What place discourse, what role rigorous argumentation? Against the standard image of Hadot's conception of philosophy as a way of life

After an introduction situating the piece in light of debates surrounding Hadot et al's work on the history of philosophy, Part I of what follows lays out, as briefly as possible, the 'standard view' of Hadot promoted by the texts that have been translated hitherto, and which has attracted Cooper, Nussbaum et al’s criticisms about misrepresenting--or dismissing-the place of rational argument in philosophy 'comme manière de vivre'. In Part II, will we see how several of Hadot’s as-yet-untranslated pieces, led by 'La Philosophie Antique: Une Éthique ou une Pratique?', indicate his own much more qualified perspectives about the place of discourse in ancient philosophy conceived as a way of life. To argue that philosophy included the paranoetic prescription of imaginative, mnemic, and even somatic exercises to rehape subjects' beliefs, habits, and desires is not to deny that these exercises were justified rationally, or based in rigorous theoretical accounts of the human being and its place in the cosmos.

Diabetes and end-of-life care: ethical issues, practices and challenges

Abstract:
Diabetes is the most significant chronic disease and the global prevalence is increasing. Diabetes is associated with debilitating long term complications and other comorbidities that cause high rates of morbidity and mortality. Keeping blood glucose and other metabolic parameters within an acceptable, personalised range is important to comfort and quality of life but can be challenging, especially during end-of-life care. Guidelines can help clinicians make appropriate care decisions; however, there is little research about what constitutes best practice diabetes care at the end-of-life: existing recommendations and guidelines blend the best available evidence with consensus opinion. In addition, there are important ethical and methodological considerations concerning research involving vulnerable people at the end-of-life. Chapter 3 describes the ethical and methodological issues that needed to be considered when developing guidelines for managing diabetes at the end-of-life and the contribution interviews with dying people and their family carers made to developing a guiding philosophy and to person-centred guidelines.

Contemplation as philosophical practice : "reason in the sphere of understanding"

This essay seeks to explore the practice of contemplation as a method to cultivate insight into some of the key concerns of philosophy. In our discussion, philosophical contemplation is understood as a phenomenological method that instigates dynamic patterns of understanding(s) of an issue or object. Seen in this light, contemplation involves the cultivation of certain introspective qualities that are central to widening the parameters of attention. It is the contention of this paper that a contemplative approach to philosophical inquiry generates a basis for multi-dimensional understandings that can facilitate the possibility of “doing conceptual justice to the world in all its variety” (Sanders 207). In line with the idea of philosophy as a way of life, contemplation as philosophical practice envisions philosophy not simply as a system of propositions but also as an existential practice that both offers ways of gathering knowledge and that can provide epistemic justification for multiplicity, diversity, and seemingly contradictory modes of thought. From the beginning it is important to note that we are not positing a philosophy of contemplation but, following Russell (1912) and Sherman (2014), we are exploring a contemplative conception of philosophy that is predicated on the classical understanding of philosophy as a way of life with an integral practice component that instigates a mutually enriching union of theory and praxis.

Socratic ironies: reading Hadot, reading Kierkegaard

This paper examines the seemingly unlikely rapport between the ‘Christian existentialist’, radically Protestant thinker, Søren Kierkegaard and French classicist and historian of philosophy, Pierre Hadot, famous for advocating a return to the ancient pagan sense of philosophy as a way of life. Despite decisive differences we stress in our concluding remarks, we argue that the conception of philosophy in Hadot as a way of life shares decisive features with Kierkegaard’s understanding of the true ‘religious’ life: as something demanding existential engagement from its proponent, as well as the learning or recitation of accepted doctrines. The mediating figure between the two authors, the paper agrees with Irina (2012), is Socrates and his famous irony. In order to appreciate Kierkegaard’s rapport with Hadot, then (and in contrast to Gregor, who has also treated the two figures) we first of all consider Hadot’s treatment of the enigmatic ‘old wise man’ who remains central to Kierkegaard’s entire authorship. (Part 1) However, to highlight Hadot’s Socratic proximity to Kierkegaard (in contrast to Irina), we set up Hadot’s Socrates against the contrasting portrait readers can find in John M. Cooper’s recent work on Socrates and philosophy as a way of life. Part II of the essay turns back from Hadot’s and Kierkegaard’s Socrates towards Hadot’s own work, and argues—again moving beyond both Gregor and Irina’s works on Hadot and Kierkegaard—that the shape of Hadot’s ‘authorship’, including his remarkably classical style, can be understood by way of Kierkegaard’s notion of indirect communication. In our concluding remarks, in the spirit of Kierkegaard, we pinpoint the fundamental difference between the two thinkers, arguing that for Hadot in contrast to Kierkegaard, a stress on existential commitment in no way speaks against the philosophical defence of a form of rational universalism. Reading Hadot via Kierkegaard allows us to appreciate Hadot’s novelty as attempting to ‘squaring the circle’ between an emphasis on subjectivity and, as it were, the subjective dimensions of philosophers’ pursuit of rational universality.

Philosophy and the care of the self: a literature survey

This article reviews a number of recent books and practices that address a renewed interest in the role that philosophy might play in the living of a rich and fulfilling life. The review looks at books addressed to the general public as well as books which discuss such classical and Hellenistic philosophers as took their task to be helping people achieve happiness in life. It then turns to contemporary studies of the self and of wisdom and turns finally to some newly emerging philosophical practices such as philosophical counselling and philosophical discussion groups of various kinds in order to explore whether philosophy can still be a source of consolation or guidance in contemporary life.

