This paper discusses the role that the personal history plays in a patient’s perception of his or her own illness in the light of the patient’s own personal history. It demonstrates the regrettable modern tendency to regards the patient as the “bearer of a disease” rather than as a human being with personal values and experiences into which their current illness needs to be integrated. I illustrate my point by an exchange between a student and an “attending” and (...) the “attending” and the patient. It represents only one out of unfortunately many such instances in which the pressures of “managed care” and “efficiency” have made truly knowing the patient as an individual with life experiences and personal values much more difficult. (shrink)

This article argues that the Supreme Court’s decision in Dobbs is likely to impact medical decision-making by pregnant patients in a variety of contexts. Of particular concern are situations where a patient declines treatment recommended for its potential benefit to the fetus and situations where treatment is withheld due to potential risk to the fetus. The Court’s elevation of fetal interests, combined with a history of courts using abortion jurisprudence to guide their reasoning in compelled treatment cases, (...) means that Dobbs has the potential to limit patient autonomy in a wide array of clinical settings. The article calls on professional medical associations to issue ethical guidance affirming the duty to respect the medical self-determination of pregnant patients. (shrink)

Love, fear, hope, calculus, and game shows-how do all these spring from a few delicate pounds of meat? Neurophysiologist Ian Glynn lays the foundation for answering this question in his expansive An Anatomy of Thought, but stops short of committing to one particular theory. The book is a pleasant challenge, presenting the reader with the latest research and thinking about neuroscience and how it relates to various models of consciousness. Combining the aim of a textbook with the style of (...) a popularization, it provides all the lay reader needs to know to participate in the philosophical debate that is redefining our attitudes about our minds. Drawing on the rich history of neurological case studies, Glynn picks through the building blocks of our nervous system, examines our visual and linguistic systems, and probes deeply into our higher thought processes. The stories of great scientists, like Ramon y Cajal, and famous patients, like Sperry's split-brained epileptics, illuminate the scientific issues Glynn selects as essential for understanding consciousness. Some might argue that his lengthy explorations of natural selection overemphasize evolutionary explanations of psychological phenomena, but they must also agree that evolutionary psychology has distanced itself mightily from social Darwinism in recent years and merits a reappraisal. The great consciousness debate may form the core of the 21st-century Zeitgeist; get ready for it with An Anatomy of Thought. -Rob Lightner From Publishers Weekly How do we know? What do we think? How could a philosophical problem-'the mind-body problem,' say-induce a headache? What can evolutionary theory, molecular biology, the history of medicine and experimental psychology tell us about the features of human consciousness, and (once again) how do we know? Glynn, a physician and Cambridge University professor, meticulously attempts to answer these questions and more, setting forth the results of all sorts of research relevant to our brains-from 19th-century dissections to Oliver Sacks-like case studies, work with monkeys and supercomputers, and the enduring puzzles of philosophy, which he rightly saves for near the end. After explaining evolution by natural selection and 'clearing away much dross,' Glynn lays out the experiments and theories that have shown 'how nerve cells can carry information about the body, how they can interact' and how sense organs work; demonstrates the 'mixture of parallel and hierarchical organization' in our brains and 'the striking localization of function within it'; considers where neuroscience is likely to go; and admits that, among the many fields of exciting research just ahead, 'we can be least confident of progress toward a complete, scientific explanation of our sensations and thoughts and feelings.' Other recent explaining-the-brain books have sometimes advanced simplistic, or implausibly grand, claims about the nature and features of consciousness in general. Instead, Glynn offers a patient, informative, well-laid-out researcher's-eye view of what we have learned, how we figured it out and what we still don't know about neurons, senses, feelings, brains and minds. (Apr.) Copyright 2000 Reed Business Information, Inc. From Library Journal The nature of consciousness, which perennially troubles the minds of scientists and philosophers, is the subject of an ever-growing body of literature. Two of the latest entries approach the topic from different perspectives. Glynn, a professor of physiology and head of the Physiological Laboratory at Cambridge, offers a comprehensive summary of what we know about the brain-both its evolution and its mechanisms. Among the topics he covers are natural selection, molecular evolution, nerves and the nervous system, sensory perception, and the specific structures responsible for our intellect. Using the mechanisms involved in vision and speech as models, Glynn skillfully describes various neurological deficiencies that can lead to 'disordered seeing' and problems with the use of language. He carefully distinguishes what we know through experimental evidence from what we know through the observation of patients with neurological damage. He also describes some of the major theories that attempt to explain why these structures arose. While his book concentrates on the structures that make up the mind, Glynn is well aware that some physical events appear explicable only in terms of conscious mental events-a situation that conflicts with the laws of modern physics. Only briefly, however, does he consider the various approaches that have been taken to deal with the issues of mind/body and free will. In contrast, this is the primary focus of The Physics of Consciousness. After reviewing the fundamentals of classic physics, Walker (who has a Ph.D. in physics) summarizes elements of the new physics in which our knowledge of space, time, matter, and energy are all dependent on the moment of observation. Walker explores the meaning of consciousness as a characteristic of the observer. In this context both the observer and the act of measurement are critical. In essence, Walker leads his reader on a journey through his concept of a 'quantum mind,' which can both affect matter (including other minds) and can be affected by other distant matter/minds. To break up what would otherwise be an extremely dense text, Walker also relates the very touching story of the loss of his high-school sweetheart to leukemia. Indeed, it is his memory of their relationship that drives Walker to seek an understanding of ultimate reality. At times, he has a tendency to be dogmatic-as when he concludes, 'our consciousness, our mind, and the will of God are the same mind.' While An Anatomy of Thought is appropriate for most academic libraries, the Physics of Consciousness will be most accessible to readers with some knowledge of advanced physics. -Laurie Bartolini, Illinois State Lib., Springfield Copyright 2000 Reed Business Information, Inc. From Booklist The codiscoverers of natural selection-Charles Darwin and Alfred Wallace-disagreed over the possibility of finding an evolutionary explanation for the human mind. Glynn here argues Darwin's side of the debate, tracing an eons-long path of development starting from simple amino acids floating in primal seas and extending through the erect hominids in which the powers of a massive brain first manifest themselves. Patiently adducing evidence of an evolutionary origin for the underlying molecular machinery, Glynn dissects the nerve centers that make possible speech and hearing, sight, and reading. Pressing deeper, he lays bare the cortical foundations of personality. But those who deal with the mind must attend also to the arguments advanced by philosophers. And it is when he turns from dendrites to syllogisms (especially the vexing mind-body paradox) that Glynn's empirical reasoning fails him. In the end, he concedes his perplexity in trying to conceive of an evolutionary origin for human consciousness. This concession may set the shade of Alfred Wallace to chortling, but it will draw readers into an honest confrontation with a profound enigma. Bryce Christensen. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex interaction (...) of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)

This article explores the history of ‘subordination-authority-relation’ (SAR) psychotherapy, a brand of psychotherapy largely forgotten today that was introduced and practised in inter-war Vienna by the psychiatrist Erwin Stransky (1877–1962). I situate ‘SAR’ psychotherapy in the medical, cultural and political context of the inter-war period and argue that – although Stransky’s approach had little impact on historical and present-day debates and reached only a very limited number of patients – it provides a particularly clear example for the political (...) dimensions of psychotherapy. In the early 20th century, the emerging field of psychotherapy was largely dominated by Freudian psychoanalysis and its Adlerian and Jungian offshoots. Psychotherapists’ relations with academic psychiatry were often uneasy, but the psychodynamic schools succeeded in establishing independent institutions for training and treatment. However, as this article shows, the gulf between mainstream psychiatry and psychotherapy was not as wide as many histories of the psy-disciplines in the early 20th century suggest. In inter-war Vienna, where these conflicts raged most fiercely, Stransky’s ‘SAR’ psychotherapy was intended as an academic psychiatrist’s response to the challenge posed by the emerging competitors. Moreover, Stransky also proposed a political alternative to the existing psychotherapeutic schools. Whereas psychoanalysis was a liberal project, and Adlerian individual psychology was closely affiliated with the socialist movement, ‘SAR’ psychotherapy with its focus on authority, subordination and social hierarchy tried to translate a right-wing, authoritarian understanding of society into a treatment for nervous disorders. (shrink)

