The new introduction to the second edition of Habits of the Heart is a very helpful reminder of the main points of the first edition. Moreover, it is very useful in situating, indeed resituating the book’s concerns, given the lapse of time since the book’s first appearance. It provides new insights made possible by second thoughts, as well as by the questions and criticisms of others. The problem of individualism and the slackening, not to say refusal, of traditional communal ties, (...) has accelerated in American society since the first writing. We find phenomena such as middle class ‘cocooning,’ as well as an often low grade civil war, let us say the culture wars. There is a widespread disquiet — to the left, to the right, in the anxious middle — about the future direction of society. One thing is noted from the beginning as common across the divisions, namely, a certain view of the economy. Correspondingly, the authors themselves seem more insistent on issues of class than they were previously: “the festering secret that Americans would rather not face.”I will confine myself to two points: first, the issue of economy in terms of more basic metaphysical assumptions in the whole notion of ‘use.’ I will suggest some connections between serviceable disposability and the culture of autonomy, and between these and the equivocal relation to the other that besets the identification of freedom with autonomy. I work towards the question: must not our communal relations to others be placed in a deeply ambivalent position, if economic relations are dominated by serviceable disposability and freedom as autonomy is idolized?Second, I want to remark on how far we dwell in an ethos of will to power of which use and autonomy serve as masks. I must summon to our discussion the roaming, uninterred ghost of Nietzsche. Whence comes the spell that spoils our taste for the good? Whence comes this, this blandness of the good? The issue of nihilism and religion cannot be buried. Is this issue even more urgent than Bellah and his collaborators, in their essential decency, acknowledge? (shrink)

The line separating the “good life” and the savagery that the “good life” requires, or, perhaps what might be articulated as the line between the space of biopolitics and the space of necropolitics, is maintained in the present through both practices of global policing and imperial war. These practices of policing and war produce the very global refuse that constantly threatens the “good life”—actively wasting the lives and livelihoods of people and non-human lifeworlds Western colonialism established as the raw (...) materials, instruments, and objects of its civilizational goal—against which violence acts to protect a fundamentally human life worth living. At the same time, through capital-intensive projects of “saving” the very targeted populations it destroys, permanent war also produces the subordinated life that will come to serve as the means of maintaining and upholding that “good life.” Beyond this mode of colonial inhabitation, however, subsist other ecologies of life-making practices on the part of those deemed disposable, a planetary remainder which might well be our only hope for a possible future. (shrink)

Publication date: 22 December 2020 Source: International Letters of Social and Humanistic Sciences Vol. 89 Author: Temitope A. Ogunweide The study sought to assess the social context of solid waste disposal pattern of residents in Ibadan metropolis, in order to assess the Solid waste disposal patterns of people in Ibadan metropolis, Oyo State, Nigeria. Specifically, the study identified solid waste disposal habits of residents, frequency of clearing the dumpsters, accessibility of waste dumpsters to people determines the waste (...) disposal pattern of people; and analyze the willingness of people in Ibadan to pay for improved service. Solid waste management has been part of human activities right from time. Efforts by Oyo State Government is seen in the collection of dirt that have been placed on the medians. Waste generation is an unavoidable product of man activities, however, sustainable management of such waste is a challenge faced in many countries today. Nigeria, a developing country in Africa, has been in a quandary of how to efficiently manage the municipal solid waste its population generates. Many states in the country lack adequate plans and infrastructure required for efficient and sustainable management of municipal solid waste. For Ibadan, the largest city in Nigeria, the problem is further compounded by its rather large and still increasing population. In this research, Ibadan metropolis is taken as a case study; the rate of solid waste handling in households as regards solid waste management from household collection to final disposal are focused upon. The study found out that 45.6% drop their refuse in the dumpsters as 18.8% burns their refuse, 17.7% of the respondents drops their waste on the median, 12% in the drainage while 6% opts to drop their waste in the streams. On the effectiveness of the Private operators collecting waste from the respondents, the study found out that 7.6% effective, 37.5% of the respondents says the operators waste collection is poor, 7% says it is abysmal while 43.5% said it is not applicable to them because they do not have storage containers in their houses and as a result did not subscribe to their service. Many countries, particularly the developed ones, have employed options in the waste management hierarchy for sustainable management of their municipal solid waste and the blend of options employed is usually highly dependent on local factors. Following the waste management hierarchy, possible options for sustainable municipal solid waste management in Ibadan are discussed. It is concluded that waste reduction, reuse, and recycling are potential management options for the state. Landfilling will remain an important option for final disposal but reliance on this method could be significantly reduced if management options are exploited to the maximum in a sustainable solid waste management structure in Ibadan metropolis. Key Words: Waste handling, Ibadan Metropolis, Landfill, Municipal Solid Waste Word Count: 435. (shrink)