Extending studies of collaborative cognition by way of care giving situations

Care giving situations contain several features that offer opportunities for expanding the way that collaborative cognition is conceptualised and explored. These features are the presence of several possible contributors, more than one kind of change in participation, distinctions drawn among parts of a task, and differences in understanding based on interests. All represent departures from the traditional focus on dyads, tasks that emphasise one kind of change only, single problems, and differences in competence or expertise. All are also features likely to be found in everyday problem solving. Study 1 focuses on family contributions, based on reports by care givers about their current situation and their preferences for the involvement of other family members. Study 2 presents a standard family scenario and focuses on the views held by care givers, older adults, and community nurses about the reasonableness of various changes in participation. Results are discussed in terms of the ways situations such as care giving can help build a richer picture of collaborative cognition, one that is applicable to a variety of tasks and to all parts of the life span.

New way of seeing things : Ernst Troeltsch and the theological agenda

The aim of this thesis, as set out in the Introduction, is to assess the (seminal) significance of Troeltsch as one who set the agenda for twentieth century theology, particularly modern sociopolitical theology, and whose thought still has a special relevance. The first main chapter deals with the implications of the philosophy of history for theology. The Protestant theological orthodoxy of Troeltsch's time was essential ahistorical: he thought this to be untenable. Theology had to come to terms with the historical method, which was ‘a leaven which transforms everything, and finally bursts all previous forms of theological method.’ This chapter discusses Troeltsch's work concerning the principles, the cultural matrix, and the philosophy of history. The second main chapter examines another main concern of Troeltsch, namely, the status of Christianity vis-a-vis other religions. The background to this was the increasing awareness of the existence of other religions and the question of relativity and universality which this posed. Troeltschfs major response was Die Absolutheit des Christentums in which the ideas of essence, Europeanism, and absolutism were discussed, The third, and longest, chapter looks at the impact of social theory on theology. Sociology gave Troeltsch ‘a new way of seeing things’, and this new perspective is to be seen pre-eminently in The Social Teaching of the Christian Churches. Discussion of this centres on the three main concepts that Troeltsch delineated, compromise, natural law, and church/sect typology.

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Bioethics, cultural differences and the problem of moral disagreements in end-Of-life care : a terror management theory

Cultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made.

The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia : findings from a population-based, cross-sectional study

Purpose Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.

Methods Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).

Results Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: −0.32, 95% CI: −0.40, −0.23), after adjusting for covariates. Those with MDD only (Coef: −0.27, 95% CI: −0.30, −0.24) and CVD only (Coef: −0.08, 95% CI: −0.11, −0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose–response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.

Conclusions HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.

The relationship between coronary heart disease (CHD) and major depressive disorder (MDD) : key mechanisms and the role of quality of life

Various trials have been conducted evaluating depression management programs for patients with Coronary Heart Disease (CHD). However, to date, the most effective way to manage this co-morbidity in the real world setting remains unclear. To better understand the past successes and failures of previous trials and subsequently develop suitable interventions that target key components of health related quality of life (HRQOL) such as mental, physical and vocational functioning, we first need to understand the mechanisms underpinning the relationship between the two conditions. This paper will draw on the key literature in this field as identified by psychiatric, medical and social sciences databases (Cochrane Central Register of Controlled Trials, PubMed, OVID, Medline) available up to January 2012, with the aim to conduct a narrative review which explores: the aetiological relationship between depression and CHD; its association with HRQOL; the relationship between CHD, depression and vocational functioning; and the impact of depression treatment on these outcomes. Key recommendations are made regarding the management of this prevalent co-morbidity in clinical settings.

Impact of depression treatment on mental and physical health-related quality of life of cardiac patients : a meta-analysis

PURPOSE: To conduct a meta-analysis evaluating the effectiveness of depression treatment on mental and physical health-related quality of life (HRQOL) of cardiac patients.

METHODS: Studies were identified using medical, health, psychiatry, psychology, and social sciences databases. Inclusion criteria were (1) 1 or more control conditions, (2) random assignment to condition after admission for myocardial infarction (MI)/acute coronary syndrome, after recording positive results on a depression screener, (3) documentation of depression symptoms at baseline, (4) depression management as a component of the rehabilitation/intervention, (5) validated measure of HRQOL as an outcome, at minimum 6-month followup. For meta-analysis, mental and physical HRQOL were the end points studied, using standardized mean differences for continuous outcome measures, with 95% confidence intervals. Heterogeneity was explored by calculating I2 statistic.

RESULTS: Five randomized controlled trials included in the analysis represented 2105 participants (1058 intervention vs 1047 comparator). Compared with a comparator group at 6 months, a test for overall effect demonstrated statistically significant improvements in mental HRQOL in favor of the intervention (standardized mean differences = −0.29 [−0.38 to −0.20], [P < .00001]; I2 = 0%). Depression treatment had a modest yet significant impact on physical HRQOL (standardized mean differences = −0.14 [−0.24 to −0.04] [P = .009]; I2 = 15%).

CONCLUSION: While the impact of post-MI depression interventions on physical HRQOL is modest, treatment can improve mental HRQOL in a significant way. Future research is required to develop and evaluate a program that can achieve vital improvements in overall HRQOL, and potentially cardiovascular outcomes, of cardiac patients.