How do physicians handle informing patients of their diagnoses and how much information do patients really want? How do registered nurses view both sides of this question? Three questionnaires were constructed and administered in a mid-size hospital in New York state. Physicians and nurses underestimate the number of patients who want detailed information. Patients who earn more than average, have a college education, and who are under age 60 are more likely to want information, and state that their physician should (...) give it to them. Only 42% of physicians state that patients want a detailed description of their diagnosis and treatment options. Physicians educated outside the USA appeared to be more likely to change their criteria for informing patients and, along with American-educated nurses, were more willing to participate in formal discussions of the issue. Physicians should comply with the wishes of patients for information and include them in the team deciding on diagnosis and treatment. (shrink)

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

This study describes discourse features of messages posted to an Internet discussion forum about depression based on the analysis of a small corpus of message texts. The message texts were classified into three types: problem messages, advice messages and thanks messages, and salient discourse features of each message type were described and analyzed in terms of discourse function. Features of problem messages included: frequent use of metaphorical language to describe symptoms, use of or type questions to request advice, and a (...) general lack of direct requests for advice. Advice messages were characterized by casual style and exhibited a variety of discourse patterns with the common function of expressing positive regard and solidarity. The occurrence of these patterns can be related to the special interpersonal needs associated with the discourse function of giving advice. Thanks messages were responses to advice messages, and usually included some expression of thanks for advice, but interestingly, thanks message writers never indicated that they had acted upon or would act upon the advice they received. (shrink)

Traditional analyses of the curve fitting problem maintain that the data do not indicate what form the fitted curve should take. Rather, this issue is said to be settled by prior probabilities, by simplicity, or by a background theory. In this paper, we describe a result due to Akaike [1973], which shows how the data can underwrite an inference concerning the curve's form based on an estimate of how predictively accurate it will be. We argue that this approach throws light (...) on the theoretical virtues of parsimoniousness, unification, and non ad hocness, on the dispute about Bayesianism, and on empiricism and scientific realism. * Both of us gratefully acknowledge support from the Graduate School at the University of Wisconsin-Madison, and NSF grant DIR-8822278 (M.F.) and NSF grant SBE-9212294 (E.S.). Special thanks go to A. W. F. Edwards.William Harper. Martin Leckey. Brian Skyrms, and especially Peter Turney for helpful comments on an earlier draft. (shrink)

The article is intended to reveal important similarities between fiction and sport. I build on Jonathan Gottschall’s discussion in The Storytelling Animal: How Stories Make Us Human by celebrating the significance of stories and their ‘witchy power’ and by examining factors that demonstrate similarities between fiction and sport. I suggest that an unmistakable semantic, structural, and cultural kinship exists between the two. This argument requires a discussion of play theory, play resources and constitutive rules, the semantic power of problems and (...) the uncertainty they produce, and the role of ‘frames’ in bringing problems to life. I conclude by noting the unique frame capabilities of ‘the big game’ and zero-sum dichotomous sporting motifs. (shrink)

Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

Are fictional characters such as Sherlock Holmes real? What can fiction tell us about the nature of truth and reality? In this excellent introduction to the problem of fictionalism R. M. Sainsbury covers the following key topics: what is fiction? realism about fictional objects, including the arguments that fictional objects are real but non-existent; real but non-factual; real but non-concrete the relationship between fictional characters and non-actual worlds fictional entities as abstract artefacts fiction and intentionality and the problem of irrealism (...) fictionalism about possible worlds moral fictionalism. R. M. Sainsbury makes extensive use of examples from fiction, such as Sherlock Holmes, Anna Karenina and Madame Bovary and examines the work of philosophers who have made significant contributions to the topic, including Meinong, David Lewis, and Bas Van Fraassen. Additional features include chapter summaries, annotated further reading and a glossary of technical terms, making _Fiction and Fictionalism_ ideal for those coming to the issue for the first time. (shrink)

