The purpose of this paper is to analyse a particularly influential case of memory continuity in Portugal, that of _Padrão dos Descobrimentos_. Spaces of collective memory (such as public monuments) raise questions about what we celebrate, remember or rescue from oblivion, providing an opportunity to rethink the trauma. As such, care for public spaces is associated with ethical and cultural values. One of the difficulties with certain monuments has to do with the fact that they recall actions that today we (...) see as traumatic acts. Thus, it is important to reflect on a critical use of memory. On August 8, 2021, _Padrão dos Descobrimentos_ was the subject of a graffiti. One of the sides of the monument could read: “Blindly sailing for money, humanity is drowning in a scarlet sea”. A great controversy immediately arose around the meaning of this gesture, as well as the role played by a monument that, after being temporarily built in 1940 for the Portuguese World Exhibition, was, in its current version, inaugurated in 1960, on the occasion of the fifth centenary of the death of Infante D. Henrique. This episode reignited a deeper cleavage around the uses of history and memory, the Portuguese colonial past, and the role of the _Padrão dos Descobrimentos_ as an instrument for the reproduction of nationalism. In this sense, and with the authors proposing a new theoretical frame of reference based on the thought of Arendt and Ricoeur, its critical reading becomes relevant. (shrink)

The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of (...) the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture. (shrink)

The increasing costs of healthcare delivery led to different political and administrative approaches trying to preserve the core values of the welfare state. This approach has well documented weaknesses namely with regard to healthcare rationing. The objective of this paper is to evaluate if independent healthcare regulation is an important tool with regard to the construction of fair processes for setting limits to healthcare. Methodologically the authors depart from Norman Daniels’ and James Sabin’s theory of accountability for reasonableness and try (...) to determine if new regulatory models—namely independent agencies—perform better with regard to the public disclosure of the reasons and rationales of healthcare rationing. In publicly financed healthcare systems independent regulation is an important tool to assure fair and reasonable procedures of prioritising services. In accordance with the principle of public accountability, independent regulatory agencies are particularly well suited to assure publicity of the decision-making processes, relevance of the rationale involved and particularly mechanisms for challenge and dispute resolution regarding limit setting decisions. It follows that independent healthcare regulation could be regarded not only as an instrument for performance improvement but also as a tool of social justice. The authors conclude by stating that accountability for reasonableness should be regarded as a landmark of any healthcare reform. And therefore regulators have the social task of assuring that the rationales for limit-setting decisions are clearly accessible to the public. (shrink)

In all countries where health care access is considered a social right, regulation is both a tool of performance improvement as well as an instrument of social justice. Both social (equity in access) and economical (promoting competition) regulation are at stake due to the nature of the good itself. Different modalities of regulation do exist and usually new regulatory cycles include the creation of stronger regulatory agencies. Indeed, health care regulation is rising steadily in most developed countries as a consequence (...) of the introduction of the New Public Management perspective to provide essential public goods.Health care is delivered by different organisations with very different cultural backgrounds—public and private (profit and non-profit)—that should be accountable for their decisions. Control by regulatory agencies is instrumental to accomplish this goal. However, there is some dispute with regards the degree of regulatory autonomy. The objective of this paper is to determine if independent regulatory agencies (IRAs) are effective in carrying out health care regulation. The authors apply Walshe’s analytical framework to the Regulatory Authority of Health (Portugal) to answer the question if independent regulation works.In conclusion, the two year experience of the Regulatory Authority of Health is important not only because the primary goals of independent regulation were achieved but also because this authority is now a full partner in the health care sector. However, independent agencies need to develop strong mechanisms of accountability because good regulatory governance is the paradigm of this institutional innovation. (shrink)

Introduction: All countries face the issue of choice in healthcare. Allocation of healthcare resources is clearly associated with the concept of distributive justice and to the existence of a right to healthcare. Nevertheless, there is still the question of whether this right should include all types of healthcare services or if it should be limited to selected types. It follows that choices must be made, priorities must be set and that efficiency of healthcare services should be maximum.