While the Trigonia story is a microcosmic representation of nineteenth-century evolutionary debates, it also serves as a model for assessing the impact of new empirical material upon a controversial issue potentially explained by several internally consistent but contradictory theories; for there can be no fact quite so pristine as a discovery anticipated by no one. The reaction to modern trigonians was, I suspect, completely typical; all parties to the dispute managed to incorporate the new datum into their systems. Evolutionists emphasized (...) the morphological differences between Mesozoic and modern forms and assumed that the disjunct distribution was an artifact of an imperfect record. Agassiz cited the known distribution in support of special creation, but announced that the discovery of a Tertiary species would discredit none of his ideas. Parkinson could not readily encompass the difference without evident improvement in his progressionist synthesis, but invoked almighty wisdom in his ignorance.I do not doublt that all these naturalists proceeded properly in refusing to yield to the anomalies of a single fact which destroyed no deductive sequence in any of their theories. When one considers the stupendous amount of misinformation current in early nineteenth-century scientific circles,49 it is easy to appreciate the salutary aspects of stubbornness in the face of inevitable contradictory citations.De Beer50 has marveled at Darwin's ability, in the 1844 sketch, to work his way through a mire of misinformation: “It is a matter for wonder that with the meagre materials at his disposal he was able to steer a straight course across a largely uncharted ocean of ignorance, with rocks of falsehood right across his path.” Yet Darwin approached these rocks with the idea of natural selection already firmly in mind. Any pure empiricist would have surrendered to confusion long before 1859. (shrink)

The search for a historically conscious individual who is disposed to “radical action” is the main thrust of this paper. This is premised on the following claims: first, that the modern society is a pathological society whose rules, most often but not necessarily, imply control and domination; thus a “refusal” to abide by these rules is the most appropriate alternative available; and, second, that there is still hope for the Enlightenment’s project of emancipation, that is, such “refusal,” which means a (...) political fight for liberation, is still winnable no matter how formidable the forces of domination may be. But this paper can only do so much. I do not offer any universal and prefab solution to the pathological society. What I do instead is argue that the emergence of a historically conscious individual who is disposed to “radical action,” which eventually leads to a “collective radical action,” is still possible today. I also argue that “radical action” presupposes an awareness of the concrete socio-historical situations, thus the importance of “historicity.” This is done through a reconstructive reading of Marcuse’sCritical Theory. In fact, my argument is just an echo on what Marcuse did more than four decades ago. (shrink)

Dispossession describes the condition of those who have lost land, citizenship, property, and a broader belonging to the world. This thought-provoking book seeks to elaborate our understanding of dispossession outside of the conventional logic of possession, a hallmark of capitalism, liberalism, and humanism. Can dispossession simultaneously characterize political responses and opposition to the disenfranchisement associated with unjust dispossession of land, economic and political power, and basic conditions for living? In the context of neoliberal expropriation of labor and livelihood, dispossession opens (...) up a performative condition of being both affected by injustice and prompted to act. From the uprisings in the Middle East and North Africa to the anti-neoliberal gatherings at Puerta del Sol, Syntagma and Zucchotti Park, an alternative political and affective economy of bodies in public is being formed. Bodies on the street are precarious - exposed to police force, they are also standing for, and opposing, their dispossession. These bodies insist upon their collective standing, organize themselves without and against hierarchy, and refuse to become disposable: they demand regard. This book interrogates the agonistic and open-ended corporeality and conviviality of the crowd as it assembles in cities to protest political and economic dispossession through a performative dispossession of the sovereign subject and its propriety. (shrink)

