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PubMed1993

Alternative approaches to research in physical therapy: positivism and phenomenology.

This article presents philosophical approaches to research in physical therapy. A comparison is made to demonstrate how the research purpose, research design, research methods, and research data differ when one approaches research from the philosophical perspective of positivism (predominantly quantitative) as compared with the philosophical perspective of phenomenology (predominantly qualitative). Differences between the two approaches are highlighted by examples from research articles published in Physical Therapy. The authors urge physical therapy researchers to become familiar with the tenets, rigor, and knowledge gained from the use of both approaches in order to increase their options in conducting research relevant to the practice of physical therapy.

Forecasting↗
PubMed2001

Ethical boundary work: geneticization, philosophy and the social sciences.

This paper is a response to Henk ten Have's "Genetics and Culture: The Geneticization thesis". In it, I refute Ten Have's suggestion that geneticization is not the sort of process that can be measured and commented on in terms of empirical evidence, even if he is correct in suggesting that it should be seen as part of 'philosophical discourse'. At the end, I relate this discussion to broader debates within bioethics between the social science and philosophy, and suggest the need for philosophical approaches to take the social sciences seriously.

Bioethics↗
PubMed2002

An existential approach to risk perception.

Existential, or existential-phenomenological philosophical approaches to the social psychology of risk perception provide a novel framework for understanding issues that are common to all humanity, such as fear of death, freedom and responsibility, isolation and meaninglessness, as these anxieties are a function of existing, or being-in-the-world. These fundamental anxieties can be related theoretically to the ways people perceive risks within social and cultural milieus, and can also be used practically within case studies, as demonstrated in the three examples presented, which examine perceptions of climate change, food-related risks, and environmental awareness via a mixture of quantitative and qualitative techniques. The discussion focuses on the possible insights that can be gained from taking an existential perspective on risk perception, and relates notions of contemporary technologically-oriented societies to the existential challenges faced by individuals and societies in the contemporary world.

Anxiety↗
PubMed2002

In focus. Life after BioethicsLine: a reply to Joyce Plaza.

The recent closure and removal of BioethicsLine led many researchers to wonder where to turn for their research needs. Joyce Plaza wrote that the closure is a mistake. In this essay I maintain, contra Plaza, that due to its cross-disciplinary nature researchers can find bioethics literature in other databases. In developing the search strategy the researcher needs to consider what the problem is about. If the researcher has a philosophical approach in mind, a wise choice would be to use Philosopher's Index; a legal approach suggests using Academic Universe, Westlaw, Lexis or legal databases freely available through state and federal websites. Further, in so far as the National Library of Medicine is integrating citations in BioethicsLine into the NLM Gateway databases (PubMed and LOCATORplus) I point out suggestions on using the latter databases effectively. There is a wealth of information readily available and researchers have much to learn by trying the alternatives.

Abstracting and Indexing↗
PubMedDate not supplied

Patient autonomy in care: a theoretical framework for nursing.

Patient autonomy has increasingly become an issue in a health care system that often promotes dependence in decision making. The complex technology of health care creates situations in which difficult decisions need to be made by patients and their families. Nurses are important participants in that decision-making process. Models available for developing a theoretical approach to patient autonomy traditionally have been limited to ethics literature. A more recent approach to personal autonomy is Meyer's philosophical feminist perspective. Any philosophical approach to patient autonomy must be congruent with other critical nursing concepts. In addition, a model of patient autonomy for nursing must be useful for persons who operate at various functional levels. The model, Patient-Autonomy in Care, based on the Meyer's model, was developed to incorporate the special vulnerability and functional needs of patients in the health care system.

Decision Making↗
PubMed1995

[Three approaches to culpability. 1].

During our psychiatric practice, we noted consistently the important role devoted to culpability as a symptom but also its presence in our psychic functions apart from any pathological decompensation. This double existence guided our research, we considered culpability through three different approaches: namely, in this first part, a philosophical approach and a sociological approach (the psychoanalytical approach will be examined in the second part). We will particularly insist here on the cultural dimension of culpability and on its dynamic function in social relations.

Cross-Cultural Comparison↗
PubMed2002

Reflections on genetic manipulation and duties to posterity: an engagement with Skene and Coady.

In addressing the regulation of human genetic futures, scientific standards concerning human kinds are endorsed by philosophical approaches that tend to exclude many people with genetic conditions from the deliberative process. In broadening the axiological, ontological and epistemological framework to include disability perspectives, the focus is shifted from questions of regulation to practical matters of participation, invoking ideals of community equality and enabled choice. In developing practical community engagements to deliberate upon genetic futures, a process that allows dialectical encounter between eugenic and non-eugenic approaches is envisioned so that strong versions of eugenics are avoided.

Persons with Disabilities↗
PubMed2003

Critical perspectives of animal agriculture: introduction.

