The precipitous cliffs, rolling headlands, and rocky inlets of the Big Sur coast of California prompted Robinson Jeffers to extol their wild beauty throughout his long career as a poet. This extraordinary volume brings together Jeffers’s haunting poetry with magnificent photographs of Big Sur by his friend and neighbor, famed photographer Morley Baer.

The commitment to evidence-based practice in clinical psychology requires scientific investigation of the effects of treatment and mechanisms of change. Empirical evidence suggests that mindfulness-based treatments provide clinically meaningful improvement for people suffering from many important problems, including depression, anxiety, pain, and stress. However, the processes of change that produce these beneficial outcomes are not entirely clear. Central questions include whether mindfulness training leads to increases in the general tendency to respond mindfully to the experiences of daily life, and if (...) so, whether these changes are responsible for the improvements in mental health that are often observed. Answering these questions requires methods for assessing mindfulness. Several tools for this purpose are now available and early evidence suggests that they are useful and informative, despite shortcomings that require additional work. This paper summarizes the rationale for mindfulness questionnaires, the methods used to construct them, and research findings on their utility. Challenges related to maintaining consistency with Buddhist conceptions of mindfulness while applying psychological research methods to the study of its assessment are discussed. (shrink)

One of the core debates concerning equity in the response to the threat of anthropogenic climate change is how the responsibility to reduce greenhouse gas emissions should be allocated, or, correspondingly, how the right to emit greenhouse gases should be allocated. Two alternative approaches that have been widely promoted are, first, to assign obligations to the industrialized countries on the basis of both their ability to pay (wealth) and their responsibility for the majority of prior emissions, or, second, to assign (...) emissions rights on a (possibly modified) equal per capita basis. Both these proposals ignore intra-national distributional equity. Instead, we develop a policy framework we call ‘Greenhouse Development Rights’ (GDRs) which allocates obligations to pay for climate policies (both mitigation and adaptation) on the basis of an individually quantified metric of capacity (ability to pay) and responsibility (prior emissions). Crucially, the GDRs framework looks at the distribution of income within countries and treats people of equal wealth similarly, whatever country they live in. Thus even poor countries have obligations proportional to the size and wealth of their middle and upper classes, defined relative to a ‘development threshold’. While this method nominally identifies the ‘right to development’ as applying to people, not countries, as a proposal for a treaty among sovereign nations, there is no obvious way to give legal meaning to that right. In this paper, then, we raise some of the philosophical and political questions that arise in trying to quantify capacity and responsibility and to use the ‘right to development’ as a principle for allocating costs.Footnote**The ‘Greenhouse Development Rights’ (GDRs) framework is a collective project. The core team includes the author, Tom Athanasiou, Sivan Kartha and Eric Kemp-Benedict; this is the ‘we’ that appears where the text refers to the project, as in ‘we intended this’, and so on. This paper, however, is primarily the author's own product and, beyond the description of GDRs, my collaborators have not read or approved it; thus much of the writing and philosophical speculation uses the first person singular. And, while credit for useful work goes to all team members, the blame for philosophical sloppiness remains with the author. (shrink)

The debate about the ethical implications of Artificial Intelligence dates from the 1960s :741–742, 1960; Wiener in Cybernetics: or control and communication in the animal and the machine, MIT Press, New York, 1961). However, in recent years symbolic AI has been complemented and sometimes replaced by Neural Networks and Machine Learning techniques. This has vastly increased its potential utility and impact on society, with the consequence that the ethical debate has gone mainstream. Such a debate has primarily focused on principles—the (...) ‘what’ of AI ethics —rather than on practices, the ‘how.’ Awareness of the potential issues is increasing at a fast rate, but the AI community’s ability to take action to mitigate the associated risks is still at its infancy. Our intention in presenting this research is to contribute to closing the gap between principles and practices by constructing a typology that may help practically-minded developers apply ethics at each stage of the Machine Learning development pipeline, and to signal to researchers where further work is needed. The focus is exclusively on Machine Learning, but it is hoped that the results of this research may be easily applicable to other branches of AI. The article outlines the research method for creating this typology, the initial findings, and provides a summary of future research needs. (shrink)

Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the (...) concept of moral distress in nursing both empirically and conceptually. Methodology Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

