical claims of ecofeminist philosophy. And it supports the need for and role of emotional intelligence (including the ability to care) in ethics, ethical-decision making, and the creation of life-affirming, nonviolent communities and social systems.Given the nature of the issues I address and the positions I advocate in Ecofeminist Philosophy, it is to be expected that critics will raise questions, offer criticisms, and encourage further reflection on my part about my conception and defense of ecofeminist philosophy. That is precisely what the three critics who have written commentaries on my book for this special Symposium of Ethics & the Environment—philosophers Chris Cuomo, Trish Glazebrook, and Jim Sterba—have done. It is a humbling and gratifying experience to have one's scholarship the focus of a special issue of a journal; it is even more so when the critics offer comments that are helpful and constructive. I am grateful for the time and philosophical energy all three critics have invested in writing their commentaries.In what follows, I comment on each essay separately. My hope is to provide each essay with the thoughtful attention it deserves, while offering clarifying remarks on what I attempted to do, and the version of ecofeminist philosophy I defend, in Ecofeminist Philosophy. [End Page 40] Trish Glazebrook's Essay It was a pleasure to read Professor Trish Glazebrook's essay. Glazebrook understands what I attempted to do in this book, while also providing useful, illuminating questions and suggestions for future work. I am grateful for her supportive sensitivity and scholarly attention to what I argued in Ecofeminist Philosophy and to ways I might improve my... (shrink)

Performance is increasingly important to the poet, which is evidenced by the growing numbers of videos and audio recordings online including YouTube, the National Poetry library, and Poetry Archive. As a result, there are greater opportunities to engage with poets reading their own work and consequently, there is a need to move away from thinking of poetry as primary something that takes shape on the page. Furthermore, by refocusing attention to poetry as an oral artform, in particular to poetry (...) performance, different ways of understanding the value of poetry come to the fore. The live poetry performance, I argue, offers an attempt to reclaim the personal individual expression of language in contemporary society and demands attention by the audience because of the role of voice and body in the performance. Through awareness of ‘uniqueness of voice,’ the performed poem becomes a site of collective meaning making with individual identity intact as a shared endeavour between performer and audience, and necessarily resists appropriation (in the sense that the words experienced cannot be divorced from the performer or the performance space to serve as a proxy for meaning elsewhere). This chapter therefore makes an argument for the need to engage with spoken word and performance poetry in the live performance space. (shrink)

