Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

Contextualism and the Skeptic: Comments on Engel

Mylan Engels paper (2004) is divided into two parts: a negative part, criticizing the costs of contextualism and a constructive part proposing a noncontextualist resolution of the skeptical problem. I will only address the constructive part here. The constructive part is composed of three elements: (i) a reconstruction or reformulation of the original skeptical argument, which draws on the notion of epistemic possibility (e-possibility), (ii) a distinction between two senses of knowledge (and two corresponding kinds of e-possibility): fallibilistic and infallibilistic, and (iii) an argument which tries to hoist the skeptic by their own petard, namely the closure principle (CP). As I will argue, there are two ways to understand Engels anti-skeptical argument. Only in one interpretation does the argument depend on the proposed reconstruction of the skeptical argument in terms of e-possibility. But this version of the argument is unsound. More importantly, the skeptic has a strong prima facie objection at her disposal, which applies to both interpretations of the argument. If this objection is valid, Engels argument does not hold. But once it is invalidated, his argument is superfluous.     

The Dancing Philosopher

This excerpt from Kenneth Kings essay, The Dancing Philosopher, traces its genesis from Nietzsches Thus Spoke Zarathustra (a work that greatly impacted Isadora Duncans founding of modern dance) that, in tandem with the emerging technology of the writing machine (typewriter), camera and kinetoscope (cinematography), conjoined the kinetropic and lexigraphemic to inaugurate the kinetic cogito. Maurice Merleau-Pontys phenomenological exposition of corporeality further amplified the reflexive potential of movement and the philosophical understanding of kinesthesia, and King cites as well the technosophic synergy of John Cages and Merce Cunninghams long artistic collaboration that furthered the frontier of a mind-body epistemic.     

Group beliefs

It is argued in this paper that there can be both normative and nonnormative, merely factual group beliefs. The former involve the whole social group in question, while the latter only relate to the distributions of personal beliefs within the group. The paper develops a detailed theory, called the positional account of group beliefs, to explicate normative, group-involving group beliefs. Normative group beliefs are characterized within this approach in terms of joint acceptances of views by the group members — or their representatives — acting in their right positions and tasks, and in a sense creating group commitments for all the members to accept (and keep accepting) the view in question. Also aggregate accounts of group belief are considered in the paper, especially the shared we-belief approach. Such aggregate accounts purport to account for merely factual group beliefs.I wish to thank Kaarlo Miller and Philip Pettit for critical comments.     

Suffering without subjectivity

This paper argues that it is possible for suffering to occur in the absence of phenomenal consciousness – in the absence of a certain sort of experiential subjectivity, that is. (Phenomenal consciousness is the property that some mental states possess, when it is like something to undergo them, or when they have subjective feels, or possess qualia.) So even if theories of phenomenal consciousness that would withhold such consciousness from most species of non-human animal are correct, this neednt mean that those animals dont suffer, and arent appropriate objects of sympathy and concern.     