Peircean scholars in particular and historians of philosophy in general will welcome this initial volume of a new critical edition of the most important writings of this scientist/philosopher, not inaptly referred to as the "Socrates of America" because of the richness of seminal ideas to be found in his philosophical speculations. Until now, students of his basic philosophy have had to rely mainly on the topological Hartshorne-Weiss edition of his "collected works," which introduced the philosophical world to the goldmine (...) of original conceptions to be found in this hitherto unknown thinker. Like virtually all systematic philosophers, however, Peirce's seminal notions underwent development during almost six decades of literary activity. Those reading his collected works soon discovered that to reach any adequate idea of his system, they needed to know not only the time the item was written but also its context, and this meant going back to the manuscripts in the Houghton Library of Harvard, available in microfilm. It was here the enterprising researcher was confronted with substantial problems, for the material contained therein, would run to approximately a hundred thousand printed pages. Many of the manuscripts were repetitious, representing subsequent working drafts, but each with some new and exciting idea or important digression. The serious and intrigued scholar was both prompted on the one hand to pursue a particular topic further and at the same time repelled by the time and effort required to do so. It was to remedy this unhappy situation, particularly in view of the widespread growing interest in America's most original thinker both here and abroad, that resulted in the creation of the "Pierce Edition Project" at Indiana University/purdue University of Indianapolis under the general editorship of that internationally famous Peirce scholar, Max H. Fisch, aided by a staff directed by Professor Edward C. Moore. Almost a decade has passed since they began the gargantuan task of sifting through the mass of unpublished manuscripts, arranging dated items in chronological order, and determining as far as possible from paper watermarkings, similarity of thought and expression, etc. the approximate time of composition of the numerous bits and pieces of undated material spanning a period of some sixty years. More than three years time was devoted to this dating process alone, and the job of determining the final ordering and renumbering of the known manuscripts assigned to the project's principal associate editor, Christian J. W. Kloessel. In the Preface to the present volume, Moore sets out the general plan of this elaborate edition. "Each volume will contain a brief historical introduction giving an account of the activities of Peirce within its time span, including the work he was doing in the sciences, in mathematics, and in the history of science. Each volume will also include a single chronological list of all the papers Peirce wrote within the period covered by that volume. Thus readers who wish to make a thorough study of Peirce's work will find within each volume a guide to the complete Peirce corpus for the years of the particular volume. The historical introduction near the beginning and the chronological list near the end of each volume will serve as a frame for the papers that appear between them. It is hoped that reference to these additional materials will provide a comprehensive sense of Peirce's work in mathematics, the sciences, and philosophy". Because most of the texts in this initial volume exist only in a manuscript form of a working copy, never intended for publication as they exist, with their haphazard punctuation, phonetic spellings, abbreviations, etc., the editors felt it necessary to append over a hundred pages of editorial notes to satisfy the most meticulous historiophile who might like to reconstruct the original form of the writings in question, but which to the general user will probably seem to be an unnecessary expenditure of time and effort that might have been used to better purpose. Be that as it may, those interested in the history of ideas will be more than gratified that the many years of careful and patient labor by the editorial staff of the Peirce Edition Project at the Indiana University/ Purdue University of Indianapolis has begun to bear fruit. (shrink)

This paper presents an applied approach to conversation analysis in a setting comprising student dietitians and patients attending an outpatient clinic for heart disease and related disorders. In the first phase of the study interactions involving students deemed competent by supervisors were closely examined for distinctive configurations which could be attributed to satisfactory entry level practice. Reference was made to studies in similar settings and a particular emphasis was placed on the narrative structure for producing the diet (...) class='Hi'>history account. In the second phase a different group of students were taught history taking skills using findings and materials from the initial analysis. This focused on how to introduce the history and how to support its progression to achieve the outcomes required by the professional. In the final phase, interactions involving this second group of students were studied in detail to determine whether the interactional patterns taught were displayed in subsequent interactions. A further application of conversation analysis demonstrated that the second group of students co-constructed history phases which befitted the preferred narrative structure. These findings displayed the way in which conversation analysis could be applied in the teaching setting, bearing in mind that there is no escape from the situated order of professional interaction (nor indeed of the teaching context). The perspective presented of the interaction was one of 'professional medicine', that is it exposed issues of accountability and practical circumstances, when, in this case, novice dietitians 'do' nutrition counselling. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.3 (2003) 411-412 [Access article in PDF] Deborah Achtenberg. Cognition of Value in Aristotle's Ethics: Promise of Enrichment, Threat of Destruction. Albany: The State University of New York Press, 2002. Pp. xiii + 218. Paper, $20.95.Deborah Achtenberg argues that, for Aristotle, virtue is a disposition to respond to situations with the appropriate emotions, where emotions are understood as perceptions of the value (...) of particulars. To perceive the value of a particular is to perceive that particular as a limit; some limits enable what they limit to be more fully what it is, while other limits do the opposite. My activity in writing this review, for example, is "limited" both by the rules of grammar and by my computer's tendency to crash frequently; one kind of limit enriches my activity, while the other hinders and threatens it (hence Achtenberg's subtitle). An enabling limit is a telos or end; something is a telos of yours if it connects you to a larger context that in some way fulfills or completes you.Achtenberg's interpretation enables her to steer Aristotle clear of a number of persistent false dichotomies. For example: is the doctrine of the mean an uninspiring counsel to do the middling thing, or a vacuous counsel to do whatever one ought to do? Neither, says Achtenberg; rather, it is Aristotle's way of insisting on the flexibility of the virtuous person's [End Page 411] responses. Is Aristotle siding, then, with Odysseus, who suppressed his emotions in order to suit his actions to the demands of the occasion, as against Achilles, who stubbornly followed his emotions regardless of circumstance? No, that dichotomy falls as well: the virtuous person has flexible emotional (not just behavioral) responses, and so can be as adaptable as Odysseus yet as sincere as Achilles.Does Aristotle's ethics have a metaphysical foundation, or is it autonomous? Achtenberg dissolves that dichotomy by distinguishing two different ways in which Aristotle takes ethics to be an "imprecise" science. First, ethics and metaphysics are both imprecise, because they share a common subject-matter (final causation) that is an analogical equivocal and so indefinable. Second, ethics is less precise than metaphysics because ethics can establish that, but not explain why, its claims are true. Metaphysics can explain the why of ethics, but for practical purposes the why is not necessary; so metaphysics is explanatorily but not epistemically prior to ethics.How can Aristotle's particularist-sounding denial that the virtuous person needs rules be reconciled with his insistence that the virtuous person follows a logos? Must we play down the logos passage, or instead conclude that Aristotle is a rule-theorist after all? Once again, neither: in this context, Achtenberg suggests, logos means "analogy," not "rule." Since goodness is an analogical equivocal, perceiving goodness means perceiving analogies. Being transcategorial, these analogies are not definable or codifiable, so the rule-theorists are wrong; but we are grasping something common to all good things, so the particularists are wrong too.Let me close with a couple of criticisms. Once the notion of an enabling limit has been established, Achtenberg seems to accept as unproblematic the inference to the legitimacy of paternalistic legislation: citizens are more free, not less, for being subjected to such coercion. Now on a view that regarded persons primarily as moral patients or recipients, it might be reasonable enough to elide in this way the difference between imposing limits on oneself and having them imposed by external compulsion; but it is harder to see how forcibly imposed limits could be constitutive of a life's being happier when happiness is defined, with Aristotle, as a self-generated activity.I think Achtenberg also fails to catch one false dichotomy. She contrasts Aristotle's theory, which seeks to increase and enhance emotional awareness, with the Stoic theory (as represented by Marcus Aurelius), which seeks to decrease or suppress such awareness. The contrast seems to me misleading. Both Aristotle and the Stoics agree that moral maturation involves... (shrink)

This book concentrates upon how economic rationalities have been embedded into particular historical practices, cultures, and moral systems. Through multiple case-studies, situated in different historical contexts of the modern West, the book shows that the development of economic rationalities takes place in the meeting with other regimes of thought, values, and moral discourses. The book offers new and refreshing insights, ranging from the development of early economic thinking to economic aspects and concepts in the works of classical thinkers such (...) as Thomas Hobbes, John Locke and Karl Marx, to the role of economic reasoning in contemporary policies of art and health care. With economic rationalities as the read thread, the reader is offered a unique chance of historical self-awareness and recollection of how economic rationality became the powerful ideological and moral force that it is today. (shrink)

The aim of this essay is to elaborate philosophical and ethical underpinnings of posthumous diagnosis of famous historical figures based on literary and artistic products, or commonly called retrospective diagnosis. It discusses ontological and epistemic challenges raised in the humanities and social sciences, and attempts to systematically reply to their criticisms from the viewpoint of clinical medicine, philosophy of medicine, particularly the ontology of disease and the epistemology of diagnosis, and medical ethics. The ontological challenge focuses on the doubt about (...) the persistence of a disease over historical time, whereas the epistemic challenge disputes the inaccessibility of scientific verification of a diagnosis in the past. I argue that the critics are in error in conflating the taxonomy of disease and the act of diagnosing a patient. Medical diagnosis is fundamentally a hypothesis-construction and an explanatory device that can be generated under various degrees of uncertainty and limited amount of information. It is not an apodictic judgment as the critics presuppose, but a probabilistic judgment with varying degrees of plausibility under uncertainty. In order to avoid this confusion, I propose that retrospective diagnosis of a historical figure be syndromic without identifying underlying disease, unless there is justifiable reason for such specification. Moreover it should be evaluated not only from the viewpoint of medical science but also in a larger context of the scholarship of the humanities and social sciences by its overall plausibility and consistency. On the other hand, I will endorse their concerns regarding the ethics and professionalism of retrospective diagnosis, and call for the need for situating such a diagnosis in an interdisciplinary scope and the context of the scholarship of the historical figure. I will then enumerate several important caveats for interdisciplinary retrospective diagnosis using an example of the retrospective diagnosis of Socrates for his life-long intermittent neurologic symptoms. Finally, I will situate the present argument in a larger context of the major debate among the historians of medicine and paleopathologists, and discuss the similarities and differences. (shrink)

