In 1998 I was hired by a local health care system to evaluate the mental health of enrolled patients who requested lethal prescriptions under Oregon's newly implemented Death with Dignity Act. I drove to the trailer home of my first patient, a man in his sixties tethered to an oxygen tank for his chronic pulmonary disease who was recently diagnosed with advanced lung cancer. He told me about his abusive, alcoholic stepfather and how he left his family and church at (...) age sixteen, determined never again to be subjugated in any relationship. But in a life marked by an avoidance of intimate relationships, he corresponded regularly with his nephew and was proud to leave him a small inheritance. He shared with me his .. (shrink)

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profession itself.

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

Background In the US, many patients forgo recommended care due to cost. The ANA Code of Ethics requires nurses to give care based on need. Therefore, US nurses are compelled to practice in a context which breaches their professional ethical code. Research Objectives This study sought to determine if nurses do care for patients who forgo treatment due to cost (PFTDC) and if so, does this result in an experience of moral distress (MD). Research Design Semi-structured interviews were transcribed and (...) analyzed using a qualitative content analysis. Participants and Research Context A convenience sample of 20 nurses in practice for at least one year from a variety of health care setting participated. Ethical Considerations This project was approved by the Michigan State University Biomedical Institutional Review Board. Results There were 19 female and one male nurse-participants, averaging 47 years old with an average of 10 years in practice. 18 reported caring for PFTDC. These 17 nurse-participants experienced a moderate degree of MD as a result, averaging 5.4 of 10 on the Moral Distress Thermometer. In the interviews, the following themes were identified, strategies to help PFTDC, and the broken US health care system which had the subthemes of preference for business over patient-oriented benefit, PFTDC using the emergency department, and limited support for treatment/management of PFTDC. Conclusions The existence of this phenomenon places the profession of nursing in the US in a position of moral compromise and threatens to corrupt the institution of nursing in the US. (shrink)

Nanotechnology: Considering the Complex Ethical, Legal, and Societal Issues with the Parameters of Human Performance Content Type Journal Article Pages 265-275 DOI 10.1007/s11569-008-0047-6 Authors Linda MacDonald Glenn, Albany Medical College/Center Alden March Bioethics Institute Albany NY 12208 USA Jeanann S. Boyce, Montgomery College Dept. of Computer Science and Business 7600 Takoma Avenue Takoma Park MD 20912 USA Journal NanoEthics Online ISSN 1871-4765 Print ISSN 1871-4757 Journal Volume Volume 2 Journal Issue Volume 2, Number 3.

In lieu of an abstract, here is a brief excerpt of the content:Could Understanding Harm?Iskra Fileva, PhD (bio) and Linda A.W. Brakel, MD (bio)We would like to thank the editors for organizing this symposium and our commentators—Marga Reimer and James Phillips—for the thought-provoking feedback. Although we had thought about the ideas we discuss from many different angles, our commentators raised several interesting issues we had not considered. We are grateful for the opportunity to continue the conversation.Reply to ReimerAs Professor (...) Reimer notes, we advocate an approach to self-constitution that we dub “understanding first.” On this approach, non-moral and non-normative understanding of the origin of maladaptive traits must precede moral evaluation and attempts to free oneself—or as we say “prune”—undesirable traits. Professor Reimer presents several interesting cases meant both to extend and test the limits of our proposal. We appreciate this approach and respond to each case in turn.Genes and AlcoholismSuppose Alejandro, an adult raised by adoptive parents, struggles with alcohol addiction. He learns that his biological parents died of alcoholic liver disease and comes to believe that his alcohol problem is caused by a genetic propensity toward alcohol abuse. One can ask: “Does an understanding first approach have the potential to undermine the sense of agency that is necessary for the effective treatment of maladaptive traits?”Answer: It can be explained to Alejandro that genetic proclivities are just that—proclivities—that can be overridden. In fact, behavior can alter our very genes—although not at the sequence level— changes known as “epigenetic.” And the liver disease of the biological parents can serve as a cautionary tale. If even in light of these considerations, Alejandro’s tendency to see genetic propensities as deterministic persists, it is worth asking why. There is no evidence that “genes are destiny,” so the disposition to see them that way must have a psychological explanation. What is the explanation? A self-destructive desire? Fear of freedom? This exploration can itself be empowering. [End Page 211]Adaptive ForgettingSuppose Beata, who has an eating disorder, was molested by her own father when she was a child. Subsequently, her father shot himself and now she has no recollection of the molestation. However, Beata’s eating disorder is largely a result of those experiences. It is quite possible that if Beata were to recall being molested, that would do more harm than good. In this connection, one can ask together with Reimer: “Does an understanding first approach have the potential to undermine an adaptive ‘forgetting’ of root causes of maladaptive traits?”Answer: Here, understanding the history, instead of forgetting it, might allow Beata to gain insight into and empathize with possible motives that may have led to becoming obese. For example, she might have the phantasy that if she had been obese and unattractive, she could have prevented the molestation—hence, become that way now to prevent it from happening again, and more wishfully reverse it. (In unconscious goings-on time is thought to be in the “unexamined present” (Brakel 2009, p. 63; 2015, p. 131; 2022, p. 4; 2023, p. 404.) One benefit of this is that in gaining this type of recognition, Beata might find it easier to change her behavior that she otherwise would not have; it was never her responsibility to prevent her own molestation, and there is no reason whatsoever for her to now make herself unattractive to her deceased father, and very little reason to remain obese in an attempt to deter current day men.Ego-Syntonic Maladaptive TraitsClaire is a concert pianist and alcoholic. Importantly, Claire does not see her own desire for alcohol as destructive but rather, as something constitutive of her own identity. “I wouldn’t be myself without alcohol,” she says. Reimer asks whether our approach would “work for cases where the agent sees a maladaptive trait as constitutive of their identity?”Answer: Although no approach can guarantee success, our claim is that our approach has a better chance than the main alternative known as the pruning view. Since Claire, by stipulation, is not inclined to see her own drinking as a problem, a... (shrink)