Mathematical quantum theory I: Random ultrafilters as hidden variables

The basic purpose of this essay, the first of an intended pair, is to interpret standard von Neumann quantum theory in a framework of iterated measure algebraic truth for mathematical (and thus mathematical-physical) assertions — a framework, that is, in which the truth-values for such assertions are elements of iterated boolean measure-algebras (cf. Sections 2.2.9, 5.2.1–5.2.6 and 5.3 below).The essay itself employs constructions of Takeuti's boolean-valued analysis (whose origins lay in work of Scott, Solovay, Krauss and others) to provide a metamathematical interpretation of ideas sometimes considered disparate, heuristic, or simply ill-defined: the collapse of the wave function, for example; Everett's many worlds'-construal of quantum measurement; and a natural product space of contextual (nonlocal) hidden variables.More precisely, these constructions permit us to write down a category-theoretically natural correlation between ideal outcomes of quantum measurements u of a universal wave function, and possible worlds of an Everett-Wheeler-like many-worlds-theory.The universal wave function, first, is simply a pure state of the Hilbert space (L ₂([0, 1]) ^M in a model M an appropriate mathematical-physical theory T, where T includes enough set-theory to derive all the analysis needed for von Neumann-algebraic formulations of quantum theory.The worlds of this framework can then be given a genuine model-theoretic construal: they are random models M(u) determined by M-random elements u of the unit interval [0, 1], where M is again a fixed model of T.Each choice of a fixed basis for a Hilbert space H in a model of M of T then assigns ideal spectral values for observables A on H (random ultrafilters on the range of A regarded as a projection-valued measure) to such M-random reals u. If is the universal Lebesgue measure-algebra on [0, 1], these assignments are interrelated by the spectral functional calculus with value 1 in the boolean extension (V( )) ^M , and therefore in each M(u).Finally, each such M-random u also generates a corresponding extension M(u) of M, in which ideal outcomes of measurements of all observables A in states are determined by the assignments just mentioned from the random spectral values u for the universal position-observable on L ₂([0, 1]) in M.At the suggestion of the essay's referee, I plan to draw on its ideas in the projected sequel to examine more recent modal and decoherence-interpretations of quantum theory, as well as Schrödinger's traditional construal of time-evolution. A preliminary account of the latter — an obvious prerequisite for any serious many-worlds-theory, given that Everett's original intention was to integrate time-evolution and wave-function collapse — is sketched briefly in Section 5.3. The basic idea is to apply results from the theory of iterated measure-algebras to reinterpret time-ordered processes of measurements (determined, for example, by a given Hamiltonian observable H in M) as individual measurements in somewhat more complexly defined extensions M(u) of M.In plainer English: if one takes a little care to distinguish boolean- from measure-algebraic tensor-products of the universal measure-algebra L, one can reinterpret formal time-evolution so that it becomes internal to the universal random models M(u).     

Stuffed Cabbage in the Old New School Cafeteria

The purpose of this lecture is to celebrate the memory of Aron Gurwitsch by examining and enlarging the domain of phenomenological clarification of some elements of what Gurwitsch called the logic of reality. Chief among those elements are the nature of the taken-for-grantedness of our existential belief, the difference between presentive and non-presentive indices of reality and the ground for the self-illumination of the world of working.     

From negation to “notion”: Cognitive processes and argumentative strategies

Summary This article deals with the role of negation as a language and cognitive operation. Such a topic is treated here within the framework of the argumentative strategies which consist in making certain cognitive landmarks of the discourse flip over with the intent of imposing the necessity to choose between two types of notions, aiming at the transformation of this choice into an implication. The reference here to the Aristotelian logic of Prior Analytics appears to be more efficient than any other contemporary logic and the author intends to give account of the role of negation as contrary coming into play on an operational and cognitive basis in all the argumentative strategies which oscillate reciprocally from universal to particular.     

Some notes on the nature of methodological indeterminacy

This paper is an attempt to extend the meaning of the concept of indeterminacy for the human sciences. The authors do this by coining the term methodological indeterminacy and arguing that indeterminacy is better understood when linked to specific methodological techniques. Paradoxically, while specific research techniques demonstrate that the issue of indeterminacy is complex, yielding the possibility of types and degrees, it does not eliminate the problem of translation first raised by Quine. However, the authors go on to argue that, from a research perspective, indeterminacy can and must be approached in such a way that it is possible to reduce cases of it, even though never completely eliminating it in the human sciences.     

Was Marx an ethical humanist?