Encounters with illness, impairment, and aging can disrupt one’s experiential relationship with self, body, others, and world. “Healing” takes place when the individual is able to re-integrate his or her world, even if the condition is not medically curable. Drawing on work in the phenomenology of the body, this article examines a series of eight “healing strategies” individuals employ, each representing a different way of orienting toward the painful or impaired body. One may lean into freeing oneself from the body, (...) through strategies of “refusing,” “ignoring,” “objectifying,” or “transcending” its problems. Conversely, one may choose to embrace the body, through strategies such as “accepting,” “listening,” “befriending,” or “witnessing.” It can be beneficial to have a good number of such coping strategies at one’s disposal, enhancing flexible response to chronic challenges. They also are often used in synergistic or complementary combinations. (shrink)

Contra the dominant readings, Hieronymi—refusing to sideline concerns of metaphysics for the impasse of normativity—argues that the core of Strawson's argument in "Freedom and Resentment" rests on an implicit and overlooked metaphysics of morals grounded in social naturalism, focusing her discussion on Strawson's conception of objective attitudes. The objective attitude deals with exemption, rather than excuse. This distinction is critical to Strawson's picture of responsibility: In addition to our personal reactive attitudes are their impersonal or vicarious analogues. There are two (...) such cases: first, cases where we suspend or modify reactive attitudes due to error about the quality of the will. In these cases of excuse, we might include an actor who we learn was innocently ignorant, or whose behavior was an accident, and so we see that he or she really meant no harm. Consequently, we exculpate the injury in question. In cases of excuse, we are mistaken about the quality of the actor's will and, thus, our reactive attitude changes, but the moral demands stay. However, one might view other people as equipped with mental attributes and as people about whom one is disposed not to indulge in with those reactive attitudes of resentment, approbation, and so on; this involves viewing others objectively. We encounter these scenarios in the case of small children, people suffering from dementia, or those with forms of other serious mental illness. This second category involves exemption: Rather than reacting with the corresponding reactive attitudes, we view those actors—who lack the capacities required to fit into the usual system tolerably well—objectively, thereby exempting them from the usual demands of ordinary interpersonal relating. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown (...) that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Freedom of Conscience and Freedom of Religion should be taken to protect two distinct sets of moral considerations. The former protects the ability of the agent to reflect critically upon the moral and political issues that arise in her society generally, and in her professional life more specifically. The latter protects the individual's ability to achieve secure membership in a set of practices and rituals that have as a moral function to inscribe her life in a temporally extended narrative. Once (...) these grounds are distinguished, it becomes more difficult to grant healthcare professionals' claims to religious exemptions on the basis of the latter than it is on the basis of the former. While both sets of considerations generate ‘internal reasons’ for rights to accommodation, the relevant ‘external’ reasons present in the case of claims of moral conscience do not possess analogues in the case of claims of religious conscience. However, the argument applies only to ‘irreducibly religious’ claims, that is to claims that cannot be translated into moral vocabulary. What's more, there may be reasons to grant the claims of religious persons to exemptions that have to do not with the nature of the claims, but with the beneficial effects that the presence of religious persons may have in the context of the healthcare institutions of multi-faith societies. (shrink)

Physicians place significant weight on the distinction between acts and omissions. Most believe that autonomous refusals for procedures, such as blood transfusions and resuscitation, ought to be respected, but they feel no similar obligation to accede to requests for treatment that will, in the physician’s opinion, harm the patient (e.g., assisted death). Thus, there is an asymmetry. In this paper, we challenge the strength of this distinction by arguing that the ordering of values should be the same in both cases. (...) The reason for respecting refusals is that, in such cases, autonomy outweighs well-being. We argue that the same should be true in request cases, which means that requests should not be denied only due to the treatment being too harmful in the physician’s opinion. Our strategy is to consider and reject a number of arguments for the asymmetrical view, including an appeal to the doing–allowing distinction and positive and negative rights. The duty to respect refusals is still greater than the duty to grant requests on our view, but, by arguing that the ordering of values is the same in both cases, we show that there is less of a distinction in healthcare between requests and refusals than many currently believe. (shrink)

Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when no (...) other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)

Nana Sita is best known for being the secretary of the Transvaal Indian Congress and for his leadership in the passive resistance movement for which he was incarcerated three times. This article focusses specifically on three more times he was sentenced to hard labour for refusing to submit to the Group Areas Act and to leave his house at 382 Van Der Hoff Street in Hercules, Pretoria. The main sources for telling the story of Nana Sita’s resistance are interviews with (...) his 93-year-old daughter, a chapter written on him by E.S. Reddy and other unpublished material placed at the author’s disposal by Maniben Sita herself. The focus of the article will be on the religious arguments against the Group Areas Act put forward by Nana Sita himself in his defense during his final trial in 1967.Contribution: Historical thought and source interpretation are not limited to historic texts but include social memory in the endeavour of faith seeking understanding. People of faith in South Africa can only come to grips with reality by engaging with the stories of the past, like that of Nana Sita. (shrink)