The purpose of this paper is to enter the conversation about stakeholder theory with the goal of clarifying certain foundational issues. I want to show, along with Boatright, that there is no stakeholder paradox, and that the principle on which such a paradox is built, the Separation Thesis, is nicely self-serving to business and ethics academics. If we give up such a thesis we find there is no stakeholder theory but that stakeholder theory becomes a genre that is quite rich. (...) It becomes one of many ways to blend together the central concepts of business with those of ethics. Rather than take each concept of business singly or the whole of “business” together and hold it to the light of ethical standards, we can use the stakeholder concept to create more fine-grained analyses that combine business and ethics; or more simply, we can tell many more, and more interesting, stories about business. (shrink)

After reviewing the history of the “affirmative” approach to interpreting Kant’s Religion, I offer four responses to the symposium papers in the previous issue of Faith and Philosophy. First, incorrectly identifying Kant’s two “experiments” leads to misunderstandings of his affirmation of Christianity. Second, Kant’s Critical Religion expounds a thoroughgoing interpretation of these experiments, and was not primarily an attempt to confirm the architectonic introduced in Kant’s System of Perspectives. Third, the surprise positions defended by most symposium contributors render the “affirmative” (...) label virtually meaningless. Finally, if Kant is read as constructing perspectival philosophy, not theology, the compatibility of his positions with Christianity stands. (shrink)

We clarify aspects of our Dynamic Functional Model of Jealousy in response to D’Arms and Stets. Our model proposes that jealousy is an evolved motivational state that arises over threat by a rival to one’s relationship or some aspect of one’s relationship. The formation or loss of relationships rarely occurs instantaneously. Therefore, we argue that jealousy, whose goal is to remove or reduce the rival threat, can occur over a longer time course than is often assumed in theories of specific (...) emotions. We further suggest that other emotions such as grief and fear also can occur over extended periods. This raises challenges for emotion theories that assume that emotions must be short-lived. (shrink)

This article offers a conceptual analysis of self-respect and self-esteem that informs the ethics of psychotherapy in palliative care. It is focused on Chochinov’s Dignity Therapy, an internationally recognized treatment offered to dying patients who express a need to bolster their sense of self-worth. Although Dignity Therapy aims to help such patients affirm their value through summarized life stories that are shared with their survivors, it is not grounded in a robust theory of self-respect. There is reason to be skeptical (...) about deathbed narratives, and Dignity Therapy can unintentionally encourage distorted representations at odds with the self-respect it aims to affirm. Dignity therapy can also encourage distortions of self-esteem that are in conflict with self-respect. Although Chochinov does not address it, the distinction between self-respect and self-esteem is relevant to deathbed accounts. Dillon’s feminist revisioning of self-respect can inform the practice of Dignity Therapy by encouraging honest life stories through a reckoning with one’s moral complexity, especially in moral generativity cases where patients seek forgiveness, relate atonement, or present their lives as examples to be followed. Her concept of self-esteem allows for therapeutic benefits that are less demanding, but no less significant, than those derived from a moral reckoning. Appropriate affirmations of self-esteem can provide much-needed solace when self-respect is damaged beyond adequate repair. Dillon’s account of self-respect and self-esteem enables a richer understanding of the kinds of personal evaluation and disclosure that Dignity Therapy accommodates. As such, their place in Dignity Therapy needs more critical evaluation than it has received. (shrink)

The existence of consciousness in animals may have been overlooked. Continuity in consciousness between humans and animals is predicted by evolutionary theory. However, there are specific methodological difficulties associated with investigating such a phenomenon: it cannot be directly measured; animals, unlike humans, cannot directly tell us about their conscious experience; experiments which have made comparisons to human consciousness cannot detect consciousness of a different form; application of the law of parsimony in science has traditionally led to the conclusion that it (...) does not exist. (shrink)

Scientists of the Human Genome Project tend to rely on three metaphors to describe their work, each of which implicitly tells much the same story. Whether they claim to interpret the ultimate "book," to fix a flawed "machine," or to map a mysterious "wilderness," they invariably cast the researcher as one who dominates and exploits the Other. This essay, which explores the ways such a story conflicts with feminist values, proposes an alternative.