This study explores the ability of career satisfaction to mediate the relationship between corporate ethical values and altruism. Using a sample of individuals employed in a four-campus, regional health science center, it was determined that individual career satisfaction fully mediated the positive relationship between perceptions of corporate ethical values and self-reported altruism. The findings imply that companies dedicating attention to positive corporate ethical values can enhance employee attitudes and altruistic behaviors, especially when individuals experience a high degree of career satisfaction.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.1 (2001) 21-37 [Access article in PDF] Conscience and the Concealments of Metaphor in Hobbes's Leviathan Karen S. Feldman Introduction Conscience is not a topic of terribly heated debate in Hobbes research. 1 Nevertheless, my claim in this article is that conscience in the Leviathan, which Hobbes poses as an example of the dangers of metaphor, is not merely an example of the dangers of (...) metaphor, but rather is the most dangerous metaphor, the metaphor that corrupts knowledge and thereby makes error and deception possible. Hobbes's brief account of conscience, which appears in the chapter of Leviathan on the ends of discourse, tells the story of the insinuation of metaphor into proper nomenclature; however, his example of the metaphorical use of the word conscience turns the story into one in which public knowledge itself is made private and thereby corrupted. Moreover, according to the story, private conscience is itself invented by means of a metaphor; it is in effect metaphorized into being. 2 With the emergence of private conscience, the potential of privatization expands from the privatization of the meaning of words to an entire private sphere of opinion. The metaphorical corruption of conscience invents a new understanding of knowledge as isolated from other witnesses, and the resultant privatization of truth lends itself to the corruption of that truth. Thus, whereas Hobbes characterizes the wrong use of names (of which metaphor is an instance) as a threat to accurate judgment and reason (L 22-23, 34, 161-62), as I will argue in the sections following, Hobbes's demand for the preservation of proper meaning in Leviathan corresponds to an anxiety regarding privacy and its peculiar potential for corrupting truth and knowledge. Hobbes's worries as to the dangers that metaphor poses to the stability of the commonwealth thereby converge with his worries about the dangers of conscience to the principle of public authority (cf. Strong 1993). [End Page 21] Hobbes's condemnations of conscience In Leviathan, conscience is condemned as a source of principles of human decision and action in a commonwealth. The problem with conscience as a principle of action is that it renders each individual inventor of his own rules and judge of his own actions. In brief, individual conscience is incommensurable with the public authority that defines a commonwealth: Another doctrine repugnant to civil society, is, that whatsoever a man does against his conscience, is sin; and it dependeth on the presumption of making himself judge of good and evil. For a man's conscience, and his judgment is the same thing, and as the judgment, so also the conscience may be erroneous. Therefore, though he that is subject to no civil law, sinneth in all he does against his conscience, because he has no other rule to follow but his own reason; yet it is not so with him that lives in a commonwealth; because the law is the public conscience, by which he hath already undertaken to be guided. Otherwise in such diversity, as there is of private consciences, which are but private opinions, the commonwealth must needs be distracted, and no man dare to obey the sovereign power, further than it shall seem good in his own eyes. (L 311) In this account, conscience is not just inferior to civil law as a principle guiding action, but at odds with civil society and the good of the commonwealth. The fact that conscience is private renders it problematic for the commonwealth for several reasons: First, as privately invented, it may be erroneous. Likewise, because it is private, conscience does not possess any binding power outside the individual, private sphere. Each person may be bound by his own conscience, but insofar as consciences differ, standards of action differ, and this leads to the undermining and distraction of the commonwealth. Likewise, private consciences may be divergent from one another, and the conflicts in private judgment produce conflicting actions that disturb the peace of the commonwealth. This rule of privacy is, moreover, associated with primitive life and with the state of nature... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Practice of SurgeryKaren DevonThere’s no one on the snowy road driving beside me. It’s Christmas Eve, the night the newest attending surgeon on staff gets to be on call. Tonight feels like an anniversary of sorts. The first time I performed an appendectomy “alone” was on Christmas Eve. I can’t recall if it was snowing back then since I hadn’t left the hospital in days. I had assumed (...) that while I was operating on that 26–year–old woman with new abdominal pain that moved towards the left lower quadrant, my attending staff on call was sleeping soundly. I didn’t even know where he lived, or how long it would take if something catastrophic were to happen. I phoned the white–haired man to get his blessing just before midnight. “Have you done this operation before?” he asked. “Yes, several, but not completely alone” I confessed. “Go for it and call me when you are done. Oh, and be safe!” Click. Gulp.As I drive in tonight, again past midnight, I reflect upon that night. Was it practice? A right of passage? The most appropriate treatment for the patient? Perhaps it was even safer this way since my attending really had never done this operation the way it is now done—laparoscopically—by residents. I clearly recall telling the patient and her mother, “We do this all the time! The staff surgeon on call will come in if I need him, but the chief residents always do this operation and I feel comfortable taking care of you.” Sign on the dotted line and make sure you read the part where you are told this is a teaching hospital. Not only was independence an expectation, but I was also supposed to teach the more junior house staff how to emulate what I was so expertly performing.That night I took out the rotting appendix without incident and called the grey haired surgeon in the wee hours. “Merry Christmas Doctor. Sorry to bother you. I just wanted to let you know that the patient is awake and doing well.” “Yes I know. Good work” he replied. “I was in my office. Just in case.”As a resident, I was often torn between the need to gain independence in order to learn and grow as a surgeon, and the idea that I was practicing. As most budding surgeons do, I wanted to be the person doing the surgery. Working on my technical skills was clearly an important part of expertise. Surgery is inherently different than other types of medicine. It seemed slightly more difficult for someone to stop my cutting, than to catch the error in a prescription, before some damage is done. Perhaps a little more like driving a car, than learning to use a calculator. Recently a more modern surgical education is evolving, whereby students practice by simulations on machines. Yet educators know that ultimately many “firsts” need to occur with real patients. That proficiency and expertise are more than a diagnosis, a steady hand, or even the two combined. If the experience of operating as the primary surgeon without immediate supervision, on a patient with acute appendicitis never occurred until we passed licensing exams wouldn’t that be more harmful? I may have been the least legally responsible for outcomes, that night of my own first, when the grey–haired surgeon took the [End Page E1] responsibility of trusting me. But in fact, the obligation I felt was enormous. We cannot simulate the weight of responsibility that comes when responsible for another human being, who you have met and who provides their trust in you. Furthermore, as the teachers of this art and science, we need to balance our obligations to each individual patient with our obligation to society to train competent and caring future surgeons. Surgery would have no history if the “practice” of surgery had nothing to do with practice, defined in its simplest form, yet how do we cover all of this during the late night conversation that is called informed consent. Interestingly since that December evening and for the next 200 laparoscopic appendectomies before my graduation in to... (shrink)

