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Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social (...) justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

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This article explores illness as an assemblage of bodies, discourses, and practices by tracing a genealogy of the condition hystero-epilepsy in order to show the precarity of dominant bio-psychiatric ideology in the present. I read Siri Hustvedt’s case study of her own nervous condition with and against other histories of nerves, including Charcot’s treatment of hystero-epilepsy in the 1870s, Foucault’s treatment of hysteria, simulation, and the ‘neurological body’ presented in his lectures in 1974, and Elizabeth Wilson’s recent treatment of the (...) Freudian concept of ‘somatic compliance.’ I assemble this eclectic hystero-epileptic archive not in order to present a definitive history of hystero-epilepsy, but rather to think about how illness is made, unmade, and remade in the clinic and narrative. (shrink)

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In this essay, I utilize the concept of the echo, as formulated in the historical and methodological work of Michel Foucault and Joan W. Scott, to help theorize the historical relationship between health feminism and AIDS activism. I trace the echoes between health feminism and AIDS activism in order to present a more complex history of both movements, and to try to think through the ways that the coming together of these two struggles in a particular place and time—New York (...) City in the 1980s—created particular practices that might be effective in other times and places. The practice that I focus on here is one that I call 'doing queer love '. As I hope to show, 'doing queer love ' both describes a particular history of health activism and opens up the possibility of bringing into being a different future than the one a conventional history of AIDS seems to predict. It is an historical echo that I believe we must try to hear now, not just in order to challenge a particular history of AIDS activism in the United States, but also in order to provide a model that can be useful for addressing the continuing problem of AIDS across the globe. (shrink)

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For over 100 years, the field of contemporary public health has existed to improve the health of communities and populations. As public health practitioners conduct their work – be it focused on preventing transmission of infectious diseases, or prevention of injury, or prevention of and cures for chronic conditions – ethical dimensions arise. Borrowing heavily from the ethical tools developed for research ethics and bioethics, the nascent field of public health ethics soon began to feel the limits of the clinical (...) model and began creating different frameworks to guide its ethical challenges. Several public health ethics frameworks have been introduced since the late 1990s, ranging from extensions of principle-based models to human rights and social justice perspectives to those based on political philosophy. None has coalesced as the framework of choice in the discipline of public health. This paper examines several of the most-known frameworks of public health ethics for their common theoretical underpinnings and values, and suggests next steps toward the formulation of a single framework. (shrink)

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In this essay, I take up the question of the time of medicine in relation to two events in the U.S. from 2005—the Terri Schiavo case and Hurricane Katrina and its aftermath. I consider both cases as “mediatized medical events,” that is, as events in which the practices of medicine received considerable media attention at a particular historical moment; or, we might say, as events that brought a convergence between media and medical practices. I juxtapose these two events because, placed (...) side by side, they help make visible two stories of catastrophe, as well as the many difficulties of telling stories of catastrophe. Bringing together these seemingly divergent events allows me to draw connections that I hope will expand our bioethical imaginary beyond the reductive approaches that tend to dominate the practice of bioethics today. I also juxtapose them to signal a bioethical tension at the heart of the neoliberal state’s response to catastrophe in general, what Foucault might have diagnosed as the difference between making live and letting die. In these two events, we glimpsed—if only fleetingly—the state’s operation of making live and letting die, and medicine’s central role in that operation, as well as the re-assertion of medical sovereignty in crisis events. (shrink)

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In their article “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Ray and Cooper (2024) invite us to prioritize environmental health...

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Drawing on her 35-year plus experience in the classroom,Lisa Lee has transformed her extensive and authentic teaching experience into a contagious passion and energy with a specialization in Gifted and Talented programs and a focus on the students who don't always fit in a box. The Heart of Teaching is a book about her experience as a teacher, and the students she both taught and learned from, and the lessons she garnered as someone who always taught from the (...) heart. (shrink)

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Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future (...) might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem-solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field. (shrink)

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Volume 20, Issue 10, October 2020, Page 61-63.