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care for (...) sick people can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Scheeben's Place in Nineteenth-Century Catholic Theology and the Question of His Theological MethodEvan S. KoopMatthias Joseph Scheeben (1835–1888) is enjoying a moment in English-speaking Catholic theological circles. In recent years his thought has attracted increasing interest from scholars who view him as an important forerunner to some of the central currents of Catholic theology in the twentieth century,1 a trend that promises only to accelerate with the recent (...) publication of the initial volumes of the first complete translation of his monumental Handbuch der katholischen Dogmatik into English.2 The much-debated question of Scheeben's proper place in the history of Catholic theology in the nineteenth century therefore, has gained a new relevance. While the present study of course, cannot and does not claim to bring this dispute to a definitive resolution, nevertheless it is hoped that it may at least help to clarify some common misunderstandings that can arise from hasty generalizations, and offer a few insights—which are not in fact new, but which are too often ignored by English-speaking scholars today—into the way in which the thought of the Jesuit theologians of the so-called "Roman School" may have served to influence Scheeben's unique theological method.In the past, numerous attempts have been made to situate Scheeben's thought within a particular theological school, and members of rival schools, in turn, have sought to claim him (or indeed repudiate him) as one of their [End Page 471] own.3 Amid the flood of divergent assessments of Scheeben's theological affinities, there at least exists some scholarly consensus about his greatness as a theologian. In 1935, during the centenary celebrations of Scheeben's birth, Pope Pius XI lauded him as a "man of genius" and proposed his thought to the students of the Germanicum as a model of the proper unity of theology's ascetical and dogmatic elements.4 In a Festschrift dedicated to Scheeben's theology published in the same year, Martin Grabmann judged that Scheeben was "the greatest dogmatic theologian of the nineteenth century,"5 and Carl Feckes, Scheeben's successor at the Cologne seminary, named him "the greatest Mariologist of our time."6 On the eve of the Second Vatican Council, no less an authority than Hans Urs von Balthasar could proclaim that Scheeben was "the greatest German theologian to-date [1961] since the time of Romanticism."7Nearly all, likewise, acknowledge the great difficulty of comprehending Scheeben's theology: even a German theologian of the stature of Joseph Ratzinger laments that Scheeben "has not made it easy, either as a professor for his hearers or as a writer for his readers. His language is rigorous, marked by the laborious travail of thought." The fact that he draws abundantly from such sources as Aquinas and the Greek Fathers "lends to his work [End Page 472] breadth and depth, but does not necessarily facilitate easy access."8 Similarly, the ultramontane Cardinal Henry Edward Manning, in his preface to an English abridgment of Scheeben's Dogmatik, warned that Scheeben's greatest work "requires not only reading but study; and study with patient care and conscientious desire to understand."9 Perhaps it is for this reason that it has become almost proverbial to observe that Scheeben's works are much praised, but seldom read.10Far less agreement, however, exists when it comes to the question of what kind of theologian Scheeben was, or to what theological school he belonged. Was he, asks the great Scheeben scholar Eugen Paul, "the prototype of those theologians who represent (if not establish) the infamous 'two-storey theory [Stockwerkstheorie] with respect to nature and grace—or does he rather belong to those who insist precisely on the transcendental unity of nature and grace?"11 Is Scheeben, in other words, a Neo-Scholastic, even "the most precious flower ever granted to the spring of Neo-Scholasticism,"12 as he was called in the first major study of his theology produced in the twentieth century? Or is he, instead, to be classed with the theologians of the Tübingen School who, under the influence of Romantic Idealism, sought to renew Catholic theology through... (shrink)

This article works across multiple disciplinary boundaries, especially queer theory, to examine critically the controversial, and often socially controlling, role of biomedical knowledge and interventions in the realm of human sexuality. It will attempt to situate scientific/medical discourses on sexuality historically, socially, and culturally in order to expose the ways in which “proper” sexual health in medical research and clinical practice has been conflated with prevailing social norms at particular historical junctures in the 20th and 21st centuries. How might (...) the relationship between clinical and cultural spheres be better engaged in biomedical knowledge and clinical practice in understanding sexual health, given the impact of homophobic and transphobic assumptions in the diagnostic histories of homosexuality and Gender Identity Disorder in Childhood, a new diagnostic category introduced into the DSM following the removal of homosexuality from the DSM-III? The article will argue further that biomedical knowledge is always already mediated through culture by analyzing normative racial, gender, class, and sexual ideologies that regulated early understandings of the epidemiology of the HIV/AIDS pandemic in the West and in the postcolonial world while informing global health policy on HIV/AIDS. The article concludes by examining the implications of medical education for both LGBTQI patients and medical professionals, for understanding gender and sexual rights as human rights, and for thinking about new kinds of interventions, contestations, and struggles to resist continued homophobic and transphobic assumptions in biomedical practice today and their ongoing effects in the everyday world. (shrink)

This book discusses feature films that enrich our understanding of doctor-patient dilemmas. The book comprises general clinical ethics themes and principles and is written in accessible language. Each theme is discussed and illuminated in chapters devoted to a particular film. Chapters start with a discussion of the film itself, which shares details behind the making of the film; critical reception; casting and other facts about production. The chapter situates the film in a history of medicine and medical sociology (...) context, analyzes ethical issues raised in the film from a clinical ethics lens, and explains to readers how to use each film as a teaching aid for clinical ethics. Readers will understand how each film in this collection served to bring particular clinical ethics issues to the public’s attention, or reflected medico-legal issues that were part of the public discourse. The book is a perfect instructor's guide for anyone teaching bioethics, healthcare ethics, medical sociology, medical history, healthcare systems narrative medicine, or nursing ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adam Smith and the History of the Invisible HandPeter HarrisonFew phrases in the history of ideas have attracted as much attention as Smith’s “invisible hand,” and there is a large body of secondary literature devoted to it. In spite of this there is no consensus on what Smith might have intended when he used this expression, or on what role it played in Smith’s thought. Estimates of (...) its significance range from the laudatory—“one of the great ideas of history,” to the dismissive—“an ironic joke.”1 Commentators are also divided on whether Smith’s “invisible hand” has teleological or providential connotations, or whether it is simply a rhetorical device. John Kenneth Galbraith declared that we do a grave disservice to Smith if we insist on understanding his invisible hand as a kind of “spiritual force.”2 Spenser J. Pack maintained that the invisible hand was “a rhetorical device which Smith made up, and knew he made up” and certainly “not [End Page 29] a theological underpinning for Smith’s social and/or economic theory.”3 Others have adopted the opposite view. Jacob Viner contended that Smith’s economic theory becomes unintelligible if “the invisible hand” is evacuated of its theological significance.4 For David A. Martin, Smith’s use of the phrase pointed to the foundational role played by divine wisdom in Smith’s thought, while for Andy Denis, “the invisible hand concept in Smith was entirely and unambiguously theological.”5Surprisingly, given this situation, a systematic study of the uses of the expression before Smith has yet to be made.6 Indeed, it is not unusual to find claims that Smith invented the expression himself, or that it was primarily owing to his influence that the phrase first became widespread.7 Those who have made perfunctory efforts at a history of the phrase generally point to a few scattered literary references with a view either to judging them irrelevant to Smith’s oeuvre, or to suggesting that Smith’s (admittedly meagre) uses of the phrase are empty metaphors. This paper seeks to remedy this deficiency, offering a history of “the invisible hand” with a particular focus on the seventeenth and early eighteenth centuries. What clearly emerges from this survey is that the concept was relatively common by the time Smith came to use it. Moreover, while “invisible hand” was used in a variety of contexts, by far the most common involved reference to God’s [End Page 30] oversight of human history and to his control of the operations of nature. Almost certainly, then, when readers encountered the phrase in Smith, they would have understood it as referring to God’s unseen agency in political economy. Whether Smith was himself committed to such a view is more difficult to determine, but the history of the expression and the contexts in which it appears in Smith’s writings offer some support for providentialist readings.Hidden and Invisible HandsThe expression “invisible hand” was not commonly used before the seventeenth century. It does not occur in classical literature (although some have suggested that the phrase may be found in Ovid).8 Neither does it appear in the Hebrew Bible or the New Testament.9 The earliest reference that I have found occurs in a Greek liturgy which invokes God’s “invisible right hand which is full of blessing.”10 The liturgy was used by the Alexandrian Church and its origins date back (probably) to the second century. However, [End Page 31] the expression is relatively rare in subsequent patristic and medieval writings. In one of his Old Testament commentaries, Alexandrian Church father Origen (185–254 ce) attributed the Israelites’ defeat of the Amalekites, recorded in Exodus 17, to the agency of God’s hidden hand.11 Some later sources made reference to the work of a “hidden” or “invisible” hand of God in restoring individuals to health. Augustine of Hippo (354–430 ce) thus spoke of the hidden hand of God which heals and makes whole.12 A medieval source refers similarly to a wound being healed by the touch of an invisible hand.13 French Benedictine Petrus Cellensis (1115–83 ce) alluded to the action... (shrink)

