In Defense of Paternalism

This paper argues that we have wrongly and not for the patient’s benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient’s good. In general – I shall argue – it is the patient’s right to select his or her own goals and the physician’s duty to inform the patient of the feasibility of that goal and of the means needed to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches. The physician should take a leading role in helping the patient select the goal. I argue that to simply present a laundry list of means and insist that patients choose for themselves is not only abandoning patients to their autonomy but is, in fact, a crass form of violating the patient’s autonomy. Freely choosing not to choose is a choice a patient with decisional capacity is entitled to make and one that needs to be respected.     

Providing Care for the “Whole Patient” in the Cancer Setting: The Psycho-Oncology Consultation Model of Patient Care

This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the “whole patient.” Specific goals include reducing distress and symptoms, building on the patient’s existing strengths, enhancing self-efficacy, expanding the patient’s repertoire of healthy coping strategies, and addressing informational needs. Specific interventions are described that clinicians can implement in order to address the above goals. The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties that are inherent in providing mental health care in a medical setting.     

Hope Against Hope in Cancer at the End of Life

Hope has many facets to it in the context of cancer. This article outlines an instrumental case study for a patient with aggressive lymphoma who rapidly deteriorated to the point of dying. How her and her family’s hope was managed is outlined here from various perspectives. Interviews were carried out with the patient’s family, medical consultant-in-charge (attending physician) and nurses caring for her at the end of life. The findings outline the transition from hope for cure to hope for a good death and the role that the patient and family’s Christian hope played in this. Religiosity and spirituality of hope in terms of Christian hope is explored from the theological perspective. Practical aspects of care in the face of changing hope are discussed. Conclusions are drawn about reframing hope in a changing clinical situation with reference to theories of hope. The importance of acknowledging hope, coping, spirituality and religiosity, especially at end of life, is emphasised.     

Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

The rhetoric of dread: Fear, uncertainty, and doubt (FUD) in information technology marketing

This article examines the nature and legality of FUD, which—as will be seen—is a timely subject. IBM may have been FUD’s originator but its greatest practitioner is allegedly none other than Microsoft, which (according to the firm’s critics) has repeatedly exercised FUD tactics in order to acquire and maintain its operating system monopoly. In particular, this article compares Amdahl’s experience with IBM to the emerging contours of Microsoft’s battle against a surprisingly able competitor, the open source operating system called Linux. A major contention of this essay is that attorneys, judges, and legal scholars tend to pay insufficient attention to the unique characteristics of technology enterprises, and thus cannot distinguish meaningfully between practices that are plainly legal under U. S. antitrust law, and those which are not. A perspective drawn from the history and sociology of technology (namely, Thomas P. Hughes’ concept of technological systems) is used to elucidate what is predatory, and what is not, in a dominant market player’s use of FUD and associated marketing tactics. where his scholarly and teaching interests include cyberlaw, intellectual property in high-tech industries, and the social issues posed by advanced information technology. He is also the author of several best-selling trade and textbook titles, including Webster’s New World Dictionary of Computer Terms, 9th ed. (Hungry Minds) and Computers in Your Future, 4th ed. (Prentice-Hall). He lives in Charlottesville, Virginia.     

Preferences for Life-Prolonging Medical Treatments and Deference to the Will of God

We defined and measured a dimension of religiosity frequently invoked in end-of-life (EOL) research—deference to God’s Will (GW)—and examined its relationship to preferences for life-prolonging treatments. In a 35-min telephone interview, 304 older men and women (60 +) were administered the 5-item GW scale, sociodemographic questions, three attitude items regarding length of life, and measures of two health indices, depression, and life-prolonging treatment preferences. The GW scale demonstrated internal consistency (Cronbach’s alpha = .94) and predictive and discriminant validity. Higher scores indicative of greater deference to GW were associated with stronger life-prolonging treatment preferences in poor-prognosis scenarios. Implications for the role of religiosity in medical decision-making are discussed.     

Question authority: in defense of moral naturalism without clout

Metaethicists of all stripes should read and learn from Richard Joyce’s book The Evolution of Morality. This includes moral realists, despite Joyce’s own nihilism. Joyce thinks that moral obligations, prohibitions, and the like are myths. But that is just a bit of a rich, broad account of moral attitudes and practices, the bulk of which can comfortably be accepted by realists. In fact, other than nihilism itself, there’s only one claim of Joyce’s which realists must reject. I argue that that claim ought to be rejected, and reply to Joyce’s argument to the contrary. The result is that—aside from nihilism and one rejectable claim—realists are free to take from Joyce whatever they like.     

