In spite of his status as a highly original thinker whose views were, in many ways, ahead of his time and anticipate those of more famous successors, the work of Johann Gottfried von Herder has not received the attention it deserves in mainstream philosophical discourse. In Herder's Hermeneutics, Kristin Gjesdal successfully addresses this deficit by exploring the enlightenment origins of the hermeneutic tradition through a careful and compelling reconstruction of Herder's theory of interpretation. Breaking with the widespread view of Herder (...) as a contra-Enlightenment thinker, Gjesdal conceives of Herder's hermeneutics as contributing to the enlightenment of the Enlightenment project through an immanent critique of... (shrink)

In Another Philosophy of History, J.G. Herder claims that his aim is not to compare and judge different cultures, but merely to describe and explain how each came into being and thus to adopt the standpoint of an impartial observer. I argue, however, that there is a tension between Herder's understanding of his own project—his stated doctrine of historicism and cultural relativism—and the way in which it is actually put into practice. That is, despite Herder's stated aims, he is nevertheless (...) unable to avoid justifying premodern forms of life and making context-transcending evaluative judgments in the process of trying to understand cultures on their own terms and holding them up as exemplars vis à vis the Enlightenment. This tension presents the challenge of accounting for it in the most charitable and illuminating way. I argue that this goal can be achieved by appealing to the resources of the philosophical hermeneutics of Hans-Georg Gadamer, which enables us to disclose two enabling conditions for Herder's project of which he was not explicitly aware, viz., the internal connection between understanding and justification and the enabling character of prejudice as the condition for the possibility of understanding as such. (shrink)

In “Understanding Demonstratives”, Gareth Evans bites the bullet regarding Rip van Winkle cases in cognitive dynamics: the fact that Rip sleeps for twenty years and completely loses track of time means he is unable to retain his original belief that “Today is a fine day”. In this paper, the author argues that Evans need not bite this bullet because there are resources in his account of the cognitive dynamics involved in belief retention developed in The Varieties of Reference to successfully (...) confront the challenge posed by the Rip van Winkle case. In particular, when we combine the two central elements of Evans’s cognitive dynamics – the skill of keeping track of one’s spatio-temporal location in addition to memory – it is possible to arrive at the conclusion that it is indeed possible for Rip to retain and re-express his original belief. (shrink)

It is widely held that reflexivity is the defining feature of selfhood: the ability of the self to stand in a certain relation to itself. The question of how exactly to theorize this self-relation, however, has been the source of ongoing debate. In recent years, Kantian and post-Kantian approaches such as Christine Korsgaard’s constitutivism and Richard Moran’s commitment view, have attempted to establish the priority of the agential over the epistemic self-relation, thereby re-orientating the debate away from metaphysics and epistemology (...) towards ethics and moral psychology. Despite the important progress they make towards a de-alienated and reified understanding of the self-relation, however, I argue that the Kantian paradigm is ultimately inadequate because its methodological individualism makes it incapable of accounting for the irreducibly social dimension of the self-relation and, therefore, of successfully making the transition from ethics to social and political philosophy. In other words, an adequate ontology of the self-relation is possible only as a social ontology. In order to motivate this thesis, I appeal to two examples that expose the “social deficit” of the Kantian approach: Frantz Fanon’s phenomenology of race/racism in “The Lived Experience of the Black” and the phenomenon of cultural collapse in Jonathan Lear’sRadical Hope. I then go on to provide a sketch of an alternative approach based on the notion of “self-appropriation”, distinguishing it from Rahel Jaeggi’s use of the term in her recent critique of alienation, in the process. (shrink)

This article is concerned with the question of the relative priority between political and social ontology within left-Heideggerianism, a tradition recently reconstructed by Oliver Marchart. Although the title seems to imply that this question is an open and live one within left-Heideggerianism – that the two paths at the crossroads have been clearly delineated when, in fact, the current predicament of left-Heideggerianism resembles more a one-way street – this is somewhat misleading: the identification of left-Heideggerianism with a post-foundationalist political ontology (...) that enjoys systematic priority over the social has contributed to the suppression of the question of the Being of the social and, therefore, prevented a critical re-examination of its relationship to the political. The aim of this article is both modest and ambitious: modest, in that it merely seeks to pose and motivate the question of the social within left-Heideggerianism both at an exegetical and at a systematic level; ambiti... (shrink)