The purpose of this paper is to describe a way of teaching business ethics using the creative arts, especially literature and theater. By drawing on these disciplines for both method and texts, we can more easily make the connection to business as a fully human activity, concerned with how meaning is created. Students are encouraged to understand story-telling and narrative and how these tools lend insight into the daily life of businesspeople. The paper describes two main courses, Business Ethics Through (...) Literature and Leadership, Ethics and Theater, and the rationale for each. We begin by suggesting three main leverage points that the courses engender. We then rely on the words of students who have taken the courses for insights into what they learned. We then critically assess some of the principles that have informed course design over time. We conclude by suggesting that paying attention to the creative arts gives rise to a rather different approach to business ethics, one grounded in the pragmatist tradition in philosophy. (shrink)

Risk preferences of Australian academics are elicited by analyzing the aggregate distribution of their retirement funds across available investment options. Not more than 10 % of retirement funds are invested as if their owners maximize expected utility under the assumption of constant relative risk aversion with an empirically plausible level of risk aversion. An implausibly high level of risk aversion is required to rationalize any investment into bonds when stocks are available. Not more than 36.54 % of all investments can (...) be rationalized by a model of loss averse preferences. Moreover, the levels of loss aversion typically reported in the experimental studies imply overinvestment in bonds, which is not observed in the data. Up to 67.18 % of all investments can be rationalized by rank-dependent utility or Yaari’s dual model with empirically plausible parameters. A median Australian academic behaves as if maximizing rank-dependent utility with parameter γ∈[0.76,0.79]\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\gamma \in [0.76, 0.79]$$\end{document} in a Tversky and Kahneman probability weighting function. (shrink)

Comprehension of moral reasoning is important both for successful moral education and for Kohlbergian claims that moral reasoning development is cognitive in nature. Because a psychometrically appropriate moral comprehension instrument does not appear to exist, the Moral Comprehension Questionnaire (MCQ) was constructed in Study 1 and displayed some positive reliability and validity findings. Study 2 used this questionnaire to examine whether the increased Defining Issue Test (DIT) p scores shown by liberals is indicative of increased cognitive development. While liberals displayed (...) slightly greater moral comprehension than conservatives, moral comprehension and political orientation mostly appear to contribute independently to high p scores. Additionally, consistent with Kohlbergian theory, comprehension of Stage 5 moral reasoning is more challenging than comprehension of Stage 3 or 4 reasoning. Consequently, while p scores are somewhat cognitive developmental in nature, they also are independently predicted by political orientation. (shrink)

Few critics can ever have shown more light-hearted thoughtlessness towards an anxious posterity than Servius in his casual preservation of the ‘Helen-episode’, lacking in our ancient manuscripts of Virgil and primarily extant only in this precarious form. A pity that Servius spoke at all, if he could not tell us more; and to make matters worse, he ignored the lines in his commentary. Aelius Donatus says nothing of them. Tiberius Claudius Donatus passes peacefully in his interpretatio from 2. 566 to (...) 2. 589; his prosy conscientiousness nowhere else allows him to skip so much. The passage so rashly preserved forms an exasperating Tummelplatz for students of Virgil: ‘quadereviridoctiiampridem inter se certarunt semperque, ni fallor, certabunt.’ The purpose of this paper is to suggest that Servius told the truth about the lines, and was not planting a forgery on a credulous world. (shrink)