The American Society of Animal Science has recently focused its attention on a variety of contentious issues in animal agriculture. This paper deals with critique, a philosophical approach to analyzing and understanding issues. This method has been employed by various contemporary philosophers. For example, feminist theorists have used this approach to critically analyze sexual harassment. Critique involves a critical analysis of the discourse (ideas or language) and practices that define the social reality in which we live. How we think about the world and how we behave in it determines how we humans interact with each other as well as with the rest of nature. This social structure is associated with power structures that benefit some individuals and harm others. In this paper, I demonstrate how critique can be used to better understand the social reality of animal agriculture. By analyzing certain popular texts in this field, I show that a "mechanical view of nature" is dominant in animal agriculture and argue that such a view contributes to a social reality that can be harmful to some humans and other animals. I conclude that various contentious issues can be better addressed when we engage in a critical analysis of this conceptual framework and base our analysis on the experiences of many different people, including those who have been harmed by our current system of animal agriculture.

Animal Husbandry↗
PubMed2003

Performance of doctoring: a philosophical and methodological approach to medical conversation.

This paper advocates a philosophical and methodological approach to the medical conversation between doctor and patient. It engages the issue of subjectivity in medicine, focusing on the dialogue between patient and physician regarding health choices and subjective experience. A performatory approach to training physicians to communicate with their patients (rather than a cognitive approach to doctor-patient communication) is described.

Attitude of Health Personnel↗
PubMed2003

Foundations of clinical logagogy.

The meaning of the term "logagogy" is elucidated, and logagogic practices are outlined in the history of medicine. It is shown how the traditional medicine of India, Ayurveda, shows signs of logagogic practices (sattvavajaya), and that not only Ayurveda but also the famous Greek physician Galenus emphasize a philosophical approach to medicine. As Galenus's logagogic practices have their roots in the tradition of practical philosophy in Greek antiquity, the most important Greek schools of thought that are relevant to logagogic approaches are sketched. It is shown that the Stoics created a rationalistic system emphasizing the importance of the logos for human beings, and that Epicurus made advances in psychoeducation and cognitive reframing that are important for logagogic practices. These logagogic approaches of antiquity have been taken up by modern counseling in philosophical practices. The article closes with an outline of a clinical logagogy.

Buddhism↗
PubMed1993

A collaborative approach to standards, practices. Setting the stage for continuous quality improvement.

In retrospect, the most important thing we did was work together. We analyzed, refined, and validated our philosophical approach to patient care. We provided an information data base that is readily available for on-the-job reference and serves as a starting point for CQI activities. The very act of joint documentation of practices encourages open discussions about improvements to patient care. One physician states, We know that flaws in the process through which we produce care are everywhere--waste, duplication of effort, unnecessary complexity, and unpredictability . . . I believe that modern total quality management offers enormous hope to a medical care field that is rather desperate. . . . Collaborative practice and CQI activities are one hope. The scope of what nurses and physicians traditionally consider when discussing standards and practices must widen. We should no longer look only at patient care. We must simultaneously focus on how the management of total systems influences quality care for all patients. The CQI process, a proactive method, requires an accurate data base of information that is easily retrieved when looking for systems and individual patient care improvements. Our Computerized Collaborative Standards and Practices Manual is the reservoir for documenting practice plans developed and approved by all the disciplines involved. The process described here began with two closely knit operating room disciplines; this framework, however, offers the potential for expansion into a hospital-wide system of information organization and use.

Anesthesia Department, Hospital↗
PubMed1999

Moral guidance, moral philosophy, and moral issues in practice.

Approaches to teaching ethics to nurses have been debated in literature for some years. Three issues in particular are commonly addressed: the intentions of such teaching; the value of examples and case studies; and the compatibility of philosophical approaches with the clinical reality experienced by students. It is argued here that moral guidance as a strategy is unacceptable, and that a basic introduction to philosophical methods is the key to effective learning of the skills required for autonomous analysis and decision making. A means for including the use of personal experiences and case study material is presented which relies upon the provision of a framework of analysis to facilitate structured thinking and the pursuit of justifiable arguments. The approach suggested is compatible with students' existing experiences and work-context, and enhances the integration of ethical reasoning into the multi-faceted totality of clinical practice.

Clinical Competence↗
PubMed2003

Discounting in cost-utility analysis of healthcare interventions: reassessing current practice.