John Harris claims that is it ‘palpable nonsense’ to suggest that ‘a child might competently consent to a treatment but not be competent to refuse it.’ In ‘Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal’ Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I will (...) argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris. He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence. (shrink)

A standard view in contemporary philosophy is that belief is involuntary, either as a matter of conceptual necessity or as a contingent fact of human psychology. We present seven experiments on patterns in ordinary folk-psychological judgments about belief. The results provide strong evidence that voluntary belief is conceptually possible and, granted minimal charitable assumptions about folk-psychological competence, provide some evidence that voluntary belief is psychologically possible. We also consider two hypotheses in an attempt to understand why many philosophers have been (...) tempted to view belief as involuntary: that belief is a prototype concept and that belief is a dual character concept. Altogether, our findings contribute to longstanding philosophical debates about the relationship between the will and the intellect, while also advancing scientific understanding of important social judgments. (shrink)

In The Ethics of Care: Personal, Political, and Global, Virginia Held asserts that those in the position to care should exercise power in ways that avoid violence and damage, and that trust and mutuality should be fostered in place of benevolent domination. With reference to Held’s idea of relational care, this essay close reads J. M. Coetzee’s depiction of prosthesis refusal in Slow Man as a nuanced critique of caring actions that are devoid of relationality. At the center of the (...) novel is the character Paul Rayment’s refusal to get fitted with a prosthetic leg after a cycling accident. He reasons that it is dishonest to give others the false impression that he is not without a leg, even if the price he must pay for “honesty” includes giving up the chance to cycle again and the quality of life he had before the accident. But Coetzee is at pains to highlight that Rayment is a confused character, and behind the confused narrative of “honesty” lies a subtext of rebellion. Specifically, this is a rebellion against care without relationality. It provokes the question, in the absence of ill intention toward the care recipient could caring actions be perfectly benign? In this article, I read the refused prosthetic leg as more than a phantasmagorical symbol of the depicted healthcare professionals’ seemingly empty appearance of care; it foregrounds relationality as the critically missing substance that could render caring actions unethical in the novel. (shrink)

Health-care professionals sometimes appeal to their own consciences in order to justify their exemption from professional duties. I argue that we can only understand the content of a conscientious refusal as either a claim about the psychological dispositions of the refusing professional or as a purely normative claim about the status of the action that is the object of the refusal. If we adopt the former view, we would still need to adjudicate these refusals in terms of the acceptability of (...) the moral views that ground them. If the latter, then we effectively abandon the conception of conscientious refusals that is most widely discussed in the philosophical literature. Whichever option we choose, we must conclude that there is no reason to allow for traditionally understood conscientious refusals by health-care professionals. (shrink)

An overview of the philosophical and bioethics literature on conscientious refusals by health care professionals to provide abortion and contraceptive services.

This paper addresses both ‘student engagement’ in contemporary universities, and student ‘disengagement’ – where the latter is often seen as a failure of performance, or absence of will. In a bold move, the paper asks whether students should be engaged in their university education, and whether there is value in forms of disengagement. It finds an original way in which student disengagement can be understood by drawing on the writings of Stanley Cavell – on the philosophical appeal to what we (...) say, our search for criteria, and on ideas of acknowledgement and avoidance in his work on Shakespearian tragedy. It shows what is at stake in our attunement with, and dissent from, criteria, and how such dissent can be educative. The paper considers the film ‘Stella Dallas’, in which Stella’s aversion to, her disengagement from, her culture’s criteria, is not a passive withdrawal, but rather the finding of voice, her education as a grownup. The paper concludes that disengagement, understood as aversion, dissent and refusal of voice, is not to be seen always as a lack of action or of care, but as the opposite: the active voicing of what we will, or will not, consent to in our education. (shrink)

The autonomous right of competent adults to decide what happens to their own body and the corresponding right to consent to or refuse medical treatment are cornerstones of modern health care. For minors the situation is not so clear cut. Since the well-known case of Gillick, mature children under the age of 16 can agree to proposed medical treatment. However, those under the age of 18 do not enjoy any corresponding right to refuse medical treatment. Can this separation (...) of the right to agree to treatment and the right to refuse treatment for those under 18, regardless of capacity, be justified? This paper evaluates the key cases in this area of the law. Changes to the current law are then proposed which aim to make the law more consistent and reasonable. (shrink)