ABSTRACTIn recent work, Maeve Cooke has criticised Jürgen Habermas’s post-metaphysical model in order to motivate an alternative “post-secular” conception of the state, which involves the replacement of the “institutional translation proviso” with the “nonauthoritarian reasoning requirement”. I provide a qualified defence of the Habermasian model by arguing that it does not lead to the kind of negative consequences regarding legitimacy and solidarity Cooke attributes to it. This, in turn, means that Cooke’s proposal for the secular foundation of political authority on (...) a post-secular basis is insufficiently motivated. In the process, I argue that the point of departure for the debate about religion in the public sphere shared by both Habermas and Cooke – the picture of the “total” religious citizen – should be rejected because it presupposes an overly simplistic view of religions and religious identities. (shrink)

In spite of his status as a highly original thinker whose views were, in many ways, ahead of his time and anticipate those of more famous successors, the work of Johann Gottfried von Herder has not received the attention it deserves in mainstream philosophical discourse. In Herder's Hermeneutics, Kristin Gjesdal successfully addresses this deficit by exploring the enlightenment origins of the hermeneutic tradition through a careful and compelling reconstruction of Herder's theory of interpretation. Breaking with the widespread view of Herder (...) as a contra-Enlightenment thinker, Gjesdal conceives of Herder's hermeneutics as contributing to the enlightenment of the Enlightenment project through an immanent critique of... (shrink)

When someone steps on your toe on purpose, it seems to hurt more than when the person does the same thing unintentionally. The physical parameters of the harm may not differ—your toe is flattened in both cases—but the psychological experience of pain is changed nonetheless. Intentional harms are premeditated by another person and have the specific purpose of causing pain. In a sense, intended harms are events initiated by one mind to communicate meaning (malice) to another, and this could shape (...) the recipient’s experience. This study examined whether self-reported pain is indeed higher when the events producing the pain are understood as intentionally (as opposed to unintentionally) caused by another person. Although pain was traditionally conceived to be solely physical in nature (Aydede, 2005), its experience varies substantially with psychological context. The placebo analgesia effect, for example, is the reduction of pain without a change in physical stimulation when context, expectations, or sugar pills challenge the interpretation of a sensation as painful (e.g., Fields, 2008). The nocebo effect, in turn, is the experience of pain without any physical stimulation—as when participants report headaches when told that a (nonexistent) electric current is passing through their heads (Schweiger & Parducci, 1981). These variations in pain experience seem to depend on the meaning of the stimulus: A sugar pill is meant to decrease pain, whereas electric current is meant to increase pain. In an interpersonal context, the meaning of an action is derived from the would complete. perceiver’s perceptions of the actor’s intention (Clark, 1996). (shrink)

We describe the educational character and leadership development processes used by the United States Air Force Academy that other educational institutions may find useful. Our processes include an integrated educational curriculum designed to complement and integrate the experiential learning that results in achieving specific organizational outcomes, co-curricular activities in cadet living, and a specific focus on the ethical development of leaders’ respect for human dignity and cultural competency as well as the mechanisms to assess and refine our processes.