This paper explores the significant strengths of Fricker's account, and then develops the following questions. Can volitional epistemic practice correct for non-volitional prejudices? How can we address the structural causes of credibility-deflation? Are the motivations behind identity prejudice mostly other-directed or self-directed? And does Fricker aim for neutrality vis-à-vis identity, in which case her account conflicts with standpoint theory?

This volume is an act of talking back, of talking heresy. To reclaim the term “realism,” to maintain the epistemic significance of identity, to defend any version of identity politics today is to swim upstream of strong academic currents in feminist theory, literary theory, and cultural studies. It is to risk, even to invite, a dismissal as naive, uninformed, theoretically unsophisticated. And it is a risk taken here by people already at risk in the academy, already assumed more often than (...) not to be uninformed and undereducated precisely because of their real identities. Of course, identity is today a growth industry in the academy, across the humanities and social sciences, influencing even law and communication studies. The constitutive power of gender, race, ethnicity, sexuality and other forms of identity has, finally, suddenly, been recognized as a relevant aspect of almost all projects of inquiry. However, as I shall discuss in this essay, simultaneous to this academic commodification of identity is an increasing tendency to view identity as politically and metaphysically problematic, some have even said pathological. So on the one hand the theoretical relevance of identities has become visible, while on the other hand many theorists are troubled by the implications of the claim that identity makes a difference. Increasingly, then, the attachment to identity has become suspect. If identity has become suspect, identity politics has been prosecuted, tried, and sentenced to death. To espouse identity politics in the academy today risks being viewed as a member of the Flat-Earth Society. Like “essentialism,” identity politics has become the shibboleth of cultural studies and social theory, and denouncing it has become the litmus test of academic respectability, political acceptability, and even a necessity for the very right to be heard. In contrast, there has been a noticeable thaw regarding the term essentialism. What was once perfunctorily denounced at the start of every paper in feminist theory has recently been tentatively examined by a few theorists for possible signs of validity.. (shrink)

This chapter contains section titled: Gender in Canonical Philosophical Writings The Emergence of Contemporary Feminist Philosophy Reflexive Critique within Philosophy Refl exive Critique within Feminist Philosophy Feminist Philosophy as a Research Program Feminist Philosophy as Transformative Notes.

Critics of Hannah Arendt's Lectures on Kant's Political Philosophy argue that Arendt fails to address the most important problem of political judgment, namely, validity. This essay shows that Arendt does indeed have an answer to the problem that preoccupies her critics, with one important caveat: she does not think that validity is the all-important problem of political judgment--the affirmation of human freedom is.