Background Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and policymakers with a synthesis of current normative literature. Methods Nine databases covering health and ethics research were searched, and 121 publications identified for the period Jan 1998 to Mar 2022. For articles, source journals were categorised according to Australian Standard Field of Research (...) codes, and normative content was analysed using a framework analytical approach. Results Most of the articles were published in biomedical journals (34%), bioethics journals (21%), and journals that carry both classifications (20%). Two central questions dominated the literature: (1) Whether vaccine refusal is justifiable (which we labelled ‘refusal arguments’); and (2) Whether strategies for dealing with those who reject vaccines are justifiable (‘response arguments’). Refusal arguments relied on principlism, religious frameworks, the rights and obligations of parents, the rights of children, the medico-legal best interests of the child standard, and the potential to cause harm to others. Response arguments were broadly divided into arguments about policy, arguments about how individual physicians should practice regarding vaccine rejectors, and both legal precedents and ethical arguments for vaccinating children against a parent’s will. Policy arguments considered the normative significance of coercion, non-medical or conscientious objections, and possible reciprocal social efforts to offset vaccine refusal. Individual physician practice arguments covered nudging and coercive practices, patient dismissal, and the ethical and professional obligations of physicians. Most of the legal precedents discussed were from the American setting, with some from the United Kingdom. Conclusions This review provides a comprehensive picture of the scope and substance of normative arguments about vaccine refusal and responses to vaccine refusal. It can serve as a platform for future research to extend the current normative literature, better understand the role of cultural context in normative judgements about vaccination, and more comprehensively translate the nuance of ethical arguments into practice and policy. (shrink)

A large part of the debate around the right to refuse life-prolonging treatment of anorexia nervosa sufferers centers on the issue of competence. Whether or not the anorexic should be allowed to refuse life-saving treatment does not depend solely or primarily on competence. It also depends on whether the anorexic’s suffering is bearable or tractable, and on the degree of involvement of the family in the therapeutic process. Anorexics could be competent to refuse lifesaving treatment (Giordano 2008). (...) However, the anorexic’s refusal of life-saving treatment should not be respected purely because it is a competent decision. In fact, anorexia has two characteristics that weaken the strength of the principle .. (shrink)

James Rachels has argued on Utilitarian grounds that since removing life-sustaining treatment and physician-assisted suicide both aim at the very same end,hastening death to limit suffering, there are no morally significant moral distinctions between them. Others have argued for maintaining this distinction based on various forms of deontological and rights-based ethical theories that maintain that all acts of killing are inherently wrong. I argue that the enduring controversy over physician-assisted suicide might not be caused by such fundamental differences of opinion (...) about moral theory, such as that which exists between Utilitarianism and Deontology, so much as by a commonly held misunderstanding of technology. In particular, the conclusion that there are no relevant ethical distinctions between killing and letting die can only be drawn by a Utilitarian, such as Rachels, by ignoring the recent work of philosophers of technology on the non-neutrality thesis. (shrink)

To speak of patients' choices is to obscure the distinction between request and refusal of treatment. The distinction is particularly crucial for questions of killing or letting die.

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of (...) refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act. (shrink)

Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering (...) whether a version of the reason-giving requirement can be salvaged despite this important difficulty. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring (...) pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality. (shrink)

Imposing artificial feeding on people with anorexia nervosa may be unethical. This seems to be Heather Draper's suggestion in her article, ‘Anorexia Nervosa and Respecting a Refusal of Life‐Prolonging Therapy: A Limited Justification.’ Although this is an important point, I shall show that the arguments supporting this point are flawed. Draper should have made a brave claim: she should have claimed that people with anorexia nervosa, who competently decide not to be artificially fed, should be respected because everybody is entitled (...) to exercise their autonomy, not only ‘in the middle’ of their life, but also at the end of it, or when their own life is at stake, because autonomy also extends to the most difficult moments of our life, and, ultimately, ‘stretches [.*T*.*T*.] far out into the distance’ at the end of it. I explain why Draper should have made the brave claim, and why she has not made it. I conclude that a defence of people's entitlement to competently refuse artificial feeding cannot rest upon the arguments developed by Draper. Whether or not we should respect competent refusal of artificial feeding depends on the normative strength that we are ready to ascribe to the principle of autonomy, to the moral relevance that we ascribe to the circumstances in which a person's autonomy is exercised, and, perhaps, eventually, on our sense of compassion. (shrink)

In their article, Navin, Brummett, and Wasserman (2022) advance the idea that there are qualitatively different types of decision-making capacity (DMC) for treatment refusals. Departing from what t...