Whereas many philosophy courses focus upon the problem that skeptical doubts can play in knowledge claims, Kierkegaard suggests that the problem of despair is a much more significant as it encompasses not only the intellect but the entire person. This paper details this problem in the context of Kierkegaard’s “The Sickness Unto Death”, Camus’s “The Plague”, and Orwell’s “1984” (a list of suggested pages from these books is also provided). While the author discusses how this problem was broached in a (...) seminar on Kierkegaard, themes of this course could be integrated into a number of other philosophy courses, e.g. Existentialism, Philosophy of Literature, Introduction to Philosophy, and the Philosophy of Religion. (shrink)

ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address (...) the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: A highly flexible intervention that can be tailored to couples’ specific RSH concerns; Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and cognitive (...) impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S72-S78, March‐April 2022.

In lieu of an abstract, here is a brief excerpt of the content:A Bridge From Analysis to Action:Psychodynamic Analyses of Religion and Michael S. Hogue's American ImmanenceAJ Turner (bio)I. IntroductionThe purpose of this essay is to work constructively with Michael S. Hogue's groundbreaking American Immanence: Democracy for an Uncertain World to demonstrate how psychodynamic analyses of religion are essential theoretical allies in the fight for resilient democracy. The "revolution in mind"1 that psychodynamic approaches contribute, especially in their analyses of religion, (...) both complements and complicates socio-political theory as a whole. In the improvisational spirit of "yes-and," the goal here is not to identify and decry the failures and shortcomings of Hogue's theopolitical vision but rather to inspire the recovery of a sibling discourse—a kind of "rebirth of a forgotten alternative"2—that also draws deeply from the American immanental tradition in order to add psychodynamic depth to Hogue's timely and important analysis. Psychodynamic theories of religion shed light on how symbolic identifications, including and especially ultimate concerns, structure personal and collective experience. By engaging religion and theology sympathetically, constructively, and creatively, theorists such as Rollo May, Gordon Allport, Karen Horney, Erich Fromm, and Ernest Becker departed from the skepticism, reductionism, and dismissal that characterized psychoanalytic analyses of religion in the wake of Freud.3 Each of these figures, and especially Becker whose work will be a focus in this essay, are noteworthy interlocutors for extending Hogue's theopolitical theorizing of resilient democracy, particularly in how they drew unique inspiration from the American immanental tradition [End Page 44] in their social analyses. In this respect, they provide a more robust theorization of the psychosocial conditions of the associational ethos needed to connect Hogue's conception of resilient democracy with forms of agonistic organization and democratic activism. Briefly stated, psychodynamic approaches are a helpful bridge for connecting these proposals to strategies of organization, their impediments, and collective action.In this way, both psychodynamic analyses of religion and Hogue's theopolitical innovation insist that no revolutionary political change is possible, and certainly not of the kind or scale needed to counter our wickedly entangled global crises, without a deep engagement with theological imaginaries. They differ, however, in their theoretical aims. Whereas Hogue compellingly argues for the political upshot of a theology deriving from the American immanental tradition, psychodynamic analysts of religion focus on the function of ultimate concerns in individual and collective life. In other words, American Immanence rests on a methodology of analyzing the philosophical and theological assumptions that have contributed to our climate crises and then presenting clear and compelling articulation of an alternative paradigm meant to open up new ways of being. In contrast psychodynamic analyses leverage conceptual clarity of psychic reality for the fundamentally therapeutic aim of transformation. At their best, both approaches share what could be called an etiological orientation to ontological questions in order to provide liberative alternatives through rational understanding and clarification, but the terrain, and thus the problems they hope to mitigate in their analyses are focused differently. Extending the visual metaphor, they are different lenses highlighting different areas of the same landscape. Furthermore, it must be said that neither are sufficient in themselves, but the psychodynamic theorists of religion to be highlighted in this essay share deeply with Hogue's heading in American Immanence.II. A Problematic AssumptionIn emphasizing and attempting to explain4 the role of non-rational processes in the both individual and social processes of perception and organization of experience, psychodynamic theories confound a widely held and problematic assumption that the triumph of rational analysis is the hallmark for building the society to which we should aspire. Political theory in general, [End Page 45] especially as it has taken its cues from a rationalist legacy about the inherently liberating force of Reason, has been weighted toward an assumption that its task of exposing the mystifications of power would suffice in inspiring more "rational" and therefore necessarily equitable social organization. This speaks to the longstanding socio-political interest in "consciousness raising" tactics, which are often meant to dispel "false consciousness." It even comes across in the emphases of Deweyan pragmatists on education. Psychologists of all stripes point out that this approach... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Mean It’s Not My Fault:Learning about Lipedema, a Fat DisorderCatherine A. Seo“As a surgeon there is nothing more I can do for you. You need to lose 75 pounds before I can even consider repairing the damage done.” Implied and not directly stated, “… Because it’s your fault.” I sat listening, dumbfounded. I was at one of the top teaching hospitals in the country, face to face with (...) a respected Harvard Medical School trained surgeon who came highly recommended.I had seemingly irreversible damage that was leading to permanent immobility. I was experiencing excessive and uncontrollable swelling in my extremities. I was in unrelenting pain that prevented me from sleeping through the night.The surgeon looked down at the floor avoiding my gaze and—after never before mentioning weight as a possible contraindication to surgery during any of our interactions associated with five surgeries, in over two years, including at least 25 consultations, pre-op, post-op, or follow-up visits stated—in essence, “I can’t help you. You are too fat. It’s your fault.” Not until now, this moment, a couple of months after “the-surgery-gone-wrong-that-ended-in-terrible-complications,” I was being told that it was my fault.He then looked down at his pager that had conveniently buzzed within minutes after he delivered this news, and then walked out of the examining room leaving me to fend for myself in dealing with serious and life-changing complications. Susan1*, his Nurse Practitioner, printed out and handed me a standard listing of BMI calculations, marched me into the common hallway to weigh me, pointed out my BMI >30, reinforced the message that he would do nothing to remedy this horrific situation unless I lost 75 pounds, and then sent me on my way.I stood outside the hospital in shock. This just wasn’t happening, and it couldn’t be happening to me. I had grown to trust this surgeon, and I was struggling to comprehend what had just happened. As the shock wore off, I reengaged in several failed attempts to get help from him. He seemed to have convinced himself that the reason the surgery had gone awry was because of my excess weight, and not because, as I later learned, I had been misdiagnosed and the procedure, as it was performed, was far too aggressive. My health condition was deteriorating and it appeared as if weight was being scapegoated for the complications.If a solution was to be found, I was going to have to find it. After many months of research, I discovered that I have lipedema, an unrecognized [End Page E6] and generally misdiagnosed hereditary, genetically-based fat disorder. I had always had lipedema, which in my case seems to have been triggered at least since puberty. There are an estimated 17 million women in the USA alone who have lipedema, unrecognized or misdiagnosed.I, like most other women in America, knew that weight was a personal choice, and fat is a result of eating too much. Or was it? This ingrained and culturally accepted structure of knowledge began to disintegrate. I then asked the question, if this disease of lipedema is a fat disorder—and I had been to many, many doctors in my 63 years—why was it never identified? Why was I left to struggle in a constant battle trying to accomplish the impossible? I then learned about and named “anti-fat bias” and began to unravel the answers.About LipedemaAccording to Karen L. Herbst, Ph.D., M.D., endocrinologist and expert on fat disorders, lipedema (lipoedema in Europe) is an inherited genetic disease, affecting at least 11% of women of all sizes, from the extremely thin to the morbidly obese, resulting in localized fat that is bilateral, symmetrical and usually from the waist to just above the ankles. It can also affect the upper arms. Unlike the “normal” fat of obesity, lipedemic fat cannot be lost through diet and exercise. It is not uncommon for the comorbidity of overweight or obesity to accompany lipedema. Allen and Hines, physicians at the Mayo Clinic, first named Lipedema in 1940.Believed... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:These Things I BelieveA. M. ShuhamI am a health care professional who has worked in the field for two decades. I have been part of small miracles and heartbreaking events, which kept me up at night. Although I do not [End Page 120] provide direct patient care, my advanced education and expertise allows me to advise members of the health care team when difficult questions arise about the (...) goals of treatment, questions about competency and interpreting patient preferences. I believe my interest in the field was shaped by my family’s experience dealing with the challenges that come with terminal illness and advancing age. I am humbled to have been part of their journey as they faced death with dignity and grace.Living in a small community presents significant challenges that may never occur in a large urban setting. The team you work with knows your family or the names of your children because in their spare time they are the piano teacher or soccer coach for your children, friends that knew you growing up. This close knit atmosphere can be a blessing when things go well and unbearable when mistakes are made or professionals disagree, because you still interact with one another outside the context of your professional role and this is when moral distress begins.I began working with A. J. ten years ago to facilitate the completion of a health care directive. At the time A. J was beginning to show the signs of a neuro–muscular disease experienced by other members of the family. In early 2000 most directives were fairly straightforward with the option to choose artificial nutrition and hydration or not. A. J. very specifically checked “none.” Years went by living independently for A. J. but as most illnesses progress so did A. J’s, and admission to a health care institution became necessary. In many situations medically assisted nutrition and hydration would be indicated, but in this case the wishes of the patient were known in the form of a health care directive. The decision makers inability to honor the directive was the purpose for my involvement almost a decade after my initial work with A. J.No matter where you stand in the debate regarding medically assisted nutrition and hydration being burdensome or ordinary care, most people believe in the importance of a health care directive given the histories of Nancy Cruzan, Karen Quinlan and Terri Schiavo. My objective was to compile the legal information that would elucidate the patient preferences and help staff and the decision maker understand it was time to honor the directive given the advanced stage of disease. Numerous attempts were made with the surrogate and health care professionals to help them understand state statutes on health care directives supporting a patient’s right to chose. It became clear that some of the team seemed disinterested in my concerns or my responsibility as a professional, and I began to believe the difficulty was a failure on my part to communicate clearly.During that first year conversations and meetings were scheduled with the patients decision makers and they felt unable to make a decision and requested the entire family provide input. Although they understood A. J’s wishes, they felt everyone should be in agreement. In my experience when leaving decisions of this magnitude to a large extended family, communications deteriorate and little can be accomplished. Some members in the family held fundamental religious beliefs and thought a miracle could change the prognosis. While I believe as health care professionals we must respect individual religious beliefs and values, we are also morally obligated to advocate on behalf of our patients a fundamental principle I hold dear.The health care team was no more eager to address the issue than the family. I had produced specific state statutes regarding the health care directive of a previously competent person and even in light of this information, some individuals continued to believe the surrogates decision took precedence over the directive. This growing tension left me feeling angry and ineffective, questioning my role in the organization, while watching A. J. linger in a state not chosen. I believed I had failed... (shrink)