By far the largest part of Nehemiah Grew?s account of a seventeenth?century collection of rarities, his Musæum Regalis Societatis (1685) is taken up with ?thick?, verbal descriptions of things in the Royal Society?s repository. Not only, Grew suggests, do his descriptions serve to signify the contents of his collection, but they enable us to discern among species and to think about the collection?s pieces in new ways. Verbal descriptions did not just signify things in the Royal Society?s collection, but had (...) the capacity to alter their meanings. The essay discusses the ?picturing? of natural things in Early Modern Europe with little direct reference to the contemporary media of graphic representation ? drawings, engravings, paintings etc. ? in order to highlight the role of the then most widely used, but now least discussed of these media, verbal descriptions. (shrink)

This essay reconsiders the links between medicine, connoisseurship, and aesthetic theory in early eighteenth-century Britain. Taking a satire on the body of the physician and collector John Woodward as its starting point, I show that medicine and connoisseurship shared a deep preoccupation with the possibility that the animal body could excessively influence the workings of the mind. Pursuing this line of argument, moreover, I will reconsider the place of mind–body dualism in eighteenth-century British medicine and aesthetics. With the exception of (...) materialists such as the philosopher-physician Bernard Mandeville, medics and aesthetic theorists tended to identify the exercise of judgment with the operations of a disembodied mind, unsullied by the embodied mechanisms of the lower body. In practice, however, the insistence that the most refined forms of judgment depended on the presence and activity of a disembodied, immaterial soul was less meaningful than it seems. When confronted by failures of judgment, medics and connoisseurs alike sought explanations in the mechanisms of the animal body. Whether or not they believed in the immateriality of the soul, they pictured the mind as a malfunctioning animal machine, to be cured through the material agency of medical therapeutics. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

By mid-2019 there were more than 80 AI ethics guides available in the public domain. Despite this, 2020 saw numerous news stories break related to ethically questionable uses of AI. In part, this is because AI ethics theory remains highly abstract, and of limited practical applicability to those actually responsible for designing algorithms and AI systems. Our previous research sought to start closing this gap between the ‘what’ and the ‘how’ of AI ethics through the creation of a searchable typology (...) of tools and methods designed to translate between the five most common AI ethics principles and implementable design practices. Whilst a useful starting point, that research rested on the assumption that _all_ AI practitioners are aware of the ethical implications of AI, understand their importance, and are actively seeking to respond to them. In reality, it is unclear whether this is the case. It is this limitation that we seek to overcome here by conducting a mixed-methods qualitative analysis to answer the following four questions: what do AI practitioners understand about the need to translate ethical principles into practice? What motivates AI practitioners to embed ethical principles into design practices? What barriers do AI practitioners face when attempting to translate ethical principles into practice? And finally, what assistance do AI practitioners want and need when translating ethical principles into practice? (shrink)

As the range of potential uses for Artificial Intelligence, in particular machine learning, has increased, so has awareness of the associated ethical issues. This increased awareness has led to the realisation that existing legislation and regulation provides insufficient protection to individuals, groups, society, and the environment from AI harms. In response to this realisation, there has been a proliferation of principle-based ethics codes, guidelines and frameworks. However, it has become increasingly clear that a significant gap exists between the theory of (...) AI ethics principles and the practical design of AI systems. In previous work, we analysed whether it is possible to close this gap between the ‘what’ and the ‘how’ of AI ethics through the use of tools and methods designed to help AI developers, engineers, and designers translate principles into practice. We concluded that this method of closure is currently ineffective as almost all existing translational tools and methods are either too flexible or too strict. This raised the question: if, even with technical guidance, AI ethics is challenging to embed in the process of algorithmic design, is the entire pro-ethical design endeavour rendered futile? And, if no, then how can AI ethics be made useful for AI practitioners? This is the question we seek to address here by exploring why principles and technical translational tools are still needed even if they are limited, and how these limitations can be potentially overcome by providing theoretical grounding of a concept that has been termed ‘Ethics as a Service.’. (shrink)

Technologies to rapidly alert people when they have been in contact with someone carrying the coronavirus SARS-CoV-2 are part of a strategy to bring the pandemic under control. Currently, at least 47 contact-tracing apps are available globally. They are already in use in Australia, South Korea and Singapore, for instance. And many other governments are testing or considering them. Here we set out 16 questions to assess whether — and to what extent — a contact-tracing app is ethically justifiable.