<Emphasis Type="Italic">Wissenschaftslogik</Emphasis>: The role of logic in the philosophy of science

Carl Hempel introduced what he called “Craig’s theorem” into the philosophy of science in a famous discussion of the “problem of theoretical terms.” Beginning with Hempel’s use of ‘Craig’s theorem,” I shall bring out some of the key differences between Hempel’s treatment of the “problem of theoretical terms” and Carnap’s in order to illuminate the peculiar function of Wissenschaftslogik in Carnap’s mature philosophy. Carnap’s treatment, in particular, is fundamentally anti-metaphysical—he aims to use the tools of mathematical logic to dissolve rather solve traditional philosophical problems—and it is precisely this point that is missed by his logically-minded contemporaries such as Hempel and Quine.     

Psychology is About Persons: On Brinkmann’s Expansion of Harré’s Hybrid Psychology

Brinkmann has recently put forward an integrative theory of the mind by expanding Harré’s hybrid psychology. The theory is integrative because it establishes that in order for one to gain a full understanding of the mind—which is represented as a set of dispositions—one has to take into account theories about the brain, the body, social practices, and technological artifacts. All of these are said to be ‘mediators’ upon which the mind depends. An important claim underlying the theory is that in psychology the basic ontological unit is the person. We agree with Brinkmann both on this and on the dispositional nature of the mind. Still, he does not make a strong case for the latter. Furthermore, we believe the concept of mediation is by no means helpful to produce an integrative view in psychology, not only because the theoretical job of such a concept is unclear but also because qua unifying concept it may end up undermining the ontological primacy of the person (in psychology). In this paper we refer to these issues and suggest some ideas that may help improve Brinkmann’s (and Harré’s) proposal.     

Addressing Challenges in Individual Psychotherapy with Delusional Patients: A Case Study

Although cognitive-behavioral treatments for schizophrenia and other psychotic disorders demonstrate strong results in clinical trials, not all patients respond to these treatments. Common challenges in psychotherapy with delusional patients include a mismatch between the therapist’s and the patient’s expectations about the purpose of therapy, the patient’s lack of motivation to reduce delusional beliefs in service of other goals, and the patient’s dependence on the delusions in order to preserve an intact sense of self. This case highlights the value of integrating a psychodynamic perspective with cognitive-behavioral interventions to address challenges in psychotherapy with chronically delusional patients.     

Islamising Malayness: Ulama discourse and authority in contemporary Malaysia

This paper seeks to discuss Malay identity as it has been understood by the Malay Muslim religious elites (the Ulama) in Malaysia. I posit that the Ulama’s voices have been privileged in the context of the Islamic resurgence period. Although there has been a general consensus by the Ulama that Islam is a key component of the Malay identity and that the two are inseparable, the Ulama are, at present, divided in the contest for a clear definition of what ‘Islam’ is and how Malayness can be refashioned towards Islam. By couching these debates and contestations within the context of the Islamic resurgence period and the state’s Islamisation project, I shall highlight the ways in which issues such as Malay rites, rituals and cultural practices, and what constitutes bid’ah (sinful innovations) in Islam are elucidated. The works and sermons of three key Ulama in contemporary Malaysia—Nik Aziz, Mohd Asri, and Harussani Zakaria—shall be treated as case studies. Their attitude towards other key markers of Malayness, such as the Malay Royalty and Malay language, and how they are negotiated in relation to Islam are also examined.     

Foucault’s politicization of ontology

The paper explicates a politicized conception of reality with the help of Michel Foucault’s critical project. I contend that Foucault’s genealogies of power problematize the relationship between ontology and politics. His idea of productive power incorporates a radical, ontological claim about the nature of reality: Reality as we know it is the result of social practices and struggles over truth and objectivity. Rather than translating the true ontology into the right politics, he reverses the argument. The radicality of his method lies in showing how the ontological order of things is in itself the outcome of a political struggle: Ontology is politics that has forgotten itself. I argue that Foucault’s thought accomplishes the politicization of ontology with two key theoretical moves. The first is the contestation and provocation of all given and necessary ontological foundations. He affirms the ontological view that there is a discontinuity between reality and all ontological schemas that order it, and a subsequent indeterminacy of reason in establishing ultimate truths or foundations. After this initial step whereby ontology is denaturalized—made arbitrary or at least historically contingent—the way is open for explanations that treat the alternative and competing ontological frameworks as resulting from historical, linguistic and social practices of power. The second key move is thus the exposure of power relations and their constitutive role in our conception of reality. I conclude by considering the implications of Foucault’s politicization of ontology for our understanding of politics.     

Just for Fun: The Playful Image of Nanotechnology

In 1959, Richard Feynman suggested that the most compelling reason to pursue nanoscale research might be ‘just for fun.’ This article traces a history of playful images and ludic practices in nanotechnology. Two case studies—nanocars and nanosoccer—exemplify the ways in which scientific research mobilizes speculative futures, less through engineering design or stepwise protocol than through the recreational dynamics of play. Although such molecular toys might appear frivolous, they index the increasingly widespread conditions of play labor, or ‘playbor’, shaping today’s technoculture. Exploring the processes of transmutation and transvaluation by which technological imaginaries are rendered operative, this article tells a story of how the nanoworld became an everyday reality by becoming a game.     