_Memory, Myth, and Seduction_ reveals the development and evolution of Jean-Georges Schimek's thinking on unconscious fantasy and the interpretive process derived from a close reading of Freud as well as contemporary psychoanalysis. Contributing richly to North American psychoanalytic thought, Schimek challenges local views from the perspective of continental discourse. A practicing psychoanalyst, teacher, and consummate Freud scholar, Schimek sought to clarify Freud's concepts and theories and to disentangle complexities borne of inconsistencies in Freud's assumptions and expositions. This book is divided (...) thematically into three sections. The first concerns fantasy and interpretation as they play out in the analytic situation, and the manner in which analyst and patient coconstruct meaning and reconstruct and recover memory. The second consists of two seminal papers which provide the sequence of steps in the five revisions in Freud's seduction theory. Schimek's careful scholarship lays out the data of Freud's writing, which allows one to draw one's own conclusions about the implications of the changes in the theory that he made. In the third, more theoretical section, he provides a foundation for understanding many of today's discussions about unconscious fantasy, dreaming, remembering, consciousness, affect, self-reflection, mentalization, and implicit relational knowing. He clarifies and illustrates Freud's original formulations through a careful reading of sections of _The Interpretation of Dreams_, and a study of Freud's famous Signorelli parapraxis. Skillfully arranged and carefully edited by Deborah Browning and including a foreword by Alan Bass, this collection of Schimek's published and unpublished papers will be of interest to practicing psychoanalysts, psychoanalytically-oriented psychotherapists, and students of the history of ideas and philosophy who have a particular interest in fantasy, interpretation, and Freud. (shrink)

From the Series Editor's Introduction: For much of the twentieth century, French intellectual life was dominated by theoreticians and historians of mentalite. Traditionally, the study of the mind and of its limits and capabilities was the domain of philosophy, however in the first decades of the twentieth century practitioners of the emergent human and social sciences were increasingly competing with philosophers in this field: ethnologists, sociologists, psychologists and historians of science were all claiming to study 'how people think'. Scholars, including (...) Gaston Bachelard, Georges Canguilhem, Leon Brunschvicg, Lucien Levy-Bruhl, Lucien Febvre, Abel Rey, Alexandre Koyre and Helene Metzger were all investigating the mind historically and participating in shared research projects. Yet, as they have since been appropriated by the different disciplines, literature on their findings has so far failed to recognise the connections between their research and their importance in intellectual history.In this exemplary book, Cristina Chimisso reconstructs the world of these intellectuals and the key debates in the philosophy of mind, particularly between those who studied specific mentalities by employing prevalently historical and philological methods, and those who thought it possible to write a history of the mind, outlining the evolution of ways of thinking that had produced the modern mentality. Dr Chimisso situates the key French scholars in their historical context and shows how their ideas and agendas were indissolubly linked with their social and institutional positions, such as their political and religious allegiances, their status in academia, and their familial situation.The author employs a vast range of original research, using philosophical and scientific texts as well as archive documents, correspondence and seminar minutes from the period covered, to recreate the milieu in which these relatively neglected scholars made advances in the history of philosophy and science, and produced ideas that would greatly influence later intellectuals such as Foucault, Derrida and Bourdieu. This book will appeal to historians of science and philosophy, particularly Continental philosophy, and those with interest in the history of ideas and the historiography of the disciplines of the social sciences. (shrink)

Extensive scholarship has described the historical and ethical imperatives shaping the emergence of the brain death criteria in the 1960s and 1970s. This essay explores the longer intellectual history that shaped theories of neurological consciousness from the late-nineteenth century to that period, and argues that a significant transformation occurred in the elaboration of those theories in the 1960s and after, the period when various disturbances of consciousness were discovered or thoroughly elaborated. Numerous historical conditions can be identified and attributed (...) to the production of the new theories that emerged from that period-on, not least in the broader social and cultural transformations that occurred with decolonialization, pro-democracy movements, and civil and disability rights advocacy, all contexts which exerted pressures on the institutions and professions of medicine. In this telling, the discovery of the locked-in patient is thus the exploration of a transformed vision of medical patients – one that moved them from a liminal indefinite space into a firmly grounded epistemological existence – in a backdrop in which medical professionals in particular and society in general was beginning to see the body differently. With this new vision, came a relational theory of consciousness to, a reading of a body and it signs, that shifted consciousness from an internally-derived state into a relationally-constructed object. The ontology of consciousness, whatever it was, thereby became entangled with the social condition of consciousness, one that bridged the worlds of close relationship with the social movements and anxieties about personhood that emanated out of that fraught period. (shrink)

A vital and timely reminder that modern life owes as much to outlandish thinking as to dominant ideologies What do the Nag Hammadi library, Dan Brown's The Da Vinci Code, speculative feminist historiography, Marcus Garvey's finances, and maps drawn by asylum patients have in common? Jonathan P. Eburne explores this question as never before in Outsider Theory, a timely book about outlandish ideas. Eburne brings readers on an adventure in intellectual history that stresses the urgency of taking seriously--especially (...) in an era of fake news--ideas that might otherwise be discarded or regarded as errant, unfashionable, or even unreasonable. Examining the role of such thinking in contemporary intellectual history, Eburne challenges the categorical demarcation of good ideas from flawed, wild, or bad ones, addressing the surprising extent to which speculative inquiry extends beyond the work of professional intellectuals to include that of nonprofessionals as well, whether amateurs, unfashionable observers, or the clinically insane. Considering the work of a variety of such figures--from popular occult writers and gnostics to so-called outsider artists and pseudoscientists--Eburne argues that an understanding of its circulation and recirculation is indispensable to the history of ideas. He devotes close attention to ideas and texts usually omitted from or marginalized within orthodox histories of literary modernism, critical theory, and continental philosophy, yet which have long garnered the critical attention of specialists in religion, science studies, critical race theory, and the history of the occult. In doing so he not only sheds new light on a fascinating body of creative thought but also proposes new approaches for situating contemporary humanities scholarship within the history of ideas. However important it might be to protect ourselves from "bad" ideas, Outsider Theory shows how crucial it is for us to know how and why such ideas have left their impression on modern-day thinking and continue to shape its evolution. (shrink)

Respect for autonomy is a key concept in contemporary bioethics and in ethics at the end of life in particular. An individualistic interpretation of autonomy may not incorporate the aspects of consideration that patients may have for their wider construct of personhood, which includes their love and consideration for their families. This anonymous case describes the intricacies of a patient’s decision making at the end of life, the choices she made, and how her decisions changed as her situation (...) evolved. The tension this produced within the medical team is unpacked using a lens of compassionate care in the intensive care unit. (shrink)

This book brings together a broad spectrum of authors, both from inside and from outside Cuba, who describe the development of Cuba's scientific system from the colonial period to the present. It is a unique documentation of the self-organizing power of a local scientific community engaged in scientific research on an international level. The first part includes several contributions that reconstruct the different stages of the history of physics in Cuba, from its beginnings in the late colonial era to (...) the present. The second part comprises testimonies of Cuban physicists, who offer lively insights from the perspective of the actors themselves. The third part presents a series of testimonies by foreign physicists, some of whom were directly involved in developing Cuban physics, in particular in the development of teaching and research activities in the early years of the Escuela de Física. The fourth part of the volume deals with some of the issues surrounding the publishing of scientific research in Cuba. Cuba's recent history and current situation are very controversial issues. Little is known about the development and status of higher education and scientific research on the island. However, Cuba has one of the highest proportions in the world of people with a university degree or doctorate and is known for its highly developed medical system. This book focuses on a comprehensive overview of the history of the development of one specific scientific discipline: physics in Cuba. It traces the evolution of an advanced research system in a developing country and shows a striking capacity to link the development of modern research with the concrete needs of the country and its population. A little known aspect is the active participation of several "western" physicists and technicians during the 1960s, the role of summer schools, organized by French, Italian, and other western physicists, as well as the active collaboration with European universities.<. (shrink)

History and philosophy complement and overlap each other in subject matter, but the two disciplines exhibit conflict over methodology. Since Hempel's challenge to historians that they should adopt the covering law model of explanation, the methodological conflict has revolved around the respective roles of the general and the particular in each discipline. In recent years, the revival of narrativism in history, coupled with the trend in philosophy of science to rely upon case studies, joins the methodological conflict (...) anew. So long as contemporary philosophy of science relies upon history's methodology to construct its case studies, it subjects itself to a paradoxical situation: the better the history, the worse the philosophy. An example of the methodological conflict is presented in the case of Antoine Lavoisier. This example also serves our ultimateconclusion, which is that distinctively philosophical methods of case-study design promise enhanced prescriptive powers for philosophy of science. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The (...) bioethics discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