Öz: Bu makale Neolitik döneme ait ve Anadolu’da inşa edilen ilk tapınak olma özelliğine sahip Göbeklitepe’yi ele almaktadır. Arkeologlara göre burası insanlığın en eski tapınaklarından biridir. Göbeklitepe, yerleşik hayattan ve tarımsal üretimden yoksun olan avcı-toplayıcı toplulukların dinsel inanışları hakkında çok önemli bilgiler sunar. Bu tapınak, arkaik insanların dinden ve inançtan yoksun ilkel bir hayat sürmediklerini, aksine bir inanca sahip olduklarını, inançlarını yaşamak için tapınak inşa ettiklerini ve zengin bir dinî sembol kullandıklarını göstermektedir. Göbeklitepe, insanların yerleşik hayata geçip kendisi için konut (...) yapmadan, hayvanları evcilleştirmeden ve tarımsal üretime başlamadan önce dinî ihtiyaçlarını karşılamak için tapınak yaptığının bir göstergesidir. Özet: Bu makale Neolitik döneme ait ve Anadolu’da inşa edilen ilk tapınak olma özelliğine sahip Göbeklitepe’yi ele almaktadır. Şanlıurfa yakınlarında 1995 yılında başlatılan arkeolojik kazılar, insanlık tarihine bakış açımızı değiştirmiş ve geçmiş hakkında sahip olduğumuz bilgilerin doğruluğunu test etme imkânı sunmuştur. Göbeklitepe, arkaik insanın inanç ve düşünce dünyası hakkındaki bilgilerimizin gerçeği yansıtmadığını göstermiştir. Yaşamını avcı-toplayıcı olarak sağlamaya çalışan, din ve soyut düşünceden yoksun olduğu düşünülen, çanak-çömlek yapmasını bile bilmeyen, tarımı ve yerleşik hayatı keşfetmemiş insanların yoğun ve zengin bir sembolik anlatıma sahip tapınaklar yapması, bilim adamlarını derinden etkilemiştir. Toplamda 20 adet olan ve çapı 10 -30 metre arasında değişen dairesel yapılardan oluşan Göbeklitepe tapınaklarının en ilgi çekici unsuru, T biçiminde olan ve üzerinde soyut sembol ve hayvan kabartmalarını bulunduran dikili taşlardır. Dairesel yapının merkezinde iki adet ve çevresinde 10 ile 12 adet arasında T biçiminde yaklaşık 200 tane dikili taş bulunmaktadır. Bu T biçimindeki dikili taşlar üzerinde kapsamlı bir inceleme yapıldığında ve kadim Anadolu ve Mezopotamya uygarlıklarının dinsel inanışları ve tapınak kültü göz önünde bulundurulduğunda, bu dikili taşların tanrıları sembolize ettiği anlaşılmaktadır. Göbeklitepe, çocukları veya daha küçük dereceli tanrılar tarafından çevrelenen ve bu tanrıların oluşturduğu çemberin merkezinde yer alan tanrı ve tanrıça çiftinin oluşturduğu tanrılar panteonunun kutsal alanıdır. Göbeklitepe bir tapınak olmanın ötesinde karanlıkta kalmış bir inanç sisteminin en önemli temsilcisi olarak karşımızda durmaktadır. Yazılı kaynakların bulunmadığı ve sınırlı arkeolojik verilerin elde edilebildiği Neolitik Dönemin erken evresine ait olan Göbeklitepe, bu dönemde yaşamış arkaik insanın inanç ve düşünce dünyasını bize göstermektedir. Bu megalitik yapının yapısal ve biçimsel özellikleri, arkaik insanın sanıldığı gibi ilkel olmadığını kanıtlamaktadır. Göbeklitepe, dinin doğuşu ve gelişimi konusunda çok önemli bilgiler sunmaktadır. Özellikle evrimci ve pozitivist bakış açılarıyla oluşturulmuş ve dinin büyü, ruh, korku, atalara tapma gibi basit ve asılsız yapılardan doğup zamanla karmaşık ve kurumsal inançlar biçimine dönüştüğünü öne süren teorilerin gerçeği yansıtmadığını göstermiştir. Araştırmacılar, avcı-toplayıcı toplulukların yerleşik hayata ve tarımsal üretime geçtikten sonra toplumsal yaşamla birlikte bazı sorunlarla karşılaştıklarını ve bu sorunlara çözüm arayışının dinlerin doğuşunu hazırladığını düşünüyorlardı. Diğer bir ifade ile kurumsal dinler, karmaşık toplumsal yaşamın bir ürünü ve sonucu olarak görülüyordu. Fakat Göbeklitepe dinsel inanışların düşünülenden çok daha eski dönemlerde, kurumsal olarak ve basit olmayan formlarda bulunduğunu göstermiştir. Göbeklitepe’nin, bilinen en eski ve ilk tapınak yapısı olduğu iddia edilmektedir. Kendisinden önce bilinen antik tapınaklardan en az 5000 yıl eski olan bu megalitik yapı, uygarlığın gelişiminde dinsel inanışların ne kadar etkili ve önemli olduğunu açık bir şekilde göstermektedir. Uzun yıllar kazı başkanlığını yapmış olan arkeolog Klaus Schmidt, Göbeklitepe’nin ortaya çıkmasıyla birlikte “.. önce tapınak kuruldu sonra şehir. ” sözleriyle, insanoğlunun genlerinde bulunan inanma ihtiyacının ne kadar öncelikli olduğunu ifade etmiştir. Göbeklitepe insanoğlunun konut, tarım ve çanak çömlek gibi temel ihtiyaçlardan önce görkemli ve karmaşık tapınaklar yaptığını ve bunun arkaik insan topluluklarının güçlü inanç duygusundan kaynaklandığını göstermiştir. İnsanın genlerinde bulunan inanma ihtiyacı insana her şeyden önce tapınak yapmayı ilham etmiştir. Göbeklitepe ile temsil edilen inanç sistemi ve düşünce dünyasının ne kadar zengin ve etkili olduğunu, aynı bölgede en az 5000 yıl sonra ortaya çıkan Anadolu ve Mezopotamya uygarlıkları üzerindeki etkisinden anlayabiliriz. Bu uygarlıkların tapınak yapıları ve dinsel inanışları, bu megalitik yapı ile dikkate değer bir biçimde uyuşmaktadır. Bu uygarlıkların karanlıkta kalmış yönlerini ortaya çıkarmada, Göbeklitepe kaçırılmayacak bir fırsat sunmaktadır. Bu megalitik yapı ortaya çıktığında büyük ses getirmiş ve bilim insanlarının ilgisini çekmiştir. Hakkında yazılı ve görsel basında çok sayıda haberin çıktığı bu tapınak kompleksinin, Aden bahçesi, Babil Asma Bahçelerinin kalıntısı, Şaman tapınağı ve uzaylıların merkezi olduğu iddiaları ortaya atılmıştır. Göbeklitepe üzerinde yapılan arkeolojik kazıların ilerlemesi ve onun hakkında daha fazla bilgiye ulaşılması, onun bir ritüel merkezi olarak tapınak olduğunu göstermiştir. Göbeklitepe’nin yapısal ve biçimsel özellikleri, bu yapının her şeyden önce bir tapınak olduğunu göstermiştir. Gerek dikili taşlardan oluşan dairesel yapıları ve gerekse yerleşim yerlerinden uzak yüksek bir tepede bulunması bu düşünceyi güçlendirmektedir. Göbeklitepe’yi avcı-toplayıcı toplulukların ibadet ettikleri, tanrılara kurbanlar sundukları, yılın belirli dönemlerinde dinî festival ve şölenler gerçekleştirdikleri, tanrıların yaşadığı kutsal mekânlar olarak gördükleri ve kutsalı tecrübe ettikleri bir tapınak olarak düşünmek daha doğru bir yaklaşımdır. Göbeklitepe’nin, tarih boyunca inanç merkezi olarak kalmış ve peygamberler şehri olarak bilinen Şanlıurfa’da ortaya çıkması ülkemiz için önemli bir ekonomik ve kültürel fırsat oluşturmuştur. Anadolu’nun ne kadar kadim ve zengin bir kültürel dokuya sahip olduğunu kanıtlayan bu megalitik yapı, ortaya çıktığı günden beri birçok yerli ve yabancı araştırmacının akınına uğramıştır. Bilimsel literatürün en eski ve ilk tapınağı olan Göbeklitepe, arkaik insanın günümüz insanına miras olarak bıraktığı ve insanlığın ilk dönem sırlarını taşıyan gizemli bir tapınak kompleksidir. (shrink)

