Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

This paper presents an implemented computational model of word acquisition which learns directly from raw multimodal sensory input. Set in an information theoretic framework, the model acquires a lexicon by finding and statistically modeling consistent cross‐modal structure. The model has been implemented in a system using novel speech processing, computer vision, and machine learning algorithms. In evaluations the model successfully performed speech segmentation, word discovery and visual categorization from spontaneous infant‐directed speech paired with video images of single objects. These results (...) demonstrate the possibility of using state‐of‐the‐art techniques from sensory pattern recognition and machine learning to implement cognitive models which can process raw sensor data without the need for human transcription or labeling. (shrink)

Study of Nyayabindu of Dharmakirti, 7th cent. and its commentary Nyayabindutika of Dharmottara.

Promoting respect for the four principles remains of great practical importance in ordinary medicineThe following are four “scenarios” with brief outlines of how Raanan Gillon has analysed them using the “four principles” approach. These are the four cases that the commentators were asked to analyse.Professor Gillon has for many years advocated the use of the Beauchamp and Childress four principles approach as a widely and interculturally acceptable method for medical ethics analysis . At present there seems to be (...) a backlash by some bioethicists against this approach, with among others, adherents of feminist ethics, narrative ethics, virtue ethics, and various varieties of regional ethics claiming to offer better approaches to medical ethics.At Raanan Gillon’s request this special issue of the Journal of Medical Ethics is intended to focus on this aspect of his work, with a view not only to discussing the issue of how different approaches to medical ethics are and/or are not compatible with the four principles approach but also to make clear to JME readers what alternative ethics analysis method is preferred and used by the various commentators.THE “STANDARD” JEHOVAH’S WITNESS CASEIn the first scenario, that of the “standard” Jehovah’s Witness case, a competent adult patient loses a massive amount of blood from a blood vessel bleeding in an acute duodenal ulcer. The best chance of …. (shrink)

The World Medical Association (WMA), the global representation of the medical profession, first adopted the International Code of Medical Ethics (ICoME) in 1949 to outline the professional duties of physicians to patients, other physicians and health professionals, themselves and society as a whole. The ICoME recently underwent a major 4-year revision process, culminating in its unanimous adoption by the WMA General Assembly in October 2022 in Berlin. This article describes and discusses the ICoME, its revision process, the controversial and uncontroversial (...) issues, and the broad consensus achieved among WMA constituent members, representing over 10 million physicians worldwide. The authors analyse the ICoME, including its response to contemporary changes and challenges like ethical plurality and globalisation, in light of ethical theories and approaches, reaching the conclusion that the document is a good example of international ethical professional self-regulation. (shrink)

Late last year the English Court of Appeal confirmed a lower court's ruling that doctors could impose an operation to separate recently born conjoined twins, overriding the refusal of consent of their parents. The doctors believed the operation would probably save one of the babies at the cost of killing the other, while not operating would highly probably be followed by the death of both twins within months of their birth. The parents, said to be devout Roman Catholics, believed that (...) it was absolutely wrong to kill one of their babies, even to save the life of the other.Undoubtedly many people, the writer included, would agree with the English courts that the “least worst” option was to separate the twins and save one at the cost of killing the other. But surely many fewer people would have imposed their own resolution of this acute moral dilemma upon parents who conscientiously chose the other limb of the dilemma, refusing to kill one baby even in order to save the other. Were the English judges right, then, to take away the parents' normal right and duty to make health care decisions on behalf of their children and instead impose their own answer to what they admitted to be a terrible dilemma? Describing the two alternatives in terms of choosing between the lesser of two evils on the one hand, and the obligation not to kill on the other, Lord Justice Ward declared, according to The Times law report,1 that: “Parents who were placed on the horns of such a terrible dilemma simply had to choose the lesser of their inevitable loss [sic]”. But that surely is to beg the moral question in favour of the judges' preferred answer to this moral dilemma. The fact is that there are—as …. (shrink)