In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors give their specific consent. Xenotransplantation--defined as the transplantation of animal cells, tissues or organs into human beings--is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The (...) objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

The world population aged significantly over the twentieth century, leading to an increase in the number of individuals presenting progressive, incapacitating, incurable chronic-degenerative diseases. Advances in medicine to prolong life prompted the establishment of instruments to ensure their self-determination, namely the living will, which allows for an informed person to refuse a type of treatment considered unacceptable according to their set of values. From the knowledge on the progression of Alzheimer disease, it is possible to plan the medical care, even (...) though there is still no treatment available. Irreversible cognitive incapacity underlines the unrelenting loss of autonomy of the demented individual. Such a loss requires the provision of specific and permanent care. Major ethical issues are at stake in the physician–patient–family relationship, even when dementia is still at an early stage. The authors suggest that for an adequate health care planning in Alzheimer disease the living will can be presented to the patient in the early days of their geriatric care, as soon as the clinical, metabolic or even genetic diagnosis is accomplished. They also suggest that the appointment of a health care proxy should be done when the person is still in full enjoyment of his cognitive ability, and that the existence and scope of advance directives should be conveyed to any patient in the early stages of the disease. It follows that ethical guidelines should exist so that neurologists as well as other physicians that deal with these patients should discuss these issues as soon as possible after a diagnosis is reached. (shrink)

Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...) purpose the authors depart from the “normal” functioning standard to a model that promotes effective opportunity for everyone in health care access, because even within the “normal” functioning criteria some treatments and medical interventions should have priority upon others. Equal opportunity function is a mathematical function that helps to hierarchize moral relevant necessities in health care according to this point of view. It is concluded, first, that accountability for reasonableness is an extremely valuable tool to address the issue of setting limits in health care; second, that what is called in this paper “equal opportunity function” might reflect how accountability for reasonableness results in fair limit-setting decisions; and third, that this methodology must be further specified to best achieve fair limit-setting decisions. Indeed, when resources are especially scarce the methodology suggested in this paper might allow not only prioritizing in an “all or nothing” basis but can contribute to a hierarchy system of priorities in health care. (shrink)

Background Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. Methods A cross-sectional observational study was carried out through the application of an online questionnaire that collected the (...) socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. Results A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple’s life. Conclusion There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care. (shrink)

The European Union faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this (...) right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented. (shrink)

Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that (...) cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)

Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper (...) is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility. (shrink)

The health sector is facing many challenges, and there is a need to maintain the delivery of high‐quality health‐care. Issues related to equity and access to health‐care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education (...) of nurses in daily health‐care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health‐care and to demonstrate the contribution of nursing to the sustainability of health‐care and in the promotion of individuals' dignity. The authors conclude that health‐care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system. (shrink)

Background: The theoretical framework of Jϋrgen Habermas suggests that effective communication requires competent participants with an objective attitude that complies with the rules and worlds designated as objective, social and subjective. This situation determines communicative action, which stimulates the search for mutual understanding and results in a process of interaction that promotes self-determination. Objectives: In this study, the discharge letters of patients with myocardial infarction were explored regarding the provision of information. The patient’s right to information and the duty of (...) informing were analysed according to the perspective of Jϋrgen Habermas. Research design: This was a cross-sectional analysis (from a broader longitudinal study) of all discharge letters that were directly related to nursing interventions regarding the provision of information to 106 patients. In this major study, the difficulties faced by patients who experienced a myocardial infarction and the changes in their lifestyles were analysed based on the type of information received. Ethical considerations: The hospital Ethics Committee approved the study, which complied with ethical principles and required informed consent. Findings: In the nursing letters, interventions related to the provision of information were conducted at an average of 3.59 interventions per patient. For 8.5% of the patients, however, no interventions related to the provision of information were performed. The most common area of information during hospitalisation was related to the management of signs and symptoms and applied to 90.6% patients. Discussion: The nursing interventions did not cover patient education, transition processes or awareness of the disease. Thus, the right to information can be questioned. Conclusion: Information is a right, and communication is extremely important. Health professionals should be aware of this importance regarding both care management and the satisfaction guarantee. The sharing of information by health professionals based on their competency is essential for patients to exercise their right to self-determination and decision-making. (shrink)

In most western countries, there is a ‘human organ shortage’ with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors gave their specific consent.Xenotransplantation – defined as the transplantation of animal cells, tissues or organs into human beings – is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this (...) medical procedure. The objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials. (shrink)