19. yüzyıl felsefesinin önemli bir düşünürü olan Dilthey’in amacı tin bilimlerini, epistemolojik ve metodolojik açıdan temellendirmektir. Dilthey bu amacı gerçekleştirmek için tin bilimlerinin yöntemini “anlama” olarak belirlemiştir. Anlama Tin bilimleri için verimli bir zemin teşkil eder ve yeni bir dünya açan özelliğe sahiptir. Dilthey’in Tin bilimlerini temellendirmek amacı ile yazdığı en önemli eserlerinden biri “Tin Bilimlerine Giriş” adlı eseridir. Bu eserde Dilthey hem metafiziğe hem de psikolojiye getirdiği eleştiriler ile dikkat çeker. Dilthey bu eserinde psikoloji konusunda “anlamaya dayalı psikoloji” ve (...) “açıklamaya dayalı psikoloji” ayrımı yapmıştır. “Açıklamaya dayalı” psikoloji bugün bizlerin bildiği klasik psikolojidir. Dilthey’e göre bu psikoloji içsel tecrübeye yeterince önem vermez ve sadece genel yasaya dönüşebilecek durumları inceler. Buna karşılık Dilthey “anlamaya dayalı psikoloji” anlayışını ortaya koymuştur. “Anlamaya dayalı psikoloji” bireyin içsel tecrübesine önem verip onu bir bütün olarak ele alır. Dilthey metafizik konusunda ise hayatı anlamlandırmak için metafiziğe ihtiyaç duyduğumuzu fakat geleneksel metafiziğin bugün geldiği noktada hayat ile olan bağlarını kesmiş olduğuna dikkat çeker. Bu anlamda yapılması gereken şey hayat ile olan bağları koparmadan bir metafizik anlayış ortaya koymaktır. Anlama metodunun psikoloji ve metafizik üzerinden Tin bilimlerine nüfuz etmesi önemlidir. Hem metafizikte hem de psikolojinin Tin bilimlerine dâhil olabilmesin koşulu “anlama” metodunu bu iki disiplinin içerisine yerleştirilmesinden geçmektedir. (shrink)