Zusammenfassung Während der letzten zehn Jahre wurde viel über den Humanismus des jungen Marx gesprochen. Osteuropäische Marxisten, die bemüht sind, ihren Anti-Stalinismus durch Berufung auf die Autorität von Marx selbst zu untermauern, gebrauchen den Ausdruck Humanismus in einem ungenauen Sinn, etwa gleichbedeutend mit Anthropozentrismus. Aber wenn man sagt, daß Marx Haltung anthropozentrisch sei, so sind damit die Hauptfragen erst gestellt, nicht schon gelöst.Humanismus mag etwa soviel wie Säkularismus bedeuten — der Mensch, nicht Gott, wird als im Mittelpunkt stehend gedacht. Die anthropozentrische Haltung kann verschiedene Formen annehmen, vor allem die Formen, die man als Humanismus der Ideale und als Humanismus der Prinzipien bezeichnen könnte. Der Humanismus der Ideale ist ausdrücklich an derZukunft orientiert, der Humanismus der Prinzipien aber an derGegenwart. Nur ein Humanismus der Prinzipien, dem es darum geht, den Eigenwert existierender Individuen zu behaupten und zu verteidigen, verdient es, ethischer Humanismus genannt zu werden. Marx, sogar der jüngste Marx, war kein ethischer Humanist in diesem Sinn. Und nur ein Humanismus in diesem strengen Sinn würde einen philosophischen Standort bieten, von dem aus man den Stalinismus oder Neo-Stalinismus angreifen könnte.Marx war ein Säkularist, und er entwarf ein humanistisches Ideal für die Zukunft, aber humanistische Prinzipien für die Gegenwart lehnte er ab. Er betonte, daß nur dem nicht entfremdeten, produktiven Individuum der kommunistischen Zukunft ein eigener Wert zukomme. Bis dahin haben Individuen nur einen geschichtlich instrumentalen Wert: jene, die an der Verwirklichung der kommunistischen Gesellschaft arbeiten, sind zu respektieren; diejenigen, welche dabei Widerstand leisten oder versagen, müssen ausschließlich als Hindernisse auf dem Wege des geschichtlichen Fortschritts behandelt werden.In diesem Sinn ist der Leninismus und sogar der Stalinismus und Neo-Stalinismus in dem zukunftsorientierten Humanismus der Ideale des jungen Marx einbegriffen, oder zumindest davon nicht ausgeschlossen. Selbst der jüngste Marx machte sich den Modeirrtum des 19. Jahrhunderts zu eigen — den Irrtum des aufgeschobenen Wertes oder des zeitlich verstellten Wertes und nahm damit eine mit dem ethischen Humanismus grundsätzlich unvereinbare Position ein.

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An earlier, and much shorter, version of this paper was read at a session on Marxism and Humanism at the Fourteenth International Philosophy Congress in Vienna, September 4, 1968, and published in Vol. II of the Congress Proceedings, Vienna, 1968, pp. 69–73.     

A notorious affair called exportation

In Quantifiers and Propositional Attitudes, Quine held (a) that the rule of exportation is always admissible, and (b) that there is a significant distinction between a believes-true (Ex)Fx and (Ex) a believes-true F of x. An argument of Hintikka's, also urged by Sleigh, persuaded him that these two intuitions are incompatible; and he consequently repudiated the rule of exportation. Hintikka and Kaplan propose to restrict exportation and quantifying in to favoured contexts — Hintikka to contexts where the believer knows who or what the person or thing in question is; Kaplan to contexts where the believer possesses a vivid name of the person or thing in question. The bulk of this paper is taken up with criticisms of these proposals. Its ultimate purpose, however, is to motivate an alternative approach, which imposes no restrictions on exportation or quantifying in, but repudiates Quine's other intuition: this is the approach taken in my A Logical Form for the Propositional Attitudes.This paper is based on my doctoral dissertation (Rockefeller University, 1977). I wish to thank Susan Haack for her help in turning a draft into the present version.     

Coalescent argumentation

Coalescent argumentation is a normative ideal that involves the joining together of two disparate claims through recognition and exploration of opposing positions. By uncovering the crucial connection between a claim and the attitudes, beliefs, feelings, values and needs to which it is connected dispute partners are able to identify points of agreement and disagreement. These points can then be utilized to effect coalescence, a joining or merging of divergent positions, by forming the basis for a mutual investigation of non-conflictual options that might otherwise have remained unconsidered. The essay proceeds by defining and discussing argument, position and understanding. These notions are then brought together to outline the concept of coalescent reasoning.     