This essay revisits the scholarly production around three major pandemics in the region: (a) the Third Plague Pandemic; (b) HIV/AIDS in the 1980s; and (c) COVID-19. The essay aims to provide a comprehensive set of resources (both printed and digital) in four languages (Portuguese, Spanish, English, and French) to examine how scholars have approached these phenomena and how their scope and interpretations have changed over time. Historians of health paid particular attention to sociocultural aspects of the disease, which enabled (...) them to consider usually-neglected actors, such as patients of Indigenous and African descent with their own medical traditions. This added more complexity to our understanding of how these pandemics were fought and received. In addition, the essay suggests that COVID-19 prompted the emergence of historians of health as public scholars. They actively used social networks and other digital tools not only to communicate about the long history of diseases and pandemics in the region, but also to provide an authorized or informed perspective amid misinformation and fake news. In addition, the internet was crucial to the development of helpful databases and virtual conferences beyond academic campuses and paywalls. (shrink)

For over two and a half millennia human beings have attempted to invent strategies to “discover” the truth of time, to determine whether time is infinite, whether eternity is the infinite duration of a continuous present, or whether it too rises and falls with the cycles of universal creation and destruction. _Time-Fetishes_ recounts the history of a tradition that runs counter to the dominant tradition in Western metaphysics, which has sought to purify eternity of its temporal character. From the (...) pre-Socratics to Ovid and Plotinus, and from Shakespeare to Hegel, Schelling, Nietzsche, Heidegger, and Derrida, _Time-Fetishes_ traces the secret tradition of the idea of eternal recurrence and situates it as the grounding thought of Western philosophy and literature. The thinkers in this counter-history of the eternal return lingered long enough on the question of time to learn how to resist separating eternity from time, and how to reflect on the possible identity of time and eternity as a way of resisting all prior metaphysical determinations. Drawing out the implications of Nietzsche’s reinvention of the doctrine of return, Lukacher ranges across a broad spectrum of ancient and modern thinkers. Shakespeare’s role in this history as the “poet of time” is particularly significant, for not only does Shakespeare reactivate the pre-Christian arguments of eternal return, he regards them, and all arguments and images concerning the essence of time and Being, from an inimitably ironic perspective. As he makes transitions from literature to philosophy and psychoanalysis, Lukacher displays a theoretical imagination and historical vision that bring to the forefront a host of pre- and post-Christian texts in order to decipher in them an encounter with the thought of eternal recurrence that has been too long buried under layers of rigid metaphysical interpretation. (shrink)

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy (...) as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)

This paper attempts to argue for the theory-ladenness of evidence. It does so by employing and analysing an episode from the history of eighteenth century chemistry. It delineates attempts by Joseph Priestley and Antoine Lavoisier to construct entirely different kinds of evidence for and against a particular hypothesis from a set of agreed upon observations or (raw) data. Based on an augmented version of a distinction, drawn by J. Bogen and J. Woodward, between data and phenomena it is (...) shown that the role of theoretical auxiliary assumptions is very important in constructing evidence for (or against) a theory from observation or (raw) data. In revolutionary situations, rival groups hold radically different theories and theoretical auxiliary assumptions. These are employed to construct very different evidence from the agreed upon set of observations or (raw) data. Hence, theory resolution becomes difficult. It is argued that evidence construction is a multi-layered exercise and can be disputed at any level. What counts as unproblematic observation or (raw) data at one level may become problematic at another level. The contingency of these constructions and the (un)problematic nature of evidence are shown to be partially dependent upon the scientific knowledge that the scientific community possesses. (shrink)

Performing Madness: The Clinic as Stage. In the second half of the nineteenth century, clinical demonstrations became the dominant teaching method in psychiatry, playing a key role in medical‐professional disputes, as well. This paper traces this widely used though historiographically neglected practice of knowledge implementation and mediation, as demonstrated in the psychiatric clinic of the Berlin Charité (Psychiatrische und Nervenklinik der Berliner Charité) from 1881 to 1927. Documentation of this practice, found within individual medical records, forms the basis of this (...) research. The concept of ‘theatricality’ assists in uncovering the dramatic quality of the clinical demonstration: Psychiatric knowledge was not simply disseminated through such a practice; rather, such knowledge was first performatively created through the very logic of its presentation of exemplary patient histories, as well as through the examination and diagnostic positioning of its patients. The ‘success’ of such presentations depended on many variables, related to staff, time, place, and other situational factors. These include the presence of appropriate lecture halls, the availability and calculated selection of patients, and the employment of specific performative techniques by doctors for the sake of producing desired results. As one effect, clinical demonstrations also encouraged patients to both learn and rehearse behavior considered relevant to the particular diagnosis that was to be demonstrated. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by (...) the notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

This major work of reference is an indispensable resource for anyone conducting research or teaching in philosophy. An international team of over 100 leading scholars has been brought together under the general editorship of Alan Schrift and the volume editors to provide authoritative analyses of the continental tradition of philosophy from Kant to the present day. Divided, chronologically, into eight volumes, "The History of Continental Philosophy" is designed to be accessible to a wide range of readers, from the scholar (...) looking for original insight and the latest thinking to the student wishing for a masterly encapsulation of a particular thinker's views. By placing continental philosophy within a historical context, "The History of Continental Philosophy" helps define what the continental tradition has been and where it is moving. It will become a landmark publication in its field. Volume 1 covers the period from 1780 until 1848, focusing primarily on the main philosophical figures and developments in Germany during that period, but also including a description of economic and social theories in France that set the stage for the philosophical and social movements that predominated in Germany and France during the second half of the nineteenth century. Volume 2 examines what is often referred to as the 'Age of Revolution' as various responses to Hegel, while also attending to developments in science, mathematics, sociology and aesthetics during the second half of the nineteenth century that would set the stage for the twentieth century. Volume 3 examines the earliest developments in the twentieth century: while attending to a number of key thinkers, it also discusses the emergence of French sociology in the Durkheim school, developments in modern science, the philosophical response to evolution, and the schools of phenomenology and neo-Kantianism. Volume 4, as the title indicates, charts the various responses to phenomenology that appeared in the years following Husserl, with particular attention to the emergence of existentialism and existential theology, as well as its relations with philosophy of science, aesthetics and ethics. Volume 5 surveys some of the main continental movements and philosophers associated with social and political philosophy and philosophy of the human sciences during the period from 1940 through to 1968. Volume 6 looks at the major figures associated with the two dominant movements that emerge in the 1960s - poststructuralism and critical theory - while also attending to the emergence of philosophical feminism and some influential figures in those years not easily situated in the "standard" histories of the period. Volume 7 examines the developments in Continental philosophy in the years, roughly, 1980-95, the period immediately after the hegemony of poststructuralism in France and of Habermas in Germany. Volume 8 attempts to situate the present scene in continental philosophy in terms of various new developments that are framed as attempts to rethink some of the classic themes with which the history of continental philosophy has been more or less consistently engaged. (shrink)

Bevir?s view that theories are prior to theorists, just in so far as they are prior to any observations which one might make and, by extension, any facts which one might invoke in support of any particular interpretative conclusions, is problematic when applied to intellectual history, for although it is in one sense true that all facts are ineluctably constituted by some or other underlying theory, it is also true that, in a vast number of important situations, all (...) human beings share the same basic theory. The most important implication of this shared stock of concepts, observations and facts, is that we shall often be able to see numerous aspects of a long?dead author?s world in much the same way as he or she saw it. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying (...) process. Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