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The Presidential Commission for the Study of Bioethical Issues was created by President Obama in 2009 to identify and promote policies and practices that ensure scientific research, health care delivery, and technological innovation are conducted in socially and ethically responsible manners. The bioethics commission is an independent and thoughtful group of experts who advises the President and, in so doing, strives to educate the nation on bioethical issues. As part of the effort to promote policies and practices ensuring the ethical (...) conduct of research, innovation, and health care delivery, the bioethics commission staff, in consultation with commission members, has used the bioethics commission reports to develop pedagogical materials for traditional and nontraditional educational settings. The goal is to use contemporary issues addressed by the bioethics commission to support teaching of bioethics ideas, principles, and theories across the major areas of study and practice. (shrink)

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In this essay, I analyze two memoirs—Rafael Campo's The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire and Abraham Verghese's My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS—which describe the effects of treating HIV/AIDS on each doctor's identity, on his desire for community and belonging, and on his identification and/or disidentification with the medical profession in the United States. My readings of Campo and Verghese revolve around three key (...) terms provided by Campo's subtitle: identity, empathy, and desire. I shift the order of these terms in Campo's subtitle because I want to read identity, empathy, and desire in Campo and Verghese through and along with the theoretical “pragmatics” of Gilles Deleuze and Felix Guattari. (shrink)

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In this paper, I offer a treatment of “the clinic” in which the clinic—as concept and space—is que(e)ried, that is, both questioned and made queer. I present two historical case studies that queer clinical thought and practices in the period before AIDS and before the full-blown arrival of queer theory on the western theoretical landscape. These two cases—the practice of self-help developed in the women’s health movement in the United States and the practice of tranversality developed out of and beyond (...) the Institutional Psychiatry movement in France—challenge the practice of medicine in the prehistory of both AIDS and queer theory, yet, they are not generally seen as precursors, or related in any way, to AIDS activism. In a sense, then, I also want to question and make queer the history of AIDS as we conventionally know it today by extending that history backwards and outwards to earlier queer critical and clinical practices like self-help and transversality. (shrink)

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Feminist Time Against Nation Time offers a series of essays that explore the complex and oftentimes contradictory relationship between feminism and nationalism through a problematization of contemporality. The collection pursues the following questions: how do the specific temporalities of nationalism and war limit and delimit public spaces in which dissent might happen; and how might we account for the often contradictory and ambiguous relationship of "feminism" and "nationalism" through an exploration of the problem of time?

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Drawing on comparisons to genetic exceptionalism, Cheung et al. (2025) reject psychedelic exceptionalism—that psychedelics raise unique concerns regarding increased vulnerability and diminished aut...

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For the first time, the revised Common Rule specifies that public health surveillance activities are not research. This article reviews the historical development of the public health surveillance exclusion and implications for other foundational public health practices.

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The first Ethics Bowl competition was established in the 1990s by Dr. Robert Ladenson of the Illinois Institute of Technology to help students reason through ethical challenges they will face in their personal and professional lives, and help them develop responsibilities as citizens of a democracy. Since then, the Ethics Bowl format and its pedagogical goals have been adapted to many other academic disciplines and a variety of student and professional populations. Our aim was to quantify the growth of the (...) Ethics Bowl concept by enumerating and describing extant Ethics Bowl programs, outlining both pedagogical goals and operational aspects. Using respondent-driven sampling, we identified 20 Ethics Bowl programs across the globe, reaching tens of thousands of participants annually, and an additional two programs preparing to launch in the near future. We conclude by making recommendations for pedagogical and operational dimensions of the programs. (shrink)

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Ethical considerations from both the clinical and public health perspectives have been used to examine whether it is ethically permissible to mandate the seasonal influenza vaccine for healthcare workers (HCWs). Both frameworks have resulted in arguments for and against the requirement. Neither perspective resolves the question fully. By adding components of justice to the argument, I seek to provide a more fulsome ethical defence for requiring seasonal influenza immunisation for HCWs. Two critical components of a just society support requiring vaccination: (...) fairness of opportunity and the obligation to follow democratically formulated rules. The fairness of opportunity is informed by Rawls’ two principles of justice. The obligation to follow democratically formulated rules allows us to focus simultaneously on freedom, plurality and solidarity. Justice requires equitable participation in and benefit from cooperative schemes to gain or profit socially as individuals and as a community. And to be just, HCW immunisation exemptions should be limited to medical contraindications only. In addition to the HCWs fiduciary duty to do what is best for the patient and the public health duty to protect the community with effective and minimally intrusive interventions, HCWs are members of a just society in which all members have an obligation to participate equitably in order to partake in the benefits of membership. (shrink)