Anfang einer unvollendeten Selbstdarstellung, von G. Simmel.--Bausteine zur Biographie, von M. Landmann.--Graphologische Analyse, von A. Gaugler.--Zur Dialektik der Simmelschen Konzeptioneiner formalen Soziologie, von H. J. Lieber und P. Furth.--Plan einer Gesamtausgabe der Werke Georg Simmels, von H. Müller.--Simmels Briefe. An P. Ernst [et. al.]--Georg Simmel-Bibliographie, von K. Gassen (p.[313]-365).

Die Erziehung des Menschengeschlechts, von G.E. Lessing.--Das Prinzip der Geschichte der Menschheit, von J.G. Herder.--Idee zu einer allgemeinen Geschichte in weltbürgerlicher Absicht. Erneuerte Frage: Ob das menschliche Geschlecht im beständigen Fortschreiten zum Besseren sei, von I, Kant.--Was heisst und zu welchem Ende studiert man Universalgeschichte, von F. Schiller.--Zur Geschichte, von J.W. Goethe.--Betrachtungen über die bewegenden Ursachen der Weltgeschichte. Über die Aufgabe des Geschichtsschreibers, von W. von Humboldt.--Die Grundzüge des gegenwärtigen Zeitalters, von J.G. Fichte.--Die Weltalter, von F.W.J. Schelling.--Der allgemeine Begriff der (...) philosophischen Weltgeschichte. Die Weltgeschichte, von G.W.F. Hegel.--Manifest der Kommunistischen Partei, von K. Marx und F. Engels. Über Glück und Unglück in der Weltgeschichte, von J. Burckhardt.--Die Geisteswissenschaften, von W. Dilthey.--Vom Nutzen und Nachteil der Historie für das Leben, von F. Nietzsche.--Wissenschaft als Beruf, von M. Weber.--Vom sinn der Geschichte, von K. Jaspers. (shrink)

This collection consists of a two-part Introduction by the editors Martha Nussbaum and Amelie O. Rorty ; nineteen articles, mostly published here for the first time, by M. F. Burnyeat, Nussbaum and Hilary Putnam, S. Marc Cohen, Jennifer Whiting, Michael Frede, K. V. Wilkes, Alan Code and Julius Moravcsik, G. E. R. Lloyd, Charlotte Witt, Gareth B. Matthews, Richard Sorabji, Cynthia Freeland, Malcolm Schofield, Dorothea Frede, Julia Annas, Franz Brentano, L. A. Kosman, Charles Kahn, and Henry S. Richardson ; an (...) extremely useful Bibliography of works cited in these twenty chapters with important additions; an Index Locorum; and a Name Index. (shrink)