In this issue of the journal “Lee Elder”,1 a pseudonymous dissident Jehovah's Witness , previously an Elder of that faith and still a JW, joins the indefatigable Dr Muramoto2–5 in arguing that even by their own religious beliefs based on biblical scriptures JWs are not required to refuse potentially life-saving blood transfusions. Just as the “official” JW hierarchy has accepted that biblical scriptures do not forbid the transfusion or injection of blood fractions so too JW theology logically can and should (...) permit the transfusion of whole blood when this is medically required.Few doctors would argue that they should override the adequately autonomous decisions of Jehovah's Witnesses to refuse blood transfusions even if they are likely to die as a result of such transfusions. However, there is a case to be made for doctors asking such patients to reflect on their potentially fatal refusal of blood and for drawing to these patients' attention the reasoning of members of their own faith that justifies acceptance of potentially life-saving blood transfusions. What is that case? Simply that doctors' primary professional duty to try to benefit the health of their patients entails trying to save their patients' lives when and if doing so will benefit their patients' health. Of course this is not an absolute duty overriding all other duties; in particular if patients who are adequately autonomous to do so refuse such life-prolonging treatment doctors must generally accept such refusal, however sadly. This editorial endorses that view in the case of adequately autonomous legally competent JWs. (In another paper in this issue of the journal Professor Shimon Glick argues that ethics committees should be empowered—as they now are in Israel—to override even competent refusals of life-prolonging treatment where the committee judges that …. (shrink)

Gripped by an odd blend of excited liberation at forthcoming retirement and the sadness of impending loss, I've been skimming past issues of the JME looking for themes, for developments, for ideas, for this valedictory editorial after twenty years as its editor. A few may be worth offering. First some general impressions. The enthusiasm that medical ethics still seems to inspire in those who write about it leaps out of the JME's pages. So does the enormous breadth of the subject, (...) along with the multi-, interand trans-disciplinarity from which it is approached. Doctors, philosophers, theologians and lawyers; bishops and rabbis, social scientists and government officials; patients and patient representatives; professors and students, and many many more are in our pages, advocating and arguing vigorously: and they have been doing so from an ever increasing number of countries. One of the most agreeable benefits for me has been the friendships, intellectual with many and personal with quite a few, with people from these various disciplines, occupations and perspectives, cultures and countries, that medical ethics has facilitated and it was good to find so many of these friends communicating with me as I browsed through the journal's pages. Let me also take the opportunity of thanking all my friends and colleagues who have helped me edit this journal—authors, book reviewers, letter writers, referees (so exceedingly important and unsung and unrewarded a group), editorial and advisory board members, especially our wise chairman, Tom Oppe, members of the BMJ special journals division, and all those who actually make the journal appear once the editor has chosen its contents. While I don't have space to name all whom I thank, particular tribute is due to the small team who have been with me for eighteen or more of my editorial years, Ann Lloyd, our excellent …. (shrink)

Hegemony and Education explores how the educational insights implicit in Antonio Gramsci's historical materialist outlook have been reconciled to the post-Marxist theory of 'radical democracy.' The author argues that there is an urgent need to redefine the dynamics of hegemony as a theory centering on the problem of cognitive and moral submissiveness; that is, a problem indicative of the pathologies of capitalism with respect to democratic theorizing.

Hegemony and Education explores how the educational insights implicit in Antonio Gramsci's historical materialist outlook have been reconciled to the post-Marxist theory of "radical democracy." The author argues that there is an urgent need to redefine the dynamics of hegemony as a theory centering on the problem of cognitive and moral submissiveness; that is, a problem indicative of the pathologies of capitalism with respect to democratic theorizing.

This chapter contains sections titled: Introduction Historical‐Dialectical Thought in Hegel and Marx Marx's Onto‐formative View of Human Nature Capitalism As a Counter‐ontological, Fetishizing Force Gramsci's Historical and Dialectical Campaign against Capitalism Conclusion Notes References.