Lying and intersubjective truth: A communication based approach to understanding lying

This project was undertaken as a response to a perceived deficiency regarding the role of communication in a large block of the phenomenological discourse on lying. The arguments presented here attempt to make the communication process an explicit, rather than an implicit component of this discussion. First, a lie is explained as a communicative act that is identified by making a simple comparison between two contradictory realities, the reality presented by the lie, and some sort of true reality. Existing discussions of lying are examined and judged to be deficient because they limit their explanations of this true reality to subjective and objective standards of truth. Intersubjectivity is presented as an alternative truth standard, and it is argued that lies can only be discovered and understood through a process of interpretation or negotiation (dialogue) by human interactants.     

The relevance of Habermas' communicative turn

This paper points out the way in which educational and communicative action (Habermas) are to be related. It is shown that earlier attempts to put Habermas ideas to use have led to a dead end because they do not realize clearly that the new basic notion introduced by Habermas, namely communicative action, is the expression of a communicative turn. It is argued that Habermas' concept expresses a radical new attempt to grasp the intersubjective character of social action. Next implications of this communicative turn for the concept of education as a social praxis are indicated. Education can be conceived of as a praxis responding to the vulnerability of a communicative self.     

Happiness and virtue in Socrates' moral theory

Conclusion In Section IV above we start with texts whose prima facie import speaks so strongly for the Identity Thesis that any interpretation which stops short of it looks like a shabby, timorous, thesis-saving move. What else could Socrates mean when he declares with such conviction that no evil can come to a good man (T19), that his prosecutors could not harm him (T16(a)), that if a man has not been made more unjust he has not been harmed (T20), that all of happiness is in culture and justice (T16(a)), that living well is the same as living justly (T15)? But then doubts begin to creep in. Recalling that inflation of the quantifier is normal and innocuous in common speech (that job means everything to him, he'll do anything to get it, will stick at nothing) we ask if there is really no chance at all that no evil in T19, not harmed in T20 might be meant in the same way? The shift from no harm at T16(a) to no great harm at T16(b), once noticed, strengthens the doubt. It gets further impetus in T21(b) when to explain how all of happiness is in culture and justice he depicts a relation (that recurs more elaborately in T22) which, though still enormously strong, is not quite as strong as would be required by identity. The doubt seeps into T15 when we note that current usage did allow just that relation as a respectable use of the same.At that point we begin to wonder if resort to the Identity Thesis might not be just a first approximation to a subtler, more finely nuanced, doctrine which would give Socrates as sound a foundation for what we know he wants to maintain at all costs - the Sovereignty of Virtue - without obliterating the eudaemonic value of everything else in his world. We cast about for a credible model of such a relation of virtue to happiness and hit on that multicomponent pattern sketched on p. 9 above. We ascertain that this will afford a comprehensively coherent eudaemonist theory of rational action, while its rival would not, and will fit perfectly a flock of texts in Section V which the latter will not fit at all. Are we not entitled to conclude that this is our best guide to the true relation of virtue to happiness in Socrates' thought - the one for which he would have declared if he had formulated explicitly those two alternative theses and made a reasoned choice between them?The Socrates of this paper is the protagonist of Plato's earlier dialogues. I list these (by self-explanatory abbreviations), borrowed from T. Irwin, Plato's Moral Theory [1974] (hereafter PMT): Ap., Ch., Cr., Eud., Eu., G., HMa., HMi, Ion, La., Ly., Pr., R., I. I assume, but shall not argue here, that in this segment of his corpus, Plato aims to recreate the doctrines and arguments of his teacher in dramatic scenes, all of which (except for the Ap.) may be, and most of which undoubtedly are, fictional; I shall be referring these works, under this proviso, as Plato's Socratic dialogues. (I did not include the Menexenus in the above list, since the parody of a funeral oration in this dialogue is implicitly dissociated from Socrates.)     