This particular volume differs from other members of the series, in that it is historically as well as dialectically oriented, and is also less encyclopedic than the others. The first part develops six different theories of happiness and the second presents different controversies about happiness. In the first chapter, the author proposes Aristotle's eudemonism [[sic]] as the most complete and most influential of all theories of happiness, and he uses it as a matrix for most of the discussions in the (...) second part. Chapters following this initial exposition of Aristotle treat Plato's "mixed" eudemonism [[sic]], Stoic suppression of desire, concepts of transcendent happiness in Plotinus, Augustine and Aquinas, Kant's valorization of duty and Hegel's critique thereof, and Bentham's and Mill's utilitarianism. Moral issues discussed in the second part include: self-realization, happiness vs. performance of duty, fulfillment vs. prudence, and eudemonism [[sic]] vs. hedonism. The last thirty pages focus on contemporary pursuits of the good life, centered around the issue of self-actualization. This section is predominantly psychological, and treats very briefly some theories of Kurt Goldstein, G. W. Allport, Robert W. White, A. H. Maslow, Marie Jahoda, Carl Rogers, and Fromm. Although the author take sides, he does stimulate reflection about the good life through expositions which avoid more difficult philosophical problems but which definitely evoke practical individual and social overtones.--C. M. R. (shrink)

Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Az értelmiségi mint történelmi probléma -- Dic cur hic -- Van-e a filozófiának múltja? (hiszen örök) -- A német kontraszt -- Beszéd a félelem nélküli beszédről -- Öt tanács a hazának -- Utolsó feljegyzések -- Felhívás a Bürök című folyóirat megalapítására -- Jegyzetek -- Életrajzi kísérlet.

In _Violence and Civility_, Étienne Balibar boldly confronts the insidious causes of violence, racism, nationalism, and ethnic cleansing worldwide, as well as mass poverty and dispossession. Through a novel synthesis of theory and empirical studies of contemporary violence, the acclaimed thinker pushes past the limits of political philosophy to reconceive war, revolution, sovereignty, and class. Through the pathbreaking thought of Derrida, Balibar builds a topography of cruelty converted into extremism by ideology, juxtaposing its subjective forms and its objective manifestations. Engaging (...) with Marx, Hegel, Hobbes, Clausewitz, Schmitt, and Luxemburg, Balibar introduces a new, productive understanding of politics as antiviolence and a fresh approach to achieving and sustaining civility. Rooted in the principles of transformation and empowerment, this theory brings hope to a world increasingly divided even as it draws closer together. (shrink)

Currently, patients are expected to take control over their health and their life and act as independent users and consumers. Simultaneously, health care policy demands patients are expected to self manage their disease. This article critically questions whether this is a realistic expectation. The paper presents the auto-ethnographic narrative of the first author, which spans a period of 27 years, from 1985 to 2012. In total nine episodes were extracted from various notes, conversations and discussions in an iterative process. Each (...) of these episodes was condensed around a ‘critical moment’ as perceived by the “self”. The critical moments in the illness process vary between newly encountered problems with basic needs and mourning, to renewed strength and the desire to grow, embracing new situations. Being confronted with and living with a chronic illness involves periods of anxiety and self centredness alternating with strength and advocating the interests of peer-patients. These episodes of emotion, confusion and refinding a balance have a cyclic pattern. The narrative illustrates the vulnerability and dependency of a patient with a chronic disease. The discussion relates this to mainstream dominant views on patients ‘in control of their own life’. The narrative illustrates, that the vulnerability and dependency of the patient are key factors to take into account in health care policy. The narrative provides a counter story, challenging current thinking in terms of strength, selfmanagement, patients’ own control and independent role. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

Individual and Society in Buddhism. W. G. Weeraratne. Metro Printers Ltd., Colombo. 101pp £2.

Paul de Rapin-Thoyras's History of England has hitherto occupied a marginal position in most accounts of eighteenth-century historiography, despite its considerable readership and influence. This paper charts the publication history of the work, its politics and style, and the methods through which Rapin's British translators and booksellers successfully proposed the work as the model for new historical enquiry, and its author as the model for a modern historical writer. It is further argued that David Hume's writings and letters relating to (...) his History of England suggest a direct and critical engagement with Rapin's work, and with the identity of the historian, as it had been constructed through Rapin's success. By focussing on the mechanisms of production and circulation, and the impact which these had on the practice of historical writing in the eighteenth century, the paper aims to demonstrate the value of applying social–historical methods to the study of historical writing. (shrink)