In recent years, there has been an increase in environmental awareness in the United States, leading to steady growth in environmentally conscious consumerism. Looking specifically at green home marketing, understanding the consumer behavior of the next generation of homebuyers, Generation Z (GenZ), is important for environmental and business reasons. This study surveyed 116 university students to explore the influence of specific barriers and types of motivation (intrinsic, instrumental, and non-normative) on their perceptions of green homes. Our findings suggest certain barriers (...) have more influence on GenZ consumers than others, with the perceived lack of choice in selecting Green Home Features (GHFs) as the top barrier, followed by a lack of information about GHFs, and then the perceived effort to analyze GHFs. Furthermore, for GenZ consumers, intrinsic and non-normative motivations seem to significantly affect their willingness to buy green homes, whereas instrumental motivation does not. Our findings expand on previous studies on green consumer behavior to provide a new benchmark for understanding GenZ’s consumer behavior, specifically towards green homes. Our results can be used by marketers and policymakers to study future home trends, attract more potential buyers to green homes, and help create a sustainable environment for future generations. (shrink)

IN DEFENCE OF MEDICAL COMMITMENT CEREMONIESI confess to an overwhelming astonishment on first reading my friend Bob Veatch's attack on white coat ceremonies. Surely, I had thought, everyone who considered the issue would want doctors to commit themselves to the basic moral goals of medicine and especially that ancient Hippocratic goal of working to benefit the health of their/our patients, and only risking or doing harm with the intention and likely outcome of producing their net health benefit? Surely, too, it's (...) a good idea for the new medical student—or at least the new clinical student about to encounter and interact with real patients—to commit himself or herself to those goals? But as usual Professor Veatch is an incisive and thought-provoking critic and his three criticisms require careful reflection. Those criticisms were: that the oaths or affirmations were not legitimate, especially because the students were unlikely to understand them or their implications; that it is not clear which of the competing candidate oaths or commitments should be chosen and why, and that the “bonding” aspect of the ceremony in which the new student is welcomed as a student member of the medical profession is undesirable in so far as it tends to remove medical students from their own cultures and place them instead in a medical culture “increasingly isolated from the people and cultures from which they have come”.Too ill informed, too young, too coerced to commit?As for the first criticism, I suppose a sensible development of the white coat ceremony would be to send each medical school applicant a copy of the commitment that he or she would be expected to make on joining the medical school so that he or she can study, reflect on, and discuss it with family and friends. On the other hand if the white coat commitment I saw is typical of others, such …. (shrink)

Most observers agree that modern physical theory attempts to provide objective representations of reality. However, the claim that these representations are based on conventional choices is viewed by many as a denial of their objectivity. As a result, objectivity and conventionality in representation are often framed as polar opposites. Offering a new appraisal of symmetry in modern physics, employing detailed case studies from relativity theory and quantum mechanics, Objectivity, Invariance, and Convention contends that the physical sciences, though dependent on convention, (...) may produce objective representations of reality. Talal Debs and Michael Redhead show that both realists and constructivists have recognized important elements of an understanding of science that may not be contradictory. The position--"perspectival invariantism"-- introduced in this book highlights the shortcomings of existing approaches to symmetry in physics, and, for the constructivist, demonstrates that a dependence on conventions in representation reaches into the domain of the most technical sciences. For the realist, it stands as evidence against the claim that conventionality must undermine objectivity. We can be committed to the existence of a single real ontology while maintaining a cultural view of science. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

We thank our commentators for their thoughtful responses to our paper1 covering among other issues the relationships of ethics law and professional codes, the tensions between ethical universalism and cultural relativism and the phenomenon of moral judgement required when ethical norms conflict, including the norms of patient care versus obligations to others both now and in the future. Although the comments deserve more extensive discussion, in what follows we respond briefly to specific aspects of each commentary and remind readers that (...) professional codes of ethics are necessarily brief and that the International Code of Medical Ethics (ICoME) explicitly refers to the World Medical Association’s (WMA) mutually concordant and far more extensive ‘body of policies’.2 Sarela raises a fundamental and, as stated in the commentary, unresolved debate: ‘should ethics shape law or is it the converse’?3 We understand the ‘global medical ethos’ represented in the WMA’s revised ICoME to be firmly embedded in the assumption that ethics should shape law and that only where laws are so shaped do people governed by them have an ethical obligation to obey them. For the medical profession, laws permitting participation in torture or other cruel, inhuman or degrading practices and punishments are categorically unethical, and therefore, doctors must not facilitate or participate in them—difficult as it may be for some doctors in some regions or environments to act accordingly. Schantz and Mansoori claim that ‘if a code of ethics is an act of professional self-regulation and professional self-regulation is community-dependent, then a code of ethics cannot be …. (shrink)