This book examines the lived experiences and work of African American women educators during the 1880s to the 1960s.

Much of the built world is designed around food; for storing, producing, transporting, selling, serving and eating. We recognise the regeneration of a neighbourhood through its new cafes, restaurants and grocery shops. This title features new restaurants in London, New York, Sydney and Tokyo; the design of markets; provocative essays by architects, historians, and social scientists; and interviews with designers and entrepreneurs.

Experimental radiobiology represented a long-standing priority for the U.S. Atomic Energy Commission, but organizational issues initially impeded the laboratory progress of this government-funded work: who would direct such interdisciplinary investigations and how? And should the AEC support basic research or only mission-oriented projects? Alexander Hollaender's vision for biology in the post-war world guided AEC initiatives at Oak Ridge, where he created and presided over the Division of Biology for nearly two decades. Hollaender's scheme, at once entrepreneurial and system-oriented, made good (...) use of the unique resources provided by the AEC and by Oak Ridge's national laboratory setting, while at the same time it restructured wartime research practices to better reflect biologists' own priorities. Because Hollaender offered many academic experimental biologists a way of envisioning military-related patronage as integral - rather than antithetical - to their professional identities, his work provides an important lens through which to examine the early post-war intellectual and institutional development of radiobiology. (shrink)

An array of pressing but conceptually perplexing questions in ethics---questions concerning group rights, collective responsibility, and the ethics of nationalism---would seem to require for their resolution answers to the no less perplexing questions of what social groups are and what membership in them amounts to. In this dissertation, I offer an analysis of the concept of what I call an 'ethnic identity group' and argue that questions about ethics and ethnicity or nationality are best understood as questions about such groups (...) and their agency. The main argument for the analysis involves showing its usefulness for understanding how group membership might be involved in personal moral identity and individual agency. ;The analysis I offer makes use of Max Weber's idea that the concept of a social group is analyzable in terms of the possibility that certain kinds of social action will be performed. A Weberian analysis of a kind of social group involves a characterization of the types of social action that are possible in relation to groups of that kind. After responding to Margaret Gilbert's arguments against Weberian analyses of social groups and related phenomena, I suggest that one central social concept is that of a group defined in terms of the availability for group members of standing in a particular relation to an idea of the group, where that idea is, more specifically, an idea of a collective agent. This is the concept of an identity group. What distinguishes members of an identity group from nonmembers is the availability for the former of standing to the group in a relation I call 'moral alignment'. Roughly, an individual aligns herself with a group to the extent that she sees the group's agency as an extension of her own. This concept of moral alignment is a development of Aristotle's view that through shared deliberation and action, friends in a perfect friendship become "other selves" for each other. A group member is socially placed so as to have access to the idea that other members may act for her and she for them. If she aligns herself with the group, the group becomes another self for her, and she may act as a member of the group. An ethnic identity group is a collection of individuals, each of whom may align himself with an idea of the group---where that idea is an idea of a particular collective agent, whose collectivity rests on the shared ancestry of the collected individuals---and each of whom may, therefore, act and respond emotionally as a member of the group. (shrink)

This study investigated the attitudinal responses of 403 undergraduate students with respect to nine hypothetical marketing moral dilemmas. Participants varied by gender, major, and age.It was found that undergraduate women responded more ethically on the hypothetical marketing moral dilemmas, as hypothesized. Secondly, chosen major did not make a difference on cognitive, affective, or behavioral responses. Further, the overall means for each scenario were in the morally correct direction in every case. Also, all intercorrelations for each story were significant. Finally, whenever (...) there was a nonchance finding for age, the oldest participants answered more morally than the youngest subjects. (shrink)

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently (...) in the analysis as a high‐level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health‐care providers in spaces called ‘wait times’, where it is systematically rendered ‘unknowable’. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. (shrink)

Many health care decisions depend not only upon medical facts, but also on value judgments—patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of (...) medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients—failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals. (shrink)

This is an exploratory study of perceptions of human dignity in childhood as recalled by young adults. Our goal is to discover the range of dimensions, sources and experiences, both those that supported and violated, of the concept of human dignity. This research, drawing on responses from over two hundred university students, may help to develop a language with which to explore the concept of human dignity in a broader, more systematic way. The approach taken here permits us to move (...) beyond the ‘legal’ frame that often confines us to discussions of the extremes of child abuse and neglect, to a frame that frees us to explore the meaning and real life experiences with human dignity in childhood and the impacts on later life. Violating and not supporting human dignity in childhood helps produce a world populated by adults who, having been harmed as children, go on to harm and violate others as adults. If our goal is to have a world populated by children who were nurtured to flourish into child-centered adults who are empathic, intelligent and responsive and who have no need to hurt others, then our understanding of human dignity in childhood must be increased. This paper and the materials on which it is based seek to provide preliminary insights into the language of human dignity. (shrink)

In this research, we examine the effects that customer perceptions of employee deception have on the customers’ attitudes toward an organization. Based on interview, archival, and observational data within the international airline industry, we develop a model to explain the complex effects of perceived dishonesty on observer’s attitudes and intentions toward the airline. The data revealed three types of perceived deceit (about beliefs, intentions, and emotions) and three additional factors that influence customer intentions and attitudes: the players involved, the beneficiaries (...) of the deceit, and the harm done by the perceived lie. We develop a model with specific propositions to guide organizations with respect to apparently deceitful behavior of their employees. Implications and directions for future research are provided, focusing on the question of whether organizations should consistently encourage honesty or train their employees to be effective liars. (shrink)

Studies have failed to yield definitive evidence for the existence and/or role of well-defined chaotic attractors in real brain systems. Tsuda's transients stabilized on unstable manifolds of unstable fixed points using mechanisms similar to Ott's algorithmic “control of chaos” are demonstrable. Grebogi's order in preserving “strange nonchaotic” attractor with fractal dimension but Lyapounov is suggested for neural network tasks dependent on sequence.