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As has become tradition, executive directors of United States’ presidential bioethics committees offer reflections about their experience shortly after the orderly shutdown of the commission staff. After the records are filed according to government records regulations; after all the staff members, who are hired into temporary positions that must be renewed every two years, have secured permanent employment; after preparations are made to ensure that the next commission staff (should there be one) has a budget and standard operating procedures in (...) order to begin its work in a timely manner; after the lights are turned out for the last time, the executive director makes the final climb up the stairs into the sunlight and reflects on the whirlwind. There is much about my work with the Presidential Commission for the Study of Bioethical Issues that deserves comment, but one aspect of the commission that has been especially valuable to me is its work to educate the nation on bioethical issues. This is, moreover, a contribution in which the commission staff was central, and it is one that, as an ethics educator myself, I will cherish deeply. (shrink)

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From accessible and affordable health care to old or new reproductive technologies, human or animal research, and beyond, the justice and well‐being of our society depends on the ability of key groups—such as scientists and health care providers—along with members of the public to identify the key issues, articulate their values and concerns, deliberate openly and respectfully, and together find the most defensible ways forward.The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving (...) the ethical literacy of the American public in the domain of bioethics. But what are the best educational practices to spur and support these sorts of societal conversations? And where are the greatest gaps in our collective knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity? (shrink)

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There are no national recommendations for routine screening for sickle cell trait, nor is there guidance on whether or how to notify donors that they might be tested or identified as having sickle cell trait. As a result, the organizations that collect blood have implemented variable policies about whether and how to inform prospective donors of the possible screening and discovery of this noncommunicable condition. The question of what they should do is related to the broader question of how to (...) handle incidental and secondary findings. In a recent report, the Presidential Commission for the Study of Bioethical Issues outline a framework for handling such findings in the clinical, research, and direct‐to‐consumer contexts. While the commission's report did not directly address incidental and secondary findings in the public health context of blood donation, it made several overarching recommendations that apply in all contexts where such findings might arise. This essay outlines the special issues raised by discovering sickle cell trait in blood donation and considers the implications of the commission's framework for that problem. (shrink)

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The aim of this book is to understand what Deleuze and Guattari mean by "art." Stephen Zepke argues that art, in their account, is an ontological term and an ontological practice that results in a new understanding of aesthetics. For Deleuze and Guattari understanding what art "is" means understanding how it works, what it does, how it "becomes," and finally, how it lives. This book illuminates these philosophers' discussion of ontology from the viewpoint of art-and vice versa-in a thorough questioning (...) of aesthetic criteria as they are normally understood. (shrink)

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We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and (...) explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”. (shrink)

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Volume 19, Issue 9, September 2019, Page W1-W2.

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This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of psychiatric power. As I (...) will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis. (shrink)

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Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and (...) rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

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Chelicerates (scorpions, horseshoe crabs, spiders, mites and ticks) are the second largest group of arthropods and are of immense importance for fundamental and applied science. They occupy a basal phylogenetic position within the phylum Arthropoda, and are of crucial significance for understanding the evolution of various arthropod lineages. Chelicerates are vectors of human diseases, such as ticks, and major agricultural pests, such as spider mites, thus this group is also of importance for both medicine and agriculture. The developmental genetics of (...) chelicerates is poorly understood and a challenge for the future progress for many aspects of chelicerate biology is the development of a model organism for this group. Toward this end, we are developing a chelicerate genetic model: the two‐spotted spider mite Tetranychus urticae. T. urticae has the smallest genome of any arthropod determined so far (75 Mbp, 60% of the size of the Drosophila genome), undergoes rapid development and is easy to maintain in the laboratory. These features make T. urticae a promising reference organism for the economically important, poorly studied and species‐rich chelicerate lineage. BioEssays 29:489–496, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

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In “Bioethicists Today: Results of the Views in Bioethics Survey,” Pierson et al. (2024) provide a valuable snapshot of the normative commitments and demographic backgrounds of 824 U.S. bioethicist...

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Giving Voice to Values as a Professional Physician: An Introduction to Medical Ethics by Ira Bedzow (2019, Routledge) is a short and accessible volume that introduces practical ethical decision mak...