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

In 2016, the Colorado legislature passed an amendment to Colorado’s medical proxy law that established a process for the appointment of a physician to act as proxy decision maker of last resort for an unrepresented patient (Colorado HB 16-1101: Medical Decisions For Unrepresented Patients). The legislative process brought together a diverse set of stakeholders, not all of whom supported the legislation. Following passage of the statutory amendment, the Colorado Collaborative for Unrepresented Patients (CCUP), a group of advocates responsible for initiating (...) the legislative process, coordinated a unique effort to engage these stakeholders in the creation of a set of voluntary guidelines to assist facilities and individual careproviders in the implementation of policies and procedures enabled by the statute. This article delineates the questions and concerns of stakeholders, describes how those issues were addressed within the guidelines, and proposes additional opportunities for research to assess the impact of the legislation in Colorado. (shrink)

Semantics: A Reader contains a broad selection of classic articles on semantics and the semantics/pragmatics interface. Comprehensive in the variety and breadth of theoretical frameworks and topics that it covers, it includes articles representative of the major theoretical frameworks within semantics, including: discourse representation theory, dynamic predicate logic, truth theoretic semantics, event semantics, situation semantics, and cognitive semantics. All the major topics in semantics are covered, including lexical semantics and the semantics of quantified noun phrases, adverbs, adjectives, performatives, and interrogatives. (...) Included are classic papers in the field of semantics as well as papers written especially for the volume. The volume comes with an extensive introduction designed not only to provide an overview of the field, but also to explain the technical concepts the beginner will need to tackle before the more demanding articles. Semantics will have appeal as a textbook for upper level and graduate courses and as a reference for scholars of semantics who want the classic articles in their field in one convenient place. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and (...) Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Of the various forms of life writing with which the present collection is concerned, I want in this chapter to devote my attention to the genre of the memoir (and so the autobiographical), and its relation to the seemingly sharply contrasting literary genre of the novel (insofar as the former is understood as a mode of writing concerned with the recounting of the facts or reality of a particular human life, and the latter is understood as concerned only with the (...) appearance of such lives, with the essentially unreal or fictional). Of course, the recent interest in what is termed ‘autofiction’ has served to raise once again the question of the distinction between the memoir and the novel; but rather than engage with that discussion, I want here to focus instead on a particular author’s explicit critical response to that distinction, insofar as it has persistently marked the reception of his work. -/- In a recent lecture, the acclaimed novelist Amit Chaudhuri replied to an accusation that has greeted his fiction from the start of his literary career: that since his novels contain people and events drawn from his own life, they are better thought of as thinly disguised memoirs—as not really novels at all. To examine this charge, I want to draw on an account by the philosopher Stephen Mulhall of the work of another celebrated novelist—J.M. Coetzee (more specifically, that work which features the character Elizabeth Costello). In particular, I want to establish the pertinence to Chaudhuri’s lecture of Mulhall’s analogy between aspects of that work and the work of the influential art historian and critic Michael Fried on the history of modernist painting. In so doing, I aim to show that the commitment to the projects of literary modernism and realism which Mulhall finds in Coetzee (and Costello), can also be found in Chaudhuri’s understanding of the sense in which his novels both are, and are not, autobiographical. (shrink)

It is one thing to read about the methodology and methods of Heideggerian hermeneutic phenomenological research, the ontic description. It is quite another thing to be faced with an interview transcript. This article draws on a study that asked doctoral students about their experience of doing such research. How did they become “phenomenological/hermeneutic” in their thinking and writing? What helped them to find their way? We offer this article as a means of letting others learn from our own experiences. We (...) support our insights with the writings of Heidegger and Gadamer to show the methodological congruence that is essential to Heideggerian phenomenological hermeneutic research. (shrink)