BackgroundDepression and alcohol dependence are among the most prevalent psychiatric disorders that commonly co-occur. Therefore, gaining a better grasp of factors related to this comorbidity is particularly interesting for clinicians. Past research has highlighted the significant role that time perspective and family history of alcohol dependence play in the occurrence of depression and AD. However, much remains unexplored in the understanding of the association between them. This study explored how temporal profile and other sociodemographic characteristics of patients diagnosed (...) with AD impact the severity of depression and AD in them.MethodsThis study was multi-centered, including 381 patients. Cross-sectional information was collected from both inpatient and outpatient psychiatric clinics in China. Data were acquired using validated self-report scales, including Michigan Alcoholism Screening Test, Zung Self-Rating Depression Scale, and Zimbardo Time Perspective Inventory-Chinese version. Multiple linear regression analyzes were conducted to control social demographic variables and construct prediction models to inspect the influence factors of variables. Moderation models were constructed to inspect further interplay between variables using hierarchical regression and PROCESS Macro.ResultsResults showed that of all the patients in Chinese psychiatry clinics diagnosed with AD according to the International Classification of Diseases-10, 59.9% met the criteria of depression according to the questionnaire, and time perspective was correlated with the severity of depression. Furthermore, using regression analysis, we found that time perspective and depression could predict AD severity. The moderating role of a past negative time perspective and FH was confirmed between depression and AD. We found that, in our study, only in patients with FH and relatively moderate to high scores of past negative time perspective could the severity of depression predict the severity of AD. Therefore, during the treatment and care of patients with AD, their depression level, time perspective score, and FH should be considered. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 66.4 (2005) 527-539 [Access article in PDF] Salvatore Camporeale's Contribution to Theology and the History of the Church Mariangela Regoliosi University of Florence Salvatore Camporeale's research, as rich and varied as it was, revolved around several primary axes and was inspired by several fundamental concerns.1 One of the objectives that certainly oriented his cultural effort was a serious, critical, and passionate (...) desire to reform the church, to recuperate its radical and founding truths, to go beyond all superstructure and pseudo-truth. I believe that, for this very reason, Camporeale engaged with Valla (to whom he devoted most of his scholarly work): because the latter had, with extraordinary lucidity, raised issues and proposed solutions in perfect keeping with his own essential needs.Naturally, arriving at such a perception of the innovativevalue and ideological depth of Valla's thoughtinvolved far more than this. We are indebted to Camporeale for having developed the lesson of his mentor, Eugenio Garin: that is, the view that—against the interpretive limitations widely heldby other scholars and other schools—Lorenzo Valla was not onlythe excellentphilological emender of Livy's text, nor simply the "grammarian" restorer of the Latin language, but that such tangible gifts and capacities were sustained by more general philosophical motives and by an organic project of cultural refounding, that would challenge established categoriesin all fields, from language to history to theology.Camporeale was thus able to identify—beginning with his distinguished book published in 1972, Lorenzo Valla. Umanesimo e teologia—the foundations and ultimate scope of Valla's philosophy of language and, consequently, the unifying elements in his apparently heterogeneous works, which range from historiography to historical criticism, from ethics to linguistics, from [End Page 527] logic to rhetoric, from the philological study of classical works to that of the NewTestament. And he was able to see that, also for Valla, the critical revision of the ecclesiastical tradition, and of the "models" of theological discourse, had been a Leitmotiv or, better yet, an arrival point.It is within this specific, though not limited sphere of inquiry that I intend to situate my study, a personal, brief recollection of the friend we lost. Therefore, I will focus on two particular contributions, one from 1977, Lorenzo Valla tra Medioevo e Rinascimento. "Encomion s. Thomae". 1457, the other from 1988, Lorenzo Valla e il "De falso credita donatione". Retorica, libertà ed ecclesiologia nel '400. As their titles openly declare, they investigate two of Valla's works diverging not only in time but in content as well ("De falso credita donatione" dates from 1440, the "Encomion sancti Thomae" from 1457); the one is intended to denounce the so-called "Donation of Constantine" as a forgery, the other to commemorate Saint Thomas on the day of his liturgical anniversary. And yet, Camporeale correctly identifies a peculiar and intrinsic unity in these works, namely the effort to rediscover an authentic Christianity: an authentic "form" of the church on the one hand, and an authentic "form" of Christian theology on the other.I will start with, and devote special attention to, the Encomion sancti Thomae. Camporeale correctly recognized this short text as Valla's "spiritual testament," not only, or not so much because it is his last piece of writing (he died a few months after the Encomion), but because, in a few dense but clear pages, it sums up Valla's entire logico-linguistic program and, consequently, his stance on the expressive potentialities of human language, up to the highest levels of the expressible, those of metaphysics and of theology. The way Camporeale develops his considerations on the "panegyric" is admirable, as he supports it with the experienced philosophical and theological competence (in the history of theology, and especially Thomistic theology) that he, as a Dominican, mastered so well. (In passing, it is worth noting that such competence alone could allow for a thorough assessment of the historical significance of Valla's discourse, too frequently trivialized or misunderstood by readers lacking the necessary tools). The following... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:NOTES AND DISCUSSIONS 501 the practical problems of daily life by providing an explanation for misfortune and a source of guidance in times of uncertainty. There were also attempts to use it for divination and supernatural healing" (p. 151). Along these same lines, one should also cite a number of articles by Natalie Zemon Davis and, above all, the work of Robert Mandl 'ou. 17 To conclude these remarks, (...) I must stress once again that Cassirer's program, in its pure form, is not only impossible for any but the mystic to follow; it is fundamentally anti~ historical. Peter Gay himself, a great admirer of Cassker, and a historian who has a penchant for such neo--idealist hocus-pocus, has tended to follow Cassirer's dictum in his interpretation of the Enlightenment as a whole (to his grid, one is tempted to add).TM Earlier, in Voltaire's Politics (1959), Gay had made a most convincing case for a radically different approach, which he calls "the social history of ideas." Instead of "searching for a dynamic center of thought," "a single point of view," of which each pamphlet, poem or tale was but another facet, Gay presented Voltaire's works as responses to specific situatiom--a series of positions which, if not discrete, were at least sufficientlydiverse as to be incomprehensible without intimate knowledge of the peculiar circumstances of each. I am not suggestinghere that the historian of philosophy abandon his traditional m6tier in a mad search for more fashionable methods. There will always be a need for insightful, penetrating analyses of individual thinkers, and probing essays into internal consistencies or contradictions. Febvre readily conceded that the historian concerned only with "placing" Descartes in his century has not thereby come to grips with Cartesianism. But abstract analysis cannot safelybe divorced from its natural collateral disciplines. It is time to stop studying philosophical ideas as if they were statements propounded in a void. If we neglect the rhetorical situation of philosophy, if we forget the particular audience to which an idea was addressed, we run the risk of forgetting what it is we mean by an idea in the first place. ALeaev SOMA~ Par/~ COMPLEMENTARY METHODOLOGIES IN THE HISTORY OF IDEAS Alfred Soman doses his article with the modest statement, "I am not suggesting here that the historian of philosophy abandon his traditional metier in a mad search for more fashionable methods. There will always be a need for insightful, penetrating analyses of 1T N. Z. Davis, "The Reasons of Misrule: Youth Groups and Charivaris in Sixteenth-Century France.,"Past and Present, No. 50 (February, 1971), 41-75; "The Rites of Violence: Religious Riot in Sixteenth-Century France," ibid., No. 59 (May, 1973), 51-91. Mandrou's recent Des humaniatea au.r hommea de science: XVI 9 et XVIIe si~cles (1973) is by far the most coherent and systematic synthesisof the new historiography of ideas for this period. Specialistswill of course findroom to quarrel over some of the details;but as an initial outline and as a program for future research, the virtues of Mandrou's book are, I think, indisputable. is E.g., P. Gay, The Enlightenment, an Interpretation, 2 vols. (New York, 1966-1969). Gay's s~lmmaryremarks on Charron (I, 303) are so typical of his verbal sleights of hand that I cannot resist the following quotation: "While Charron was not a philosophe before his time---he was a priest and a theologian---the values he celebrates, in open dcfcren~ to his Romans, are the v~u of tl~ Eallghtc~m~nt." 502 HISTORY OF PHILOSOPHY individual thinkers, and probing essays into internal consistencies or contradictions.''t Yet what else might his intent be when he tacks on to a critique of an article explicitly designed as a textual analysis of De la Sagesse a glowing!audation of the new trends in the social history of ideas. The second half of his article is in fact an attack on many of the textual studies that fill this journal. The new trends in historiography that have so greatly affected eighteenth-century studies do indeed look most promising,2 hut in our concern for the social milieu in which... (shrink)

Originally published in 1971, this volume examines the relationship between the history and sociology of education. History does not stand in isolation, but has much to draw from and contribute to, other disciplines. The methods and concepts of sociology, in particular, are exerting increasing influence on historical studies, especially the history of education. Since education is considered to be part of the social system, historians and sociologists have come to survey similar fields; yet each discipline appears (...) to have its own aims and methodology. (shrink)

There seems to be a general understanding that French philosophy of science is different from ‘mainstream’ philosophy of science; this difference has been made official, as it were, in reference works and Encyclopaedias. In this, the Routledge Encyclopedia of Philosophy is paradigmatic: it has two entries, one for ‘Philosophy of Science’, and another for ‘French philosophy of science’. Is this distinction correct, and where does it come from? In this paper Cristina Chimisso gives a mixed answer: on the one hand, (...) she argues that there is a distinctive tradition in French philosophy of science, generally called historical epistemology. This tradition has developed thanks to particular institutional and intellectual arrangements that have promoted close links between philosophy and other disciplines, and thanks to the centrality of history in the study of philosophy. On the other hand, she also argues that the reception of French philosophy of science outside France has been, arguably unduly, dominated by this particular, though very important, tradition at the expense of other approaches. (shrink)

We’re in the midst of a wave of efforts to historicize and localize theory. One stream, oriented toward a global social imaginary, has sought to “ provincialize Europe,” in Dipesh Chakrabarty’s resonant trope. This means provincializing Euro-American social theory and situating it within a particular geopolitical formation—a contextualizing project that opens space to center what the Comaroffs call “theory from the South” and other regional or indigenous loci of orientation. Another stream situates itself more comfortably within Western traditions of (...) theory but casts them in new historical lights—for instance a revisionist account of critical theory as the product of Hegel’s refiguration of medieval... (shrink)