Even today, a century after the publication of the “Origin of Species”, current zoological literature often reveals an insufficient grasp of the implications of the now generally accepted view that it is natural selection that confers direction on the evolutionary process.This is, in part, due to a reaction against oversimplified teleology and against Lamarckism. In rejecting Lamarck's thesis that the activities of an animal directly affect its hereditary characters it is frequently assumed that this implies that such activities are irrelevant (...) to the study of evolution. This is a non-sequitur, for activities may affect evolution not directly, through heredity, but indirectly, by influencing the direction of the selective forces impinging on the organism. Reasons are given for concluding that changes in habits and behaviour frequently precede structural change and, in fact, determine the direction of the latter.As an example of a concept which deserves a more evolutionary treatment than it commonly receives, the subject of neoteny is considered. It appears that failure to think in terms of the selective forces involved has frequently led to error. An analysis in functional terms is made of the theory that the chordates represent secondarily glorified sea-squirts and it is concluded that this idea is unlikely to be correct. The characteristics of man that are commonly considered to be neotenous are also discussed. It is concluded that a facile and unanalytical application of the label “neoteny” to many of the evolutionary changes involved has tended to obscure rather than to clarify their significance: the neotenous features of man are not those that have been of primary importance in human evolution, but are secondary to the acquisition of new characters which are not to be found in either the adult or the young stages of any other primate.Aujourd'hui, un siècle après l'apparition de l'Originedes Espèces, la conviction est presque générale que la sélection naturelle dirige le procès de l'évolution. Néanmoins, les publications zoologiques actuelles révèlent souvent une compréhension insuffisante de ce qui en résulte.Ceci doit en partie être considéré comme réaction contre une téléologie simpliste et contre le Lamarckisme. En rejetant la thèse de Lamarck, que les activités d'un animal ont une influence directe sur ses caractéristiques héréditaires, on admet fréquemment que de pareilles activités n'ont rien à voir avec l'étude le l'évolution. Cependant, une telle conclusion n'est pas justifiée, car les activités peuvent influer sur l'évolution non pas directement, par la voie de l'hérédité, mais indirectement en agissant sur la direction des forces sélectives que l'organisme rencontre. Des raisons ont été données qui mènent à conclure que des changements dans les habitudes et dans le comportement précèdent maintes fois le changement structural et même déterminent la direction de celui-ci.Comme exemple d'un concept qui mérite un traitement plus évolutionniste qu'il ne reçoive en général, la néoténie a été examinée. Il paraît que l'on a fait beaucoup d'erreurs en ne tenant pas compte des forces sélectives engagées. Une analyse au pointde-vue de la fonction a été appliquée à la théorie que les chordées ne sont que des ascidies néoténiques transfigurées par après, et il s'ensuit que cette idée n'est probablement pas correcte. Aussi les caractéristiques de l'homme généralement regardées comme neoténiques ont été discutées. Il en résulte que, en désignant légèrement et sans analyse plusieurs changements évolutionnaires comme néoténie, on a plutôt obsurci qu'éclairci leur signification. Ce ne sont pas les traits néoteniques de l'homme qui ont joué le rôle principal dans l'évolution humaine; au contraire, ils n'apparaissent qu'après l'acquisition de quelques nouvelles caractéristiques qui ne se trouvent ni dans l'adulte ni dans les phases plus jeunes des autres primates.Sogar heutzutage, ein Jahrhundert nach dem Erscheinen der „Origin of Species”, zeigt die jetzige zoologische Literatur oft eine unzulängliche Einsicht in die Folgerungen, zu denen die jetzt allgemein akzeptierte Annahme leitet, dass die natürliche Selektion die Richtung des Evolutionsprozesses bedingt.Dies ist teilweise zu sehen als eine Reaktion gegen eine einseitige Teleologie und gegen das Lamarckismus. Bei der Ablehnung der TheseLamarck's, dass die Aktivitäten eines Tieres einen direkten Einfluss ausüben auf seine erbliche Konstitution, nimmt man oft an, dass dies bedeutet, dass derartige Aktivitäten demnach nichts zur Sache tun bei dem Studium der Evolution. Zu einer derartigen Konklusion ist man jedoch nicht berechtigt, denn, obwohl die Aktivitäten die Evolution nicht direkt beeinflussen können mittels der Erblichkeit, so können sie dies jedoch indirekt, weil sie die Richtung der selektiven Kräfte, welche auf das Organismus einwirken, bestimmen. Es werden Argumente gegeben, welche die Konklusion rechtfertigten, dass Änderungen in Gewohnheit und Verhalten oft Strukturänderungen vorhergehen und tatsächlich die Richtung dieser letztgenannten bestimmen. Die Neotenie wirdt als ein Beispiel eines Begriff betrachtet, welcher eine mehr evolutionäre Behandlung verdient als bisher geschehen ist. Es ergibt sich dass man viele Irrtümer hat gemacht, indem man den betreffenden selektiven Kräften keine Rechnung getragen hat. Eine Analyse der Theorie, welche die Chordaten als neotenische Ascidien betrachtet, wird von einem funktionellen Gesichtspunkt aus durchgeführt. Daraus scheint der Schluss berechtigt, dass diese Theorie falsch ist. Auch werden die menschlichen Kennzeichen, welche gewöhnlich als neotenische betrachtet werden, besprochen. Die Konklusion lautet, dass, wenn man leichtfertig und ohne genügende Analyse den Zettel „Neotenie“ für mancherlei evolutive Änderungen anwendet, man die richtige Bedeutung dieser Erscheinung vielmehr verdunkelt als aufklärt: nicht die neotenische Kennzeichen des Menschen sind am wichtigsten in seiner Evolution; in Gegenteil sie erscheinen nur sekundär, nachdem die neuen Kennzeichen, welche sich weder in den Erwachsenen noch in den jüngeren Stadien von den anderen Primaten finden lassen, erschienen sind. (shrink)