This essay challenges a "meta-theory" in just war analysis that purports to bridge the divide between just war and pacifism. According to the meta-theory, just war and pacifism share a common presumption against killing that can be overridden only under conditions stipulated by the just war criteria. Proponents of this meta-theory purport that their interpretation leads to ecumenical consensus between "just warriors" and pacifists, and makes the just war theory more effective in reducing recourse to war. Engagement with the new (...) meta-theory reveals, however, that these purported advantages are illusory, made possible only by ignoring fundamental questions about the nature and function of political authority that are crucial to all moral reflection on the problem of war. (shrink)

The roots and evolution of two concepts usually thought to be Western in origin-musica mundana (the music of the spheres) and musica humana (music's relation to the human soul)-are explored. Beginning with a study of the early creeds of the Near East, Professor Meyer-Baer then traces their development in the works of Plato and the Gnostics, and in the art and literature of the Middle Ages and the Renaissance. Previous studies of symbolism in music have tended to focus on (...) a single aspect of the problem. In this book the concepts of musica humana and musica mundane are related to philosophy, aesthetics, and the history of religion and are given a rightful place in the history of civilization. Originally published in 1970. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

This brief commentary is supportive of Michel Bitbol’s evocation of Merleau-Ponty’s ontology as the suitable means for understanding the mission of neurophenomenology. I try to historically ….

This is an EXACT reproduction of a book published before 1923.

The World Health Organisation declared COVID-19 a global pandemic on 11th March 2020, recognising that the underlying SARS-CoV-2 has caused the greatest global crisis since World War II. In this chapter, we present a framework to evaluate whether and to what extent the use of digital systems that track and/or trace potentially infected individuals is not only legal but also ethical.

Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics (...) activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress. (shrink)

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature (...) review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

In this essay, I examine Robert Boyle's strategies for making imperceptible entities accessible to the senses. It is well known that, in his natural philosophy, Boyle confronted the challenge of making imperceptible particles of matter into objects of sensory experience. It has never been noted, however, that Boyle confronted a strikingly similar challenge in his natural theology – he needed to make an equally imperceptible God accessible to the senses. Taking this symmetrical difficulty as my starting point, I propose a (...) new approach to thinking about the interconnections between Boyle's natural philosophy and natural theology. For the most part, studies of science and religion in the early modern period work by seeking out the influence of explicitly stated religious beliefs on scientific ideas. I argue, by contrast, that we need to focus on Boyle's representational practices, using his attempts to represent imperceptible entities as a means of uncovering metaphysical and theological presuppositions that he did not always articulate when stating his religious beliefs. With new interpretations of bothA Discourse of Things Above Reason(1681) andSome Physico-Theological Considerations about the Possibility of the Resurrection(1675), I show that there were crucial similarities between Boyle's practices for representing both God and atoms. I go on to show, moreover, that Boyle used these practices to enact an ontological stance at odds with one of his most important professed beliefs. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the classic (...) counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

All statements describing physical reality are derived through interpretation of measurement results that requires a theory of the measuring instruments used to make the measurements. The ultimate measuring instrument is our body which displays its measurement results in our mind. Since a physical theory of our mind-body is unknown, the correct interpretation of its measurement results is unknown. The success of the physical sciences has led to a tendency to treat assumption in physics as indisputable facts. This tendency hampers the (...) development of new theories capable of addressing the foundations of mind. To show the possibility that false interpretations of experimental results have lead to equally false projections onto physical reality may have happened, the double slit experiment and special relativity experiments are examined in detail. I will show that strongly held a-priory beliefs characterizing measurement instruments have lead to unjustified but widely held concepts in physical theories. For example the assumption that material bodies have minds can change the interpretation of experiments to produce alternative physical theories. Since some material bodies have minds this paper calls for a review of the conscious observer’s role in the execution and interpretation of fundamental physics experiments in order to verify or challenge the basic beliefs adopted in standard physical theories. (shrink)

Resolutions in the United Nations Human Rights Council and General Assembly provide clarification of economic, social, and cultural (ESC) rights, and most of these resolutions pass by consensus. Yet these resolutions are more contentious than they appear. This article analyzes a case study of contestation over resolutions on two ESC rights: water and sanitation. Drawing from theories of norms contestation, this article analyzes how the USA, UK, and Canada challenged the creation of the rights to water and sanitation as rights (...) and as norms. An analysis of all resolutions, archival research, and interview data reveals that while challengers failed to stop water and sanitation from becoming legal human rights, they successfully delayed the process and weakened the normative aspect of the rights. The findings show that while powerful actors may not be opposed to ESC rights in theory, they worked to keep these rights weak and aspirational. (shrink)