Teaching business ethics to professional engineers

Without question “business ethics” is one of the hot topics of the day. Over the past months we have seen business after business charged with improper practices that violate commonly-accepted ethical norms. This has led to a loss of confidence in corporate management, and has had severe economic consequences. From many quarters business educators have heard the call to put more emphasis on ethical practices in their business courses and curricula. Engineering educators are also heeding this call, since the practice of engineering usually involves working for (or leading) a business and/or engaging in business transactions. In the summer of 2002, Auburn University’s Engineering Professional Development program made the decision to produce—based on the author’s Executive MBA course in Business Ethics—a distance-delivered continuing education program for professional engineers and surveyors. Participants across the USA now may use the course to satisfy continuing education requirements with respect to professional licensing and certification. This paper outlines the purpose and content of the course and describes its production, distribution, application, and evaluation. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Minimal Empiricism Without Dogmas

John McDowell has defended a position called minimal empiricism, that aims to avoid the oscillation between traditional empiricism’s commitment to a set of contents working as external justifiers for our system of beliefs and a coherentist position where our thought receives no constraint from the world. We share McDowell’s dissatisfaction with both options, but find his minimal empiricism committed to the idea of a tribunal of experience where isolated contents are infused into our network of inferences. This commitment is prone to sceptical attacks and waters down McDowell’s holism. We propose to retain McDowell’s partial re-enchantment of nature—without appealing to McDowell’s Kantian conception of experience—, and argue that it is sufficient to avoid the oscillation and to make sense of the objectivity of thought.

The early Russell on the metaphysics of substance in Leibniz and Bradley

While considerable ink has been spilt over the rejection of idealism by Bertrand Russell and G.E. Moore at the end of the 19th Century, relatively little attention has been directed at Russell’s A Critical Exposition of the Philosophy of Leibniz, a work written in the early stages of Russell’s philosophical struggles with the metaphysics of Bradley, Bosanquet, and others. Though a sustained investigation of that work would be one of considerable scope, here I reconstruct and develop a two-pronged argument from the Philosophy of Leibniz that Russell fancied—as late as 1907—to be the downfall of the traditional category of substance. Here, I suggest, one can begin to see Russell’s own reasons—arguments largely independent of Moore—for the abandonment of idealism. Leibniz, no less than Bradley, adhered to an antiquated variety of logic: what Russell refers to as the subject-predicate doctrine of logic. Uniting this doctrine with a metaphysical principle of independence—that a substance is prior to and distinct from its properties—Russell is able to demonstrate that neither a substance pluralism nor a substance monism can be consistently maintained. As a result, Russell alleges that the metaphysics of both Leibniz and Bradley has been undermined as ultimately incoherent. Russell’s remedy for this incoherence is the postulation of a bundle theory of substance, such that the category of “substance” reduces to the most basic entities—properties.     

Phenomenological immanence,normativity, and semantic externalism

This paper argues that transcendental phenomenology (here represented by Edmund Husserl) can accommodate the main thesis of semantic externalism, namely, that intentional content is not simply a matter of what is ‘in the head,’ but depends on how the world is. I first introduce the semantic problem as an issue of how linguistic tokens or mental states can have ‘content’—that is, how they can set up conditions of satisfaction or be responsive to norms such that they can succeed or fail at referring. The standard representationalist view—which thinks of the problem in first-person terms—is contrasted with Brandom’s pragmatic inferentialist approach, which adopts a third-person stance. The rest of the paper defends a phenomenological version of the representationalist position (seeking to preserve its first-person stance) but offers a conception of representation that does not identify it with an entity ‘in the head.’ The standard view of Husserl as a Cartesian internalist is undermined by rejecting its fundamental assumption—that Husserl’s concept of the ‘noema’ is a mental entity—and by defending a concept of ‘phenomenological immanence’ that has a normative, rather than a psychological, structure. Finally, it is argued that phenomenological immanence cannot be identified with ‘consciousness’ in Husserl’s sense, though consciousness is a necessary condition for it.     

The relevance of Nash equilibrium to psychiatric disorders

In game theory, the word ‘game’ is used to describe any interdependence between interacting parties, and the Nash equilibrium is a prominent tool for analysing such interactions. I argue that the concept of the Nash equilibrium may also be used in non-gaming contexts. An individual is in a Nash equilibrium if his or her beliefs are consistent with his or her actions. Given that discordance between beliefs and behaviour is a typical cause of psychiatric disorders, individuals who are not in a Nash equilibrium are likely to be affected by such disorders. In this regard, the concept of the Nash equilibrium could aptly be introduced into the medical practitioner’s vocabulary for describing a patient’s mental health status.