Heidegger’s philosophy is a significant contribution to understanding the meaning of lived experience. Recognizing this, nurses and other health professionals have taken on the research approach of Heideggerian hermeneutic phenomenology. This requires reading the writing of Heidegger. Philosophers themselves acknowledge this writing is dense, difficult to grasp, uses language for which there is no easy translation, and leaves the reader with more questions than answers. Drawing on commentary from philosophers who seek to read Heidegger and from a research study which (...) interviewed doctoral students who were “reading Heidegger,” we seek to show the nature of the experience of pursuing such a challenging quest. (shrink)

We introduce a computational theory of situated language understanding in which the meaning of words and utterances depends on the physical environment and the goals and plans of communication partners. According to the theory, concepts that ground linguistic meaning are neither internal nor external to language users, but instead span the objective‐subjective boundary. To model the possible interactions between subject and object, the theory relies on the notion of perceived affordances: structured units of interaction that can be used for prediction (...) at multiple levels of abstraction. Language understanding is treated as a process of filtering perceived affordances. The theory accounts for many aspects of the situated nature of human language use and provides a unified solution to a number of demands on any theory of language understanding including conceptual combination, prototypicality effects, and the generative nature of lexical items.To support the theory, we describe an implemented system that understands verbal commands situated in a virtual gaming environment. The implementation uses probabilistic hierarchical plan recognition to generate perceived affordances. The system has been evaluated on its ability to correctly interpret free‐form spontaneous verbal commands recorded from unrehearsed game play between human players. The system is able to “step into the shoes” of human players and correctly respond to a broad range of verbal commands in which linguistic meaning depends on social and physical context. We quantitatively compare the system's predictions in response to direct player commands with the actions taken by human players and show generalization to unseen data across a range of situations and verbal constructions. (shrink)

Interpretations of the ethical significance of the Bhagavadgītā typically understand the debate between Arjuna and Kṛṣṇa in terms of a struggle between consequentialist and deontological doctrines. In this paper, I provide instead a reading of the Gītā which draws on a conception of moral thinking that can be understood to cut across those positions – that developed by Stanley Cavell, which he calls ‘Emersonian Moral Perfectionism’. In so doing, I emphasise how Kṛṣṇa’s consolation of Arjuna can centrally and fruitfully be (...) viewed as concerned with resuscitating the latter’s individuality, thereby allowing Arjuna to overcome an unthinking conformity to the current degenerate state of his society. This leads me to explore the relation between this perfectionist understanding of spiritual reorientation and the Gītā’s religious account of human redemption; and to conclude by suggesting how the text of the Gītā itself might have similar therapeutic designs upon its readers. (shrink)

In a recent online lecture, the acclaimed novelist Amit Chaudhuri responded to an accusation that has greeted his fiction since the start of his literary career: that since, as he openly admits, his novels contain people and events that are drawn from his own life, they are better thought of as thinly disguised memoirs—as not really novels at all. In this paper, I discuss this charge by drawing on an account by the philosopher Stephen Mulhall of the work of another (...) distinguished novelist—J.M. Coetzee (more specifically, that work which features the character Elizabeth Costello). In particular, I want to establish the pertinence to Chaudhuri’s lecture of Mulhall’s analogy between aspects of that work and the work of the influential art historian and critic Michael Fried on the history of modernist painting. In so doing, I aim to show that the commitment to the projects of literary modernism and realism which Mulhall sees in Coetzee (and Costello), can also be seen in Chaudhuri’s understanding of the sense in which his novels both are, and are not, autobiographical. (shrink)

In our article, we share the lessons we have learned after creating and running a successful legal laboratory over the past seven years at Yale Law School. Our legal laboratory, which focuses on the intersection of law and severe brain injury, represents a unique pedagogical model for legal academia, and is closely influenced by the biomedical laboratory.

In this article, I claim that Sam Mendes' Revolutionary Road is a recent version of the film genre that Stanley Cavell calls the “melodrama of the unknown woman”. Accordingly, my discussion focuses on two key elements of that identification: the film's overriding dramatic and thematic emphasis on conversation; and the central characters’ relation to the wider social and political concerns of America.