CRISPR keeps me up at night. I marvel at its potential to cure insidious genetic diseases and scourges like malaria. I shudder at the ways it might be misused to create biological weapons. What frightens me most, though, is what I can't predict: how will we use CRISPR? How will it change evolution? How will it redefine the very nature of our existence?CRISPR is an ingenious cut-and-paste system that homes in on a particular DNA gene sequence and then, using Cas9 (...) enzymes, snips it out. That sequence is then replaced with a new one that rewrites or repairs the original. Two different cells—somatic, from the body, and germline, from gametes—can be manipulated... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 87-90 [Access article in PDF] Phenomenological and Biological Psychiatry:Complementary or Mutual? James Morley Keywords: phenomenology, psychiatry, psychoanalysis, ontology. We feel that even if all possible scientific questions be answered the problems of life have still not been touched at all. (Witgenstein, Tractatus, 6.52) IF ONE WAS TO PERFORM a thought experiment by imagining a scientifically explained universe, how would this explained universe (...) resolve my issues of value and meaning? Would it help me to live a better life? In one sentence, Witgenstein expressed exactly the issues dividing, and defining, the phenomenological and biophysical approaches to psychiatry. (Natural) scientific questions are concerned with relations of physical causality while phenomenology is aimed at the problems of life, i.e., the elucidation of lived personal meanings.Clarifying the relation between phenomenology and the general psychiatric literature is clearly a significant undertaking. At this juncture in the history of psychiatry where the biophysical model is so dominant, the authors' efforts are especially welcome, as I wholeheartedly appreciate, and thank the authors for this endeavor. I only wish to explicate a few issues latent within the article and perhaps add a few supportive points. Explicitly or implicitly, the need for phenomenology in psychiatry is long enduring and will always persist (Ellenberger 1981, 1993). The integration of phenomenology with general psychiatric practice would certainly serve the needs of patients and society generally. But, in the present state of affairs where the biological model is so preeminent, a full accounting of the dramatic divergences between the two approaches is necessary if there is to be authentic dialogue between them.Essentially, I want to stress that phenomenology and natural science medicine are genuinely distinct paradigms for construing reality and organizing knowledge. As distinct scientific paradigms, each one is holistically self-contained. Like soap bubbles, if pushed together too forcefully one or the other may burst. In this case, it is more likely that the smaller, less prevalent paradigm would burst by becoming absorbed into the more dominant paradigm. I believe that this is precisely the risk when phenomenology is introduced to conventional psychiatry as "complementary." Whereas one could hardly object to any application of empathy and understanding toward the experiences of patients, it would be tragic if the [End Page 87] full philosophical power of phenomenology were to be overlooked in favor of its mere utility as a preliminary stage of diagnosis and assessment, a framework for bedside manners, or worst of all, an appendage to neuroscience or pharmacology. This would not be phenomenology but the very symptomatology that the authors have has so clearly distinguished from true phenomenology.This equation of phenomenology with symptomatology is exactly the misunderstanding that the authors so effectively address. However, I would hesitate to join the authors' optimism in regard to phenomenology's potential complementary role to conventional psychiatric practice. Furthermore, in the process of paradigm mix, certain constituents of each paradigm may be taken out of context and the strength of each paradigm thus diluted. For example, the very power of the experimental method is its reduction of phenomena to measurable variables that can be altered in order to discern causality. Unmeasurable variables detract form the rigor of this entire approach. Then on the other hand, phenomenological empathy is only possible within a standpoint that is severed from the causal thinking of experimental science. This is the holistic perceptual shift that cannot be accomplished when one only appends phenomenological insights to an otherwise materialist approach to psychiatry. Thus, it is not at all clear how one can be both phenomenological and nonphenomenologically natural scientific. Instead of positioning phenomenology as a potential complimentary component of natural-science psychiatry, both world views need to be examined, on their own terms, in a framework of mutuality.Empathy or the understanding of other peoples subjective experience is indeed an essential component of the application of phenomenology to clinical assessment and especially therapeutic treatment. But, to limit phenomenology to this theme alone may not honor the profoundly radical character of this paradigm. As the authors point out, phenomenology asks the practitioner to... (shrink)