Toulmin on Ideals of Natural Order

In this paper I criticize Toulmin's concept of Ideals of Natural Order and his account of the role these Ideals play in scientific explanation as given in his book, Foresight and Understanding. I argue that Toulmin's account of Ideals of Natural Order as those theories taken to be self evident by scientists at a given time introduces an undesirable subjectivism into his account of scientific explanation. I argue also that the history of science, especially the recent history of microphysics, does not support Toulmin's contentions about the supposed self-evidence of the basic explanatory theories in science.     

Three theories of nominalized predicates

By the term nominalization I mean any process which transforms a predicate or predicate phrase into a noun or noun phrase, e.g. feminine is transformed into feminity. I call these derivative nouns abstract singular terms. Our aim is to provide a model-theoretic interpretation for a formal language which admits the occurrence of such abstract singular terms.     

In Defence of Luck Egalitarianism

This paper considers issues raised by Elizabeth Andersons recent critique of the position she terms luck egalitarianism. It is maintained that luck egalitarianism, once clarified and elaborated in certain regards, remains the strongest egalitarian stance. Andersons arguments that luck egalitarians abandon both the negligent and prudent dependent caretakers fails to account for the moderate positions open to luck egalitarians and overemphasizes their commitment to unregulated market choices. The claim that luck egalitarianism insults citizens by redistributing on the grounds of paternalistic beliefs, pity and envy, and by making intrusive and stigmatizing judgments of responsibility, fails accurately to characterize the luck egalitarians rationale for redistribution and relies upon luck egalitarians being insensitive to the danger of stigmatization (which they need not be). The luck egalitarian position is reinforced by the fact that Andersons favoured conception of equality, democratic equality, is counterintuitively indifferent to all unchosen inequalities, including intergenerational inequalities, once bare social minima are met.I am indebted to Catriona McKinnon and Hillel Steiner for their insightful comments on earlier versions of this article. An antecedent of the paper was presented at the Northern Political Theory Association Annual Conference at the University of St Andrews in August 2003. Research for this article was supported by the University of York Alumni Fund and the Arts and Humanities Research Board.     

On two arguments for the indeterminacy of personal identity

Both arguments are based on the breakdown of normal criteria of identity in certain science-fictional circumstances. In one case, normal criteria would support the identity of person A with each of two other persons, B and C; and it is argued that, in the imagined circumstances, A=B and A=C have no truth value. In the other, a series or spectrum of cases is tailored to a sorites argument. At one end of the spectrum, persons A and B are such that A=B is clearly true; at the other end, A and B are such that the identity is clearly false. In between, normal criteria of identity leave the truth or falsehood of A=B undecided, and it is argued that in these circumstances A=B has no truth value.These arguments are to be understood counterfactually. My claim is that, so understood, neither establishes its conclusion. The first involves a pair of counterfactual situations that are equally possible or tied. If A=B and A=C have no truth value, a counterfactual conditional with one of them as consequent and an antecedent that is true in circumstances in which either is true should have no truth value. Intuitively, however, any such counterfactual is false. The second argument can be seen to invite an analogous response. If this is right, however, there is an important disanalogy between this and the classical paradox of the heap. If the disanalogy is only apparent, the argument shows at most that the existence of persons can be indeterminate.     

Three views of demonstrative reference

Three views of demonstrative reference are examined: contextual, intentional, and quasi-intentional. According to the first, such reference is determined entirely by certain publicly accessible features of the context. According to the second, speaker intentions are criterial in demonstrative reference. And according to the third, both contextual features and intentions come into play in the determination of demonstrative reference. The first two views (both of which enjoy current popularity) are rejected as implausible; the third (originally proposed by Kaplan in Dthat) is argued to be highly plausible.