This article uses medical textbooks and advice literature to analyze the persona of the physician in the early German Enlightenment. The article pursues three lines of argument. First, it uses medical textbooks to situate the physician in the context of early modern observational life, focusing in particular on epistemic virtues, techniques, and technologies for conducting and documenting observations. Second, it introduces the concept of epistemic advantage to analyze the ways in which medical advice literature – ranging from ideal accounts (...) of the political physician to satirical portrayals of the Machiavellian physician – mediated strategies for using medical knowledge to shape people’s conceptions of disease as well as of the physician as a medical authority. Third, it launches the concept epistemic contestation to capture situations of distrust and dispute, in which the physician’s authority was challenged both by patients and by other medical practitioners. Such mediation of epistemic virtues, techniques, technologies, and strategies in medical textbooks and advice literature must be understood in relation to an emerging media landscape that fundamentally affected the conditions for cultivating and performing a medical persona. By adopting this comprehensive approach to medical personhood, the article appeals to readers interested in early modern and Enlightenment medicine as well as those concerned with the broader intersections of medical persona, authority, power, and knowledge. (shrink)

In this paper we investigate the behavior patterns of Alzheimer patients and multihandicapped persons communicating with peers and therapists in an interaction situation. Communicative items were analyzed automatically and sorted into patterns. The results showed that despite their reported ‘linguistic’ disabilities, the patients not only played their role in the interaction, but were also able to lead the conversation and take initiatives. In spite of their vulnerability, both types of patients, particularly those with Alzheimer’s disease, exhibited the (...) ability to integrate new information and to get involved in the dialogue. (shrink)

This article explores the patient experience of medically unexplained symptoms (MUS) from an existentialist standpoint. Drawing on the work of Jean-Paul Sartre and Simone de Beauvoir, I explore their concepts of existential situation, existential project, authenticity, and praxis. I then analyze the situation of MUS patients in the current cultural and institutional context, elucidating that a lack of explanation for their symptoms puts MUS patients in an existential bind. I illustrate the effects of the experience of MUS on (...) patients’ existential projects. Last, I develop an ethical response in the existentialist tradition from the perspective of patients, providers, and society at large. I argue that there is a collective responsibility to foster conditions more conducive to authentic patient well-being and to improve the experience of patients with medically unexplained symptoms. (shrink)

BackgroundThe Covid-19 pandemic caused situations where, in some hospitals, there were more patients in need of urgent treatment in intensive care units (ICU) than were available. In particular, there were not sufficient ventilators or critical care resources for all patients in danger of dying from respiratory failure or other organ failures.DiscussionAs the “first come, first served” criterion was not considered adequate, more nuanced and fairer clinical criteria were proposed to assess whom to treat first. One type of (...) patients that has not been considered in the literature so far is that of “important patients”, individuals that many people might consider worthy of priority treatment for the contribution they made or might make to society as a whole.SummaryIn this article, we discuss the moral insights behind the possible treatment of “important patients” and suggest a supererogatory solution of voluntary renunciation/withdrawal. Details of the proposal are explained, and potential objections are addressed. (shrink)

In this article, the relationship between philosophy and history of education is delved into. First, it is noted that both disciplines have diverged from each other over the last few decades to become relatively autonomous subsectors within the pedagogical sciences, each with its own discourses, its own expositional characteristics, its own channels of communication, and its own networks. From the perspective of the history of education, it seems as though more affiliation has been sought with the science of (...) history. The history of education, in any event, has in the past few years become more historicizing and less ‘educationalizing’. According to the author, (who is not a philosopher of education) there are signs that indicate that such an analogous line of reasoning, mutatis mutandis, also applies for the philosophy of education. Does this mean that there are no longer any bridges from the one area to the other or that none are possible? Probably not. In the second portion, it is shown that the modern or even postmodern ‘new cultural history of education’, with its often ironical and demythologizing traits uses or can use a considerable amount of ‘grand theory’ (à la Foucault). Indeed, the development of an adequate conceptual apparatus that also has to cope with the problem of ‘presentism’ assumes a constant dialogue with the past and for this a philosophical‐interpretative (casu quo, hermeneutic) approach is still the best situated. Inversely, the Foucauldian perspective shows that philosophy in general and philosophy of education in particular equally hardly do without history. Within the reflection on pedagogical praxis, the historical and the philosophical thus probably will continue to rely on each other—if only as allies against the dominance of short‐winded empirical‐quantitative research. Still, it would be naive to think that, from this possible alliance, the fragmentation of historically developed knowledge systems with their own sociological and institutional foundation of scientific activities can be rectified in a trice. (shrink)

Decisions regarding the end-of-life of minor patients are amongst the most difficult areas of decision-making in pediatric health care. In this field of medicine, such decisions inevitably occur early in human life, which makes one aware of the fact that any life—young or old—cannot escape its temporal nature. Belgium and the Netherlands have adopted domestic regulations, which conditionally permit euthanasia and physician-assisted suicide in minors who experience hopeless and unbearable suffering. One of these conditions states that the minor involved (...) must be legally competent and able to express an authentic and lasting wish to die. This contribution is different from other legal texts on end-of-life decisions in modern health care. Foremost, it deals with the role time-bound components play in our views on the permissibility of such decisions with regard to minor patients. While other disciplines provide profound reflections on this issue, from a legal point of view this side has hardly been explored, let alone examined with regard to its relevance for the legal permissibility of end-of-life decisions in pediatrics. Therefore, the manuscript inquires whether there are legal lessons to be learned if we look more closely to temporality-related aspects of these end-of-life decisions, particularly in connection to a minor patient’s assumable ability to choose death over an agonizing existence. (shrink)

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance (...) to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

The nature of engineering and history as disciplines are explored and found to have some striking similarities, for example in the importance they place on context and practitioner involvement. They are found to be different from science, which focuses more on universal generalizations rather than on the particulars of given situations. The history of technology is paid special attention, because the discipline has developed in a way that incorporates both scientific (generalizing) and historical (context specific) characteristics. Proposals are (...) made for giving historical studies greater space in engineering education. (shrink)

As frequently pointed out in this discussion, one of the most characteristic features of Mayr's approach to the history of biology stems from the fact that he is dealing to a considerable degree with his own professional history. Furthermore, his main criterion for the selection of historical episodes is their relevance for modern biological theory. As W. F. Bynum and others have noted, the general impression of his reviewers is that “one of the towering figures of evolutionary biology (...) has now written a towering history of his discipline.”138 Bynum is here referring to The Growth of Biological Thought, but this observation holds equally true for Mayr's other historical writings: One must surely read this book [One Long Argument] not only for its content in itself, but for what it tells of its author. And certainly as one does so, one comes away full-handed. Many, if not all, of the disputes and controversies that have driven Mayr through his long intellectual life reappear, stated as forcefully and elegantly as ever.139Up to this point, most reviewers agree; the bone of contention is, rather, how to evaluate Mayr's historical work, considering this observation. The two related characteristics of his work-I will call them subjectivity and presentism-stand in opposition to a widespread approach in the history of science exemplified by Kuhn's suggestion that “insofar as possible..., the historian should set aside the science that he knows. His science should be learned from the textbooks and journals of the period he studies.”140 There are, however, historians who consider the close connection between Mayr and the subject matter of his historical studies to be an advantage.141On the other hand, it is assumed that the connection between past and present must result in a distortion of the historical truth and lead to a historiographical fallacy, commonly referred to as “Whig history”. Herbert Butterfield, who in 1931 gave the term its now generally accepted meaning, believed that “real historical understanding is not achieved by the subordination of the past to the present, but rather by our making the past our present and attempting to see life with the eyes of another century than our own”142. Unfortunately, Butterfield's definition of what he considers Whig history remains somewhat vague, and modern authors have emphasized what they consider most important. Butterfield's “subordination of the past to the present” is referred to in respect to the selection of subjects (there are more biographies of Charles Darwin than of, let's say, Louis Agassiz),143 to the evaluation of historical authors,144 or, more generally, to all kinds of histories “with one eye, so to speak, upon the present.”145 The underlying tendency of Whig historians is to produce a “historical account told from the viewpoint of those in power,”146 leading to a “glorification of the present.”147 It is obvious that Mayr's strongly presentist approach to the history of biology can be called Whiggish, if we apply the criteria of “selection” or “reference.” However, it might be worth mentioning that the program of writing a strictly historicist account of the history of science is challenged by various authors.148 For Mayr, it is not only legitimate but necessary to compare the present situation with the past. “Whiggish” is only the evaluation of an author in terms of our time.149I cannot discuss the Whit/anti-Whig controversy in any detail here, apart from saying that Mayr has defended himself rather extensively against the charges of being Whiggish.150 Nevertheless, it may be useful to touch on some of the criticisms that are predominant in reviews of his writings. First, we encounter the notion that historians can write a true and convincing historical account only if they have no personal interest or interpretation of their own; Mayr, on the other hand, because he “has such strong interpretations of his own, ... cannot possibly convince everyone that he is right about everything.”151 It makes one wonder, what historian has ever been able to convince everyone that he or she is right about everything? But apart from this peculiar idea, it unquestionably poses certain dangers if the subject matter of historical scrutiny and the author are identical. At the same time, this identity brings certain advantages with it, especially firsthand experiences of the period in discussion. Whether these personal memories ultimately result in a distorted picture of the past has to be decided in every particular instance. The notion that a scientific study can be conducted by a completely detached observer from a neutral standpoint has been shown to be impossible in physics, and it is also an illusion in historiography. The question is not whether, but which kind of interest are the underlying motivation for a historian. At this point, Mayr is ahead of his critics when he suggests that our understanding of the past always has a subjective component: The main reason, however, why histories are in constant need of revision is that at any given time they merely reflect the present state of understanding; they depend on how the author interpreted the current zeitgeist of biology and on his own conceptual framework and background. Thus, by necessity the writing of history is subjective and ephemeral.152Second, the temporal proximity between the event and the historical analysis makes difficulties inevitable and will finally result in certain false assessments. But this applies to all historians when they discuss recent problems, regardless of whether they are personally involved or not: As long as the battle between Darwinism and Lamarckism was raging, it was quite impossible to undertake an unbiased evaluation of Lamarck. ...[The] definite refutation of Lamarck's theory of evolutionary causation clears the air. We can now study him without bias and emotion and give him the attention that this major figure in the history of biology clearly deserves.153Third, Mayr is primarily interested in biological problems and not, for instance, historiographical, sociological, or psychological questions. Several authors have remarked that since the beginning of the professionalization of the history of science in the 1960s, a rift between two groups has developed, resulting from the heterogeneous professional backgrounds and interests of the people involved: the authors who were originally biologists and became interested in the history of their discipline only later on, and the authors who were trained as historians.154 Whereas the first group, the “biologists,” tend to be laymen in history proper, the “historians” are in most cases laymen in biology. Different professional backgrounds obviously shape the historical perspective in both groups, but neither approach is necessarily superior. The great number of important books in the history of biology written by “biologist” documents how valuable this point of view can be. On the other hand, it cannot be denied that the writings of biologists in the history of science tend to have a strong “internalist” tendency and often neglect the professional, cultural, and political context of science. Mayr's approach is that of a “biologist”; it is “internalist,” and typical for scientists who turn to the history of their discipline.I want to conclude my analysis with a quotation from a review by Douglas J. Futuyma, which gives a perceptive glimpse of Mayr's personality and style: One cannot help standing in awe of the germanic capacity for vast, allembracing synthesis: consider the lifelong devotion of Goethe to Faust, or Wagner's integration of the arts into a Gesamtkunstwerk in which all of human history and experience is wrought into epic myth. It is perhaps in this tradition that Ernst Mayr's The Growth of Biological Thought stands: a history of all of biology, a Ring des Nibelungen complete with leitmotivs such as the failures of reductionism, the struggle of biology for independence from physics, and the liberation of population thinking from the bounds of essentialism.155 Within this style of thinking Mayr has “to offer...nothing less than a vision of biology that places neodarwinian evolutionary theory firmly at the centre.”156 There may be other visions of biology, but few of them have as indefatigable and able representatives as Darwinism has in Ernst Mayr. (shrink)