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The use of Big Data—however the term is defined—involves a wide array of issues and stakeholders, thereby increasing numbers of complex decisions around issues including data acquisition, use, and sharing. Big Data is becoming a significant component of practice in an ever-increasing range of disciplines; however, since it is not a coherent “discipline” itself, specific codes of conduct for Big Data users and researchers do not exist. While many institutions have created, or will create, training opportunities to prepare people to (...) work in and around Big Data, insufficient time, space, and thought have been dedicated to training these people to engage with the ethical, legal, and social issues in this new domain. Since Big Data practitioners come from, and work in, diverse contexts, neither a relevant professional code of conduct nor specific formal ethics training are likely to be readily available. This normative paper describes an approach to conceptualizing ethical reasoning and integrating it into training for Big Data use and research. Our approach is based on a published framework that emphasizes ethical reasoning rather than topical knowledge. We describe the formation of professional community norms from two key disciplines that contribute to the emergent field of Big Data: computer science and statistics. Historical analogies from these professions suggest strategies for introducing trainees and orienting practitioners both to ethical reasoning and to a code of professional conduct itself. We include two semester course syllabi to strengthen our thesis that codes of conduct can be harnessed to support the development of ethical reasoning in, and a sense of professional identity among, Big Data practitioners. (shrink)

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Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

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Background HIV prevention trials conducted among disadvantaged vulnerable at-risk populations in developing countries present unique ethical dilemmas. A key concern in bioethics is the validity of informed consent for trial participation obtained from research subjects in such settings. The purpose of this study was to investigate the effectiveness of a continuous informed consent process adopted during the MDP301 phase III vaginal microbicide trial in Mwanza, Tanzania. Methods A total of 1146 women at increased risk of HIV acquisition working as alcohol (...) and food vendors or in bars, restaurants, hotels and guesthouses have been recruited into the MDP301 phase III efficacy and safety trial in Mwanza. During preparations for the trial, participatory community research methods were used to develop a locally-appropriate pictorial flipchart in order to convey key messages about the trial to potential participants. Pre-recorded audio tapes were also developed to facilitate understanding and compliance with gel-use instructions. A comprehension checklist is administered by clinical staff to all participants at screening, enrolment, 12, 24, 40 and 50 week follow-up visits during the trial. To investigate women's perceptions and experiences of the trial, including how well participants internalize and retain key messages provided through a continuous informed consent process, a random sub-sample of 102 women were invited to participate in in-depth interviews conducted immediately after their 4, 24 and 52 week follow-up visits. Results 99 women completed interviews at 4-weeks, 83 at 24-weeks, and 74 at 52 weeks. In all interviews there was evidence of good comprehension and retention of key trial messages including that the gel is not currently know to be effective against HIV; that this is the key reason for conducting the trial; and that women should stop using gel in the event of pregnancy. Conclusions Providing information to trial participants in a focussed, locally-appropriate manner, using methods developed in consultation with the community, and within a continuous informed-consent framework resulted in high levels of comprehension and message retention in this setting. This approach may represent a model for researchers conducting HIV prevention trials among other vulnerable populations in resource-poor settings. Trial registration Current Controlled Trials ISRCTN64716212. (shrink)

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It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha (...) Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

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Raymond Boisvert andLisa Heldke begin Philosophers at Table with a simile. Following Mary Midgley, they suggest that philosophy is like plumbing. We post-industrial urbanites and suburbanites rely on plumbing to bring us water and dispose of our waste. We rely on it daily, but we rarely think reflectively about it. In like fashion, we all rely on philosophy; ideas, concepts, values, and guiding principles structure and organize the way we perceive and experience the world. Philosophy lies undetected, out (...) of sight, tucked neatly in the walls and under the floorboards. We typically suffer its dripping faucets, its low water pressure, its slow drain as long as we can because these almost always involve unwieldy... (shrink)

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Evidentials and Modals offers an in-depth account of the meaning of grammatical elements representing evidentiality in connection to modality, focusing on theoretical/formal perspectives by eminent pioneers in the field and on recently discovered phenomena in Korean evidential markers by native scholars in particular. Evidentiality became a hot topic in semantics and pragmatics, trying to see what kind of evidential justification is provided by evidentials to support or be related to the 'at-issue' prejacent propositions. This book aims to provide a deeper (...) understanding of such evidentiality in discourse contexts in a broad range of languages such as American Indian, Korean and Japanese, Turkish and African languages over the world. In addition, an introduction to the concept of evidentiality and theoretical perspectives and recent issues is also provided. Contributors are Alexandra Y. Aikhenvald, Robert Botne, Kyung-Sook Chung, Martina Faller, Ezra Keshet, Iksoo Kwon, Chungmin Lee, Ji-Young Lee, Jungmee Lee, Dongsik Lim,Lisa Matthewson, William McClure, Elin McCready, Sarah E. Murray, Marisa Nagano, Jinho Park, Mary Shin Kim, Jaemog Song, Thomas Willett, and Kei Yoshimoto. (shrink)

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