In lieu of an abstract, here is a brief excerpt of the content:Tribute to an Altruistic EditorWerdie van Staden, MD, PhDThis editorial celebrates the altruistic work of Professor John Sadler during his tenure as editor of Philosophy, Psychiatry, and Psychology. Since its founding about 31 years ago, he has done this behind-the-scenes work, principally to the benefit of our scholarly community, creating a space and opportunity for excellence in advancing the common interests of philosophers, psychiatrists, psychologists and the people they (...) serve professionally. Much of this dedication and efforts never reach the limelight whilst the journal enjoys increasing visibility and impact, ranking currently seventh among 328 philosophy journals and featuring on the 94th percentile. We may attribute this achievement to the authors of PPP, but behind this success story, John has been the vital oxygen in the breathing and energy production of PPP.Our senior editors who have been working under John's leadership for some time, attest as follows in reversed alphabetical order: Michael Wong writes,I once wondered how a psychiatric ethicist like John operates as a journal chief editor? Does he always ask three questions for every submission? Could I publish it? Would I publish it? Should I publish it? I found out very soon after I joined PPP as a Senior Editor that John is actually an editor of empathy and compassion, if there is indeed such an entity in academic publishing, who also has an objective and critical mind. He impresses me that he feels the vulnerability of those who submit a manuscript for peer scrutiny and sees the imbalance of the power relationship between the author and the reviewers. This perceptiveness however never distracts him from spotting the inconvenient truth that a submission still has a lot more to work on before it is ready for publication. I am truly grateful to John for the privilege to have worked with him and to learn from the maestro how to appreciate the effort every author puts into his or her work and how to convey unambiguous yet constructive critique in a collegial manner that does nothing but to further research and scholarship. John, your generosity and leadership will always be missed.Tim Thornton writesMy most striking experience of John's editorship of PPP came at the start of my connection with the journal. In 2014, I inherited from Bill Fulford – the founding editor – the role of UK editor of what was, at the time, a dual UK-USA edited journal. 2014 was a bad year for me – my parents both died and I spent a term living in a dark cell in a castle in the University of Durham – and I leant very heavily on John's help, assisted by the very capable Linda Muncy. Editing an interdisciplinary journal seemed to me at the time an almost [End Page 93] impossible task. Balancing clinical, philosophical and relevant other reviews was difficult and time consuming. One paper – a very fine submission taking a theologically informed look at depression – had been in the review process seemingly forever though its author was very understanding of the delays. But John (and Linda) graciously and practically accommodated my apprenticeship. John wisely pressed for both the move to a modern electronic submission system and the recruitment of more senior editors. Both of these seem necessary for the smooth running of a modern journal and are a marked contrast with the time when even using a spreadsheet and a Psion Organiser seemed the height of technology.But the mark of a good editor is not just practical and technological but rather making difficult decisions balancing widening access to publication with high academic standards. This is a particular challenge for philosophy and mental healthcare but one that John has managed with aplomb.Derek Strijbos writesHe was a central figure in the international academic field of philosophy and psychiatry ever since I was introduced to the topic by my supervisors here in the Netherlands, about 20 years ago. I met John at several conferences during the past decade, one of which was in Amsterdam in 2015, about scientism in psychiatry. I clearly remember the interesting conversation we had during dinner, in which explained his view on values in psychiatry... (shrink)

Justice Sonia Sotomayor was vilified for arguing that one's social identity can contribute positively to judgment or public reason. This paper considers and expands on Sotomayor's arguments, showing that identity is relevant to snap judgments and to sensation transference that affects how speakers are assessed. It further develops a hermeneutic account of identity that can make sense of its epistemic relevance without foreclosing individual variation.

This chapter contains section titled: The Value Problem Sosa's Solution Epistemically Valuable False Beliefs Organic Unities Gettier.

How we experience space by listening: the concepts of aural architecture, with examples ranging from Gothic cathedrals to surround sound home theater. We experience spaces not only by seeing but also by listening. We can navigate a room in the dark, and "hear" the emptiness of a house without furniture. Our experience of music in a concert hall depends on whether we sit in the front row or under the balcony. The unique acoustics of religious spaces acquire symbolic meaning. Social (...) relationships are strongly influenced by the way that space changes sound. In Spaces Speak, Are You Listening?, Barry Blesser and Linda-Ruth Salter examine auditory spatial awareness: experiencing space by attentive listening. Every environment has an aural architecture.The audible attributes of physical space have always contributed to the fabric of human culture, as demonstrated by prehistoric multimedia cave paintings, classical Greek open-air theaters, Gothic cathedrals, acoustic geography of French villages, modern music reproduction, and virtual spaces in home theaters. Auditory spatial awareness is a prism that reveals a culture's attitudes toward hearing and space. Some listeners can learn to "see" objects with their ears, but even without training, we can all hear spatial geometry such as an open door or low ceiling. Integrating contributions from a wide range of disciplines—including architecture, music, acoustics, evolution, anthropology, cognitive psychology, audio engineering, and many others—Spaces Speak, Are You Listening? establishes the concepts and language of aural architecture. These concepts provide an interdisciplinary guide for anyone interested in gaining a better understanding of how space enhances our well-being. Aural architecture is not the exclusive domain of specialists. Accidentally or intentionally, we all function as aural architects. (shrink)