This paper attempts to argue for the theory-ladenness of evidence. It does so by employing and analysing an episode from the history of eighteenth century chemistry. It delineates attempts by Joseph Priestley and Antoine Lavoisier to construct entirely different kinds of evidence for and against a particular hypothesis from a set of agreed upon observations or data. Based on an augmented version of a distinction, drawn by J. Bogen and J. Woodward, between data and phenomena it is shown (...) that the role of theoretical auxiliary assumptions is very important in constructing evidence for a theory from observation or data. In revolutionary situations, rival groups hold radically different theories and theoretical auxiliary assumptions. These are employed to construct very different evidence from the agreed upon set of observations or data. Hence, theory resolution becomes difficult. It is argued that evidence construction is a multi-layered exercise and can be disputed at any level. What counts as unproblematic observation or data at one level may become problematic at another level. The contingency of these constructions and the problematic nature of evidence are shown to be partially dependent upon the scientific knowledge that the scientific community possesses.Author Keywords: Theory-ladenness of evidence; Eighteenth century chemical philosophy; Construction of evidence; Observation/data; Theory resolution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 170-174 [Access article in PDF] A Buddhist History of the West: Studies In Lack. By David R. Loy. Albany: State University of New York Press, 2002. 244 pp. The religious and philosophical situation of our time seems polarized between resurgent fundamentalisms and a cosmopolitan awareness bridging heretofore separated traditions. Even a few decades ago the notion of a dialogue between East and West was (...) a novelty in which demarcated traditions and cultures (say the Buddhist East and the Christian West) experimented with attempts to find a common language to speakacross the boundaries between their respective identities. In such a context,"Western Buddhists" were those pilgrims of the counterculture who "went East" in search of some civilizational and spiritual other; the West, abjected to the realm of soulless scientism or outdated religious authoritarianism, was left behind. The situation is different at the beginning of the twenty-first Christian century. The dialectical complexities, both inwardly in the soul or mind of seekers, and outwardly in the strange twists of contemporary history, emerge to forbid any simple assessments of what can be left behind or indeed what the use can be of what seekers have found in the "non-West." People of Western background begin to realize and consciously address the [End Page 170] karmic-historical presuppositions of their search, which continue to constitute a kind of historical unconscious to the formulation of any possible "Western Buddhisms." Meanwhile, while fundamentalists of many backgrounds posit "clashes of civilizations" that assume an absoluteness of traditional distinctions, cosmopolitans realize that, for all the particularity of their respective starting points, the global situation is inextricably a shared one. In such a context, what canWestern Buddhist intellectuals, cognizant of their own starting points but having learned some things along the Way that are perhaps of universal relevance, speak to our common condition?The "Buddhist History of the West" that David Loy provides is less a historical narrative of the events constitutive of the societies descending from Greco-Roman civilization through European epochs and American empire into the age of globalization than a form of psychoanalytic anamnesis of those societies' cultural constructions of reality. Loy's psychoanalytic interpretive frame is composed of Buddhist insight into the human mind's deep-seated grasping for solidity and certainty in the face of a reality fundamentally characterized by impermanence and ungroundedness (the "Lack" of the subtitle, our simultaneous awareness of death, impermanence, andontological emptiness and the ego's wish for eternal selfhood in an endless but impossibly fulfilling world). Loy's Buddhism is combined with the existential psychology of Ernest Becker and the revisionist Freudianism of Norman O. Brown called on as Western resources for the spiritual therapeutics "the West" seems to need as it enters the third Christian millennium both triumphant and in despair of any meaning to accompany its economic and pop-cultural hegemony.Seven anamnestic chapters take us through twenty-five hundred years of Western cultural constructions, from the Greek and Roman philosophical inquiries into Freedom, a kind of origin-tale of Humanism seen as a "religious" (religion for Loy being the way humans attempt to answer the problem of Lack as if to ground our groundlessness) vision of meaning as the development of human capacities for rational thought, through the intertwining of classical and Christian constructions in medieval and Renaissance periods, through the Protestant Reformation into the political and ideological space of modernity, culminating in a vision of the globalizing West as purveying a "Religion of the Market," an ironically meaningless (centered on the symbolic code for Value—Money—as a displacement of Value itself) system of meaning. This last, our contemporary situation, would perhaps be simply a problem of aesthetic tastelessness (American pop culture performing the dissolution of all surviving traditional sacred orders following the description of capitalism by Marx as causing "all that is sacred" to "melt into air") were it not for the massive social injustice and environmental devastation it structurally produces. Loy's therapeutic vision, following the Buddhist deconstruction of the demarcated "self" and Becker and Brown's cultural-historical or collective... (shrink)

The question, how is profound intellectual disagreement possible, even when addressed toward the paradigmatically reasonable activity of scientific communication, has generated a number of puzzling responses. On a response attributed to Thomas S. Kuhn, some episodes in the history of science don't allow for meaningful disagreement. In such situations, the adversaries talk at cross purposes until one side is either "converted" or dies off. ;This skeptical prospect has also been considered by those who study the differences between natural languages, (...) and the misunderstandings which punctuate a child's first language acquisition. I investigate theories of concepts in search of one capable of illuminating the apparent gaps in communication between scientists, between speakers of different languages, and between infants and adults. I begin by showing that the antipsychologist efforts of post-Fregean philosophers of language, in particular those built on a causal theory of reference, fail to explain either how communication is possible when it is, or why it isn't otherwise. Nor does recourse to a principle of charity or humanity help them in this regard. I conclude that such attempts can't ground an account of communication. ;I argue that an account of concept learning drawn in part from recent work in developmental psychology can explain both the possibility of serious disagreement, as well as the possibility of overcoming it reasonably. I urge that the revival of psychologism in the philosophy of language follows. Semantic psychologism is semantics informed by empirical psychology, not by the phenomenology Frege attacked. I explore the consequences of this doctrine for the philosophy and history of science. These include a rejection of the common philosophical assumption that all meaningful communication can be reduced to a form of translation, and renewed emphasis on the importance of analogy in communication. ;Finally, I apply this new semantic psychologism toward the historical interpretation of science. If the program is right, it should provide insight into the communicative dimensions of important episodes in the history of science. While a full exploration of this historical method lies beyond the scope of my thesis, two preliminary case studies indicate its fruitfulness. (shrink)