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of “terminal anorexia” suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization (...) is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected. (shrink)

This essay analyzes Fred Moten’s “antipolitical” romance with the “fugitive black sociality” that he radically opposes to “politics,” defined as inescapably tied to antiblack modernity. By comparing Moten’s argument to other voices in the black radical tradition, and by triangulating Moten with Hannah Arendt and Sheldon Wolin, this essay opens inherited conceptions of the political to risk and reworking but also complicates figurations of fugitivity and resists the antagonism Moten posits between black fugitivity and democratic politics.

The principal question of this paper is: Why are religious values special in refusal of lifesaving medical treatment? This question is approached through a critical examination of a common kind of refusal of treatment case, one involving a rational adult. The central value cited in defence of honouring such a patient's refusal is autonomy. Once autonomy is isolated from other justificatory factors, however, possible cases can be imagined which cast doubt on the great valuational weight assigned it by strong anti-paternalists. (...) This weight is sufficient, in their estimation, to justify honouring the patient's refusal. There is thus a tension between the strong anti-paternalist's commitment to the sufficiency of autonomy and our intuitions respecting such cases. Attempts can be made to relieve this tension, such as arguing that patients aren't really rational in the circumstances envisaged, or that other values, such as privacy or bodily integrity, if added to autonomy, are sufficient to justify an anti-paternalistic stance. All such attempts fail, however. But what does not fail is the addition of religious freedom, freedom respecting a patient's religious beliefs and values. Why religious freedom reduces the tension is then explained, and the specialness of religious beliefs and values examined. (shrink)

In “Scientific Experiences of a European Scholar in America,” Adorno likens his early trips from New York City to a previously abandoned New Jersey brewery, the site of the Princeton Radio Research Project, to Kafka's story about the “Great Natural Theater of Oklahama [sic]” at the end of the novel Amerika (German title: Der Verschollene). It is easy enough to account for this association. The natural theater story tells of Karl Rossmann's hire and transportation by train to a kind of (...) circus in the American dustbowl. Rossmann is a European immigrant in search of refuge. It is, however, a highly…. (shrink)

In some jurisdictions there is a puzzling asymmetry between consent and refusal, where, for some kinds of treatment, the adolescent patient has the power to permit her own treatment but her refusal does not have the same kind of normative significance as refusal of treatment by a competent adult. In this journal I recently offered a clarification and defence of this asymmetry in terms of a paternalistic justification of the sharing of normative powers between adolescents and other parties. Lawlor (2016) (...) offers a number of objections to this account. Three of his objections can be dealt with quickly. But one of them is much more challenging: the asymmetry of consent and refusal entails a practice of making sham offers (offers that purport to be responsive to the patient's choices, but which, in fact, are not). They do not really offer a choice at all. Genuine offers seem to require a commitment to be symmetrically responsive to whatever decision outcome is reached by the recipient of the offer. When we reflect upon the way that offers can be made in complex social contexts, where different parties have a ‘say’ in what ought to be done, the symmetry of responsiveness need not apply. Offers can be genuine, without being symmetrically responsive. Contrary to the seemingly plausible objection, the asymmetry of consent and refusal does not entail sham offers, or the offer of ‘sham choices’. (shrink)

This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. We argue that sedation is ethically and legally permissible not (...) only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. -/- ----- Dieser Beitrag befasst sich mit Sedierungen von Patienten am Lebensende. In der Regel werden Sedierungen nur als ultima ratio vorgenommen, wenn die Betroffenen dem Tod bereits nahe sind und Leidenssymptome aufweisen, die anders nicht zu lindern sind. Doch wie sind Fälle zu beurteilen, in denen Patienten sich selbstbestimmt für einen Behandlungs- oder einen Flüssigkeits‑/Nahrungsverzicht entscheiden, um zu sterben, und dafür eine „Begleitsedierung