Much of Ofelia Schutte's work has been focused on the question of liberation, especially for women and for colonized peoples. In this paper I discuss some of the important contributions she has made toward understanding the difficulty of dialogue across differences of culture and power, and toward thinking through the relationships of culture, identity, and social justice. Although I generally agree with Schutte's positions, I try here to initiate a dialogue about some conflicting tendencies I see in her positions. Specifically, (...) I challenge her reliance on Nietzsche in developing a general approach to the question of liberation. (shrink)

Vacuolar ATPases (V‐ATPases, V1Vo‐ATPases) are rotary motor proton pumps that acidify intracellular compartments, and, when localized to the plasma membrane, the extracellular space. V‐ATPase is regulated by a unique process referred to as reversible disassembly, wherein V1‐ATPase disengages from Vo proton channel in response to diverse environmental signals. Whereas the disassembly step of this process is ATP dependent, the (re)assembly step is not, but requires the action of a heterotrimeric chaperone referred to as the RAVE complex. Recently, an alternative pathway (...) of holoenzyme disassembly was discovered that involves binding of Oxidation Resistance 1 (Oxr1p), a poorly characterized protein implicated in oxidative stress response. Unlike conventional reversible disassembly, which depends on enzyme activity, Oxr1p induced dissociation can occur in absence of ATP. Yeast Oxr1p belongs to the family of TLDc domain containing proteins that are conserved from yeast to mammals, and have been implicated in V‐ATPase function in a variety of tissues. This brief perspective summarizes what we know about the molecular mechanisms governing both reversible (ATP dependent) and Oxr1p driven (ATP independent) V‐ATPase dissociation into autoinhibited V1 and Vo subcomplexes. (shrink)

While the scientific discourse on astrobiology—the study of the origin, evolution, and distribution of life in the universe—leans toward optimism about the possibility of extraterrestrial life, optimistic thinking is tempered by the limits of evidence and observations gathered thus far. Most astrobiologists assume that “first contact” with extraterrestrial life, if it is ever to occur, will likely be the discovery of microbial life elsewhere in our solar system. But in popular culture, “first contact” tends to be characterized as contact with (...) extraterrestrial intelligence. This article will touch on theory and research relating to the origins and evolution of life and intelligence on Earth and speculation about extraterrestrial life and intelligence. (shrink)

The question of how we apply knowledge from biomedical science to medical and public health practice has been the subject of heated debates about generalizability and related concepts, such as applicability and inductive inference. In this essay, I interpret the term from the perspective of two causal models: determinism and indeterminism. I suggest that theories of generalizability can be formulated on the basis of both models and take the form of testable but unverifiable hypotheses, an attribute that is common to (...) all scientific theories. Nonetheless, there is one noteworthy difference between the two models: determinism allows one to rationalize a decision to treat a certain kind of patient but only indirectly a decision to treat any particular patient, whereas indeterminism accommodates both types of decisions. (shrink)

Background. Imposter syndrome, associated with self-doubt and fear despite clear accomplishments and competencies, is frequently detected in medical students and has a negative impact on their well-being. This study aimed to predict the students’ IS using the machine learning ensemble approach. Methods. This study was a cross-sectional design among medical students in Bangladesh. Data were collected from February to July 2020 through snowball sampling technique across medical colleges in Bangladesh. In this study, we employed three different machine learning techniques such (...) as neural network, random forest, and ensemble learning to compare the accuracy of prediction of the IS. Results. In total, 500 students completed the questionnaire. We used the YIS scale to determine the presence of IS among medical students. The ensemble model has the highest accuracy of this predictive model, with 96.4%, while the individual accuracy of random forest and neural network is 93.5% and 96.3%, respectively. We used different performance matrices to compare the results of the models. Finally, we compared feature importance scores between neural network and random forest model. The top feature of the neural network model is Y7, and the top feature of the random forest model is Y2, which is second among the top features of the neural network model. Conclusions. Imposter syndrome is an emerging mental illness in Bangladesh and requires the immediate attention of researchers. For instance, in order to reduce the impact of IS, identifying key factors responsible for IS is an important step. Machine learning methods can be employed to identify the potential sources responsible for IS. Similarly, determining how each factor contributes to the IS condition among medical students could be a potential future direction. (shrink)