This article is an examination of the moral complexity of the act of whistleblowing in the context of corporate corruption. Whistleblowing may be a morally admirable act underataken by morally ambiguous agents, but can only be fully understood in context. Using German theologian Dietrich Bonhoeffer’s essay “What Does It Mean to Tell the Truth?” This essay will examine how the kind of deception sometimes necessary in whistleblowing cases can be testimony to a larger and more profound truth.

This study argues that the English-born, Edinburgh-educated and Bath-based physician William Falconer (1744–1824) authored the only stadial history published during the British Enlightenment that analysed the influence of socio-economic context upon religious belief. A survey of the conjectural histories of religion written by the leading literati demonstrates that discussion of religion by the Scottish literati was undertaken separate from the “Scottish narrative” of stadial economic and political progress. We have to turn to Falconer’s Remarks on the Influence of Climate (1781) (...) to see a four-stage history of religion that related belief and practice to wider social and economic developments. While heavily derivative of Montesquieu’s De l’Esprit des Lois (1748), Falconer’s Remarks has some claim to theoretical innovation and used his conjectural history to tell a story of English (not British) religious exceptionalism. Moreover, the work was received as a serious contribution to the late Enlightenment’s science of human nature and society. (shrink)

Deductive reasoning shares with other forms of thinking a reliance on strategies, as shown by the results of three experiments on the nature and development of control strategies to solve suppositional deductions. These puzzles are based on assertors who may or may not be telling the truth, and their assertions about their status as truthtellers and liars. The first experiment shows that reasoners make backward inferences as well as forward inferences, to short-cut their way through the alternatives, and the generation (...) of suppositions is a source of difficulty. The second experiment establishes that the elimination of the suppositional status of an individual does not render problems easier. The third experiment shows that reasoners can improve their reasoning accuracy and speed spontaneously, without feedback, and it clarifies the transfer of strategies and their development. We discuss the implications of these data for alternative theories of suppositional deduction and for the relationship between reasoning and other forms of thinking such as problem solving. (shrink)