The evolution of medical reasoning is deeply intertwined with philosophical thought, beginning with Aristotle’s foundational work in deductive logic. Aristotle’s principles significantly influenced early medical practice, shaping the works of Galen and Avicenna, who made empirical observations that expanded clinical knowledge. During the Enlightenment, both inductive reasoning, as advocated by Francis Bacon, and deductive methods, as stressed by René Descartes, significantly advanced medical reasoning. These approaches proved insufficient when it came to handling uncertainty and variability in medical outcomes. Nineteenth-century figures (...) like William Osler advanced a probabilistic understanding of medicine. Karl Popper’s 20th-century hypothetico-deductive method, which introduced the concept of falsifiability and transformed scientific inquiry into a rigorous process of hypothesis testing, is a fundamental aspect of evidence-based medicine (EBM). EBM emerged as the dominant paradigm, combining empirical research, clinical expertise, and statistical inference to guide medical decisions. Looking forward, Bayesian reasoning offers a further refinement in medical reasoning. By incorporating prior knowledge and continuously updating probabilities with new evidence, Bayesianism addresses the limitations of frequentist methods and offers a more dynamic and adaptable framework for clinical decision making. As medical reasoning evolves, understanding this philosophical lineage is essential to navigating the future of patient care, where evidence must be both rigorously tested and individually tailored. (shrink)

Moral and financial scandals emerging in recent years around the world have created the momentum for reconsidering the role of virtuousness in organizational settings. This empirical study seeks to contribute toward maintaining this momentum. We answer to researchers’ suggestions that the exploratory study carried out by Cameron et al. :766–790, 2004 ), which related organizational virtuousness and performance, must be pursued employing their measure of OV in other contexts and in relation to other outcomes :928–958, 2007 ). Two hundred and (...) sixteen employees reported their perceptions of OV and their affective well-being at work, their supervisors reporting their organizational citizenship behaviors. The main finding is that the perceptions of OV predict some OCB both directly and through the mediating role of AWB. The evidence suggests that OV is worthy of a higher status in the business and organizational psychology literatures. (shrink)

ARAGÃO, Ivan Rêgo. “ Vinde todas as pessoas, e vede a minha dor ”: A Festa/Procissão ao Nosso Senhor dos Passos como Atrativo Potencial Turístico em São Cristóvão-Sergipe-Brasil. 2012. 198f. Dissertação (Mestrado) Cultura e Turismo – Universidade Estadual de Santa Cruz (UESC), Ilhéus-BA. Palavras-chave: Turismo Cultural-Religioso Católico. Religiosidade Popular. Festa do Senhor dos Passos. Keywords: Catholic Religious-Cultural Tourism. Popular Religiosity. Party of Lord of the Steps.

Through a convenience sample of 260 employees, the study shows how employees’ perceptions about corporate citizenship (CC) predict their affective commitment. The study was carried out in Portugal, a high in-group and low societal collectivistic culture. Maignan et al.’s (1999, Journal of the Academy of Marketing Science27(4), 455–469) construct, including economic, legal, ethical, and discretionary responsibilities was used. The main findings are: (a) contrary to what has been presumed in the literature, the discretionary dimension includes two factors: CC toward employees (...) and toward community; (b) perceptions of CC explain 35% of unique variance of affective commitment; (c) the best predictors are perceptions of economic and legal CC and, mainly, perceptions of discretionary CC toward employees; (d) the perceptions of discretionary CC toward employees are significantly better predictors of affective commitment than are perceptions of economic, ethical, and discretionary CC toward the community; (e) perceived inconsistency of the several CC dimensions is detrimental to employees’ affective commitment. The study questions the four-dimensional model of the CC construct as operationalized by Maignan et al., suggests that culture should be included as a moderating variable in future research, and stresses that affective commitment may decrease when employees perceive that their organizations act upon the several areas of CC inconsistently. (shrink)

This essay intends to explore the ontological consequences of Vilém Flusser’s philosophy of language that he introduced in his first works, written in Portuguese and published in Brazil. This paper will critically examine its main topics: his definition of speech as an act and language as an expanding human presence in the cosmos; linguistic performance as the most dignifying human characteristic and the identification of reality with language; and finally, the thesis that language creates, shapes and disseminates reality. Starting out (...) from an instrumental definition of language, Flusser is compelled to define the world as secondary in relation to language. This paper tries to examine the underlying tensions or paradoxes of such a position as part of Flusser’s dramatic rhetoric strategy, exploring the dangers of an extremely idealistic position sustaining the project of a linguistic ontology. (shrink)