Cost-utility analysis (CUA) is a technique that can potentially be used as a guide to allocating healthcare resources so as to obtain the maximum health benefits possible under a given budget constraint. However, it is not clear that current practice captures societal preferences regarding health benefits. In analyses of healthcare interventions providing survival benefits, the market rate of interest is the sole empirical variable that reflects societal preferences. This approach is based on the assumptions that: (i) healthcare interventions should be ranked using cost-effectiveness (CE) ratios; (ii) the discount rate for costs in CUA should be equal to that used in cost-benefit analysis (CBA); (iii) the discount rate in CBA should be the market rate of interest on long-term government bonds; and (iv) the Keeler-Cretin paradox is applicable to CUA of healthcare interventions, so that the discount rate for benefits in CUA should be set equal to the discount rate for costs. This approach ignores a fundamental difference between CBA and CUA, namely that CUA assumes that a budget constraint has been specified prior to the analysis. It starts with the assumption that a given amount of funds have been withdrawn from the economy to fund healthcare, so there is no opportunity cost to consider. For that reason, the principles on which the choice of discount rate rests differ in the two techniques. Furthermore, use of CE ratios to rank interventions assumes that the budget constraint can be expressed as a single constraint. But healthcare budgets are multiyear budgets that are roughly constant from year to year. A more realistic model would involve multiple constraints and would require linear programming for solution. This can be reduced to a series of single constraints, thereby allowing use of the simpler CE ratio approach, if we assume that the budget being allocated is intended for one cohort at a time, i.e. all people for whom a new funding decision must be made in a given year. In general, we assume that future cohorts will be allotted comparable funding. However, the Keeler-Cretin paradox depends on the assumption that cohorts are competing with each other for resources, and is therefore not applicable to CUA of healthcare. Other approaches are therefore needed to assign utilities to healthcare interventions providing survival benefits. Methods should be developed that allow analyses to reflect a range of philosophical approaches through sensitivity analysis.

Attitude to Health↗
PubMed1993

The educational philosophies behind the medical humanities programs in the United States: an empirical assessment of three different approaches to humanistic medical education.

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females and other demographic data on age and educational background were consistent with other studies of the field of medical humanities. Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field.

Education, Medical↗
PubMed2002

Use of risk assessment and life cycle assessment in decision making: a common policy research agenda.

Quantitative risk assessment (RA) and life cycle assessment (LCA) are both analytical tools used to support decision making in environmental management. They have been developed and used by largely separate groups of specialists, and it is worth considering whether there is a common research agenda that may increase the relevance of these tools in decision-making processes. The validity of drawing comparisons between use of the tools is established through examining key aspects of the two approaches for their similarities and differences, including the nature of each approach and contextual and methodological aspects. Six case studies involving use of each approach in public decision making are described and used to draw out concerns about using RA and LCA in this context. The following categories of concern can be distinguished: philosophical approach of the tools; quantitative versus qualitative assessment; stakeholder participation; the nature of the results; and the usefulness of the results in relation to time and financial resource requirements. These can be distilled into a common policy research agenda focusing on: the legitimacy of using tools built on a particular perspective in decision making; recognition and role of value judgments in RA and LCA; treatment of uncertainty and variability; the influence of analytical tools in focusing attention on particular aspects of a decision-making situation; and understandability of the results for nonspecialists. It is concluded that it is time to bring together the experiences of RA and LCA specialists and benefit from cross-fertilization of ideas.

Decision Making↗
PubMed1991

Voices and paradigms: perspectives on critical and feminist theory in nursing.

Nurse scientists have explored a variety of research methods and a number of philosophic approaches to expand the discipline's ability to describe and investigate nursing's phenomena of interest. This article discusses the similarities and differences in world views, epistemologies, methodologies, and methods of two of these paradigms: critical theory and feminist theory. Attributes of these two stances are contrasted, and the relationship between the methods of analysis and the philosophic point of view are explored. An example of nursing research is given, with discussion of how the approach would differ if the nurse scientist were using critical versus feminist theory as a frame of reference.

Female↗
PubMed1991

New approaches to the treatment of follicular lymphoma.

The major avenues of clinical research into the treatment of follicular lymphoma, 'more, if so when?', interferon therapy, and antibody therapy, have been presented in the light of present knowledge about the clinical course of the disease. They must be seen within the context of the current philosophical approach to the illness, and the economic climate which prevails, at a time when new drugs, for example fludarabine (Leiby et al, 1987; Reman et al, 1988; Whelan et al, 1991), are showing promise, and differentiating agents are being tested in remission (Cunningham et al, 1985). There can be little doubt that the objective of future research should be to eliminate the disease altogether at the time of initial presentation, since patients entering remission and never having a recurrence have a far greater probability of longevity than those in whom recurrences occur (Lister, 1991). There can also be little doubt that when lymphoma is present and causing symptoms, treatment should be given, since survival is longer for those in whom a response is achieved, at least at presentation, and at first recurrence (Lister, 1991). Since the latter is sadly the reality for the majority, improving treatment at the time of recurrence must also be a priority. Time will tell whether any of the options presently under investigation will be appropriate at all, and if so when. It is certainly the case that some of them will be entirely inappropriate for some patients, because the risk of toxicity will outweigh the potential benefit, especially for the elderly. Further careful identification of prognostic variables may allow for individualization of therapy. It would be comforting to know that the newly found molecular marker of the disease would help us. Its absence may do--but its presence certainly does not, since t(14;18) containing cells may seemingly be present for many years of clinical normality (Price et al, 1991, in press). The challenge to find the right treatment at the right time--or perhaps to identify the 'right patient' for the therapy continues.

Antibodies, Monoclonal↗