The need to identify, name, count and categorize predates the rise of technology. With the wearable device, our relationship to numbers is far more complex: data flows back and forth amongst devices, consumers, companies, institutions, and networks. One might purchase a self‐monitoring device for self-control or self‐enhancing under the allure of the ability to self‐manage. On the other hand, for self-care, to be the doctor of one’s own ailments. Nonetheless, measurements associated with insights on the self do not end at (...) self‐improvement goals. In the quest for anything providing the possibility for self‐guidance, numbers are attributed mythological weight, carrying the promise embodying one’s own divine authority. Is this tied to an underlying dream to prolong life and master death? This essay presents a wide-ranging review of literature on self‐tracking device, in terms of running and shame to explore how behaviour tied to technology plays out moral or ethical constraints, dilemmas and fear of dying. Data doubles are examined in relation to Lacanian psychoanalysis and the mirror stage as formative of self‐identity, which is presently little acknowledged in relation to self‐tracking. The contributions of Etienne-Jules Marey to the concepts of the body in relation to time are also brought to the fore. The aim is to raise questions about the philosophical and psychoanalytic causes that drive habits of self‐quantification beyond identity, including internal obligations to divinity, knowledge and reality. (shrink)

Josef Sudek, the 'Poet of Prague', had a legendary career spanning almost six decades. His craftsmanship and technical virtuosity were unparalleled among his contemporaries. Faced with the legacy of cubism, surrealism and the Czech avantgarde, Sudek sought his own approach, characterized by a striking mastery of light.

The current research explored the effect of anger on hypothesis confirmation—the propensity to seek information that confirms rather than disconfirms one's opinion. We argued that the moving against action tendency associated with anger leads angry individuals to seek out more disconfirming information than sad individuals, attenuating the confirmation bias. We tested this hypothesis in two studies of experimentally primed anger and sadness on the selective exposure to hypothesis confirming and disconfirming information. In Study 1, participants in the angry condition were (...) more likely to choose disconfirming information than those in the sad or neutral condition when given the opportunity to read more about a social debate, and reading the disconfirming information affected their subsequent attitude. Study 2 measured participants' opinions and information selection about the 2008 US Presidential Election and their desire to “move against” a person or object. Participants in the angry condition reported a greater tendency to oppose a person or object, which resulted in the attenuation of the confirmation bias. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In, Out Me, You Mental, Moral Where Do I Begin?Mark D. Rego (bio)I once attended a Buddhist meditation retreat, led by an American meditation teacher. The instructor had studied and practiced is Asia for many years and was well versed in the practices and teachings of Buddhism. Among his opening remarks was something along the line of the following: "One question that is asked on every retreat is, (...) 'if there is no true self, then who is it who has come here to become free of the illusion of a self?' The answer is, I don't know, but we can start anyway."This sense of practicality in the face of unanswerable questions is built into Buddhism, as is the relationship among the particularities of each individual, a process akin to externality, mental well-being, and morality.I raise Buddhism both because of its central interest into the nature of the self (an obviously germane consideration in the papers under discussion) and because of this second feature noted, namely the comfortable integration of individuality, character building, ethical action, and mental well-being (the issue of the true self will, thankfully, have to wait). It is this theme that I raise via the discussion of externality.The commentaries of Talmadge and Graham, unintentionally I think, pull me toward a beguiling observation in my daily practice of psychiatry. Namely, patients commonly report their clinical improvements in terms of how they deal better with others, how they are more thoughtful and even handed (with themselves included), and how they better cope with the demands of their individual lives. In senses both highly individual and highly principled, and in ways both explicit and implicit, when patients feel better they often feel that they are better people (all the kinds of treatment mentioned in my paper equally apply; there is no exclusivity in this result).There is also an interesting consistency in a dual manner in which this is expressed. In one way people report the improved coping, handling, and so on mentioned. In the next breath the same person commonly says, "I feel like myself."The meditation instructor would be pleased; it appears that through a process of becoming aware of and letting go of some form of negativity an individual feels better, acts better, and feels more unified. (As the instructor was psychologically sophisticated, he would not mistake the "like myself" sentiment as a Buddhist heresy. Rather, he would understand it as a reflection of being more at ease with and aware of disparate parts of himself.) And all this without figuring out who the real self is. [End Page 331]I mention these observations about Buddhism and clinical care because when I consider the processes of evaluating, deciding, and forging identity and volition it seems to me that somewhere between the lines the individual is aligning himself with some sense of what is good. The resultant experience of volition and cohesive identity is, often but not always, experienced as good both psychologically and morally.Change, Others, and ValuesIn the two commentaries that follow my paper on Frankfurtian externality and therapeutic change (Rego 2004), Talmadge (2004) and Graham (2004) highlight different aspects of externality and therapeutics. Talmadge, an addiction psychiatrist, expands the theme of volitional change in recovery from addiction. For Talmadge, as for most in the field, the question of when and how an addict has truly committed to change (hitting "rock bottom"? accepting the first of the twelve steps?) is perennially in the air. Such knowledge would be invaluable in guiding addicts along their rocky paths.Although still far short of the mark, Talmadge finds some illustrative guidance in Frankfurt. The shift that takes place within the addict to place him on the road to recovery is not necessarily "rock bottom," or conformity to a program's dictates or a state of new knowledge. Rather, it is a shift in will. By whatever process (and Talmadge is quite aware that there seem to be many paths) the addict has come to care about sobriety in a way he or she did not before. He or she now cares in a way that is part of him or her... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Knowledge, Mental Disorders, and MedsHow to Parse the EquationMark D. Rego (bio)Keywordspsychopathology, antidepressants, suicidality, subjective experience, pre-reflectiveA few weeks, ago I was walking down the hall to my office when I spotted my brother-in-law coming the other way. This was odd on two accounts. First, he lives in Kentucky (I am in Connecticut) and second, he is at least a foot taller than the man in my (...) hallway. Nonetheless, I struggled to figure out why he was there. The resemblance was so striking it took me a minute or two to convince myself it was not him. Even after such convincing, the feeling that it was him remained.Later, I imagined that had I just returned from a crack cocaine den I would have been hypervigilant, if not paranoid, and consequently would be certain that my brother-in-law had arrived unannounced. Furthermore, I would probably assume that he was up to no good.How did I retain a strong feeling of recognition, the feeling that maybe it was really him, when I already concluded otherwise? And why, were I on crack cocaine, would the obvious facts be useless in rendering a decision about the identity of the man in the hall? Last, why would the post-cocaine man in the hall become a nefarious brother-in-law rather than a benign one?If I just computed some symbols to figure this out, wouldn't the feeling have gone away? If I activated a brother-in-law neural network, how did I come to acquire an evil brother-in-law neural network? And why wouldn't that go away either?In his article in this issue of Philosophy, Psychiatry, & Psychology, Hadreas looks at questions like these through the prism of before and after effects of people treated with selective serotonin reuptake inhibitors (SSRIs). Hadreas investigates the implications of a straightforward recomputation of self-awareness when treated with these medicines and finds such approaches unsatisfying and incomplete in their explanatory power. (My example looks at a type of awareness, but not specifically self-awareness, as does Hadreas. Furthermore, my paradigm asks about computational conclusions using language more common in psychiatric literature, whereas Hadreas uses standard philosophical terms. Although not isomorphic, I believe the interchange of the two remains true to the issues Hadreas is addressing). [End Page 57]In my example, there is clearly something else going on than the incorrect arrangement of symbols or the misfiring of nodes in a network that influences how I feel and what I think. Neither reason nor empiricism seem to serve me well here. Hadreas utilizes Husserl to begin to unpeel the layers of self-awareness and self-states that intermix to form the shifts and contradictions which are so common in psychiatric treatment (and in common experience as I describe).This is a welcome reckoning; the psychiatric literature is overflowing with unquestioned premises about the neuropsychiatric correlates of reason and empirical approaches (described more as computation and neural networks in the literature—again, not strictly analogous, but the same criticisms apply) Hadreas is critical of. Unfortunately, Hadreas has navigated through a sea of highly questionable assumptions about the psychopharmacology of depression to illustrate his points. This is due in large part to the common practice of consulting literary narratives and critics rather than one of immersion in the literature as a whole and the daily life of patients and active clinicians. He arrived at his destination despite this, because many of these details did not affect his particular analysis. However, to look forward to a continuation of this work and clarify some important issues I devote most of my commentary to these issues. The points I raise are more extensively discussed in a previous edition of this journal (Rego 2005).Affect to Reason ShiftLet's begin with the idea that SSRIs work by dampening emotions. An extension of this idea is that they dampen negative emotions and strengthen positive ones like assertiveness, confidence, and optimism. An even further development in this direction is that, by dampening strong emotions, cognitive enhancement takes place with SSRI treatment. A summary observation then is that SSRIs facilitate... (shrink)

Within common mental health treatments there exists a paradox, in which personal agency over a problem appears to increase by disownership of the problem. I endeavor to explain this paradox and by doing so, shed light on the relationships among identity, psychopathology, and therapeutic agency. The work of the philosopher Harry Frankfurt, with emphasis on his concept of externality, is used as the model for unraveling the paradox of agency.

Sixty-eight stores of a retail chain were used for testing a model in which perceived authentic leadership predicts stores’ sales achievement through the mediating role of perceived store virtuousness and perceived store potency. Employees reported AL, store virtuousness, and store potency. Sales achievement over a period of four consecutive months subsequent to data collection was considered as dependent variable . The main findings are the following: AL predicts store potency through the mediating role of store virtuousness; store virtuousness predicts sales (...) achievement through the mediating role of store potency; AL predicts sales achievement via the mediating role of both store virtuousness and store potency. By focusing on three positive constructs, whose interrelations have scarcely been explored, and relating them to store performance, the study enriches the Positive Organizational Scholarship movement, and suggests that AL and virtuousness are good in themselves and also potential facilitators of group success. (shrink)

This article reviews Alex Anievas and Kerem Nişancıoğlu’sHow the West Came to Rule: The Geopolitical Origins of Capitalism(2015). It argues that the book offers a stimulating and ambitious approach to solving the problems of Eurocentrism and the origins of capitalism in growing critical scholarship in historical sociology and International Relations. However, by focusing on the ‘problem of the international’ and proposing a ‘single unified theory’ based on uneven and combined development, the authors present a history of international relations that trades (...) off methodological openness and legal complexity for a structural and exclusive consequentialism driven by anti-Eurocentrism. By misrepresenting the concept of social-property relations in terms of the internal/external fallacy, and by confusing different types of ‘internalism’ required by early-modern jurisdictional struggles, the book problematically conflates histories of international law and capitalism. These methodological problems are contextualised by examples from the Spanish, French and British empires’ conceptions of sovereignty and jurisdiction and their significant legal actors and processes. (shrink)

This essay argues that individual-oriented informed consent is inadequate to protect human research subjects in mainland China. The practice of family-oriented decision-making is better suited to guide moral research conduct. The family’s role in medical decision-making originates from the mutual benevolence that exists among family members, and is in accordance with family harmony, which is the aim of Confucian society. I argue that the practice of informed consent for medical research on human subjects ought to remain family-oriented in mainland China. (...) This essay explores the main features of this model of informed consent and demonstrates the proper authority of the family. The family’s participation in decision-making as a whole does not negate or deny the importance of the individual who is the subject of the choice, but rather acts more fully to protect research subjects. (shrink)

Although the skeptical crisis at the dawn of modern philosophy can be properly labelled Pyrrhonian specific features of the academic school of skepticism played an important role in this crisis. Academic skepticism becomes even more influential in post-Cartesian skepticism from Foucher to Hume.

This paper is dedicated to Alonzo Church, who died in August 1995 after a long life devoted to logic. To Church we owe lambda calculus, the thesis bearing his name and the solution to the Entscheidungsproblem.His well-known book Introduction to Mathematical LogicI, defined the subject matter of mathematical logic, the approach to be taken and the basic topics addressed. Church was the creator of the Journal of Symbolic Logicthe best-known journal of the area, which he edited for several decades This (...) paper is in three sections. The first is written in journalistic style:the story of the life of AlonzoChurch is told, including some of the many anecdotes I have collected from different sources. The secondpart is devoted to his work, but is far from being exhaustive. The last part is more original; in it I attempto show that Church’s great discovery was lambda calculus and that his remaining contributions weremainly inspired afterthoughts in the sense that most of his contributions as well as some of his pupils derivefrom that initial achievement. Included are Kleene’s Recursion Theory and the completeness proof ofHenkin. I have added an appendix in which is presented the typed lambda calculus and a proof of theundecidability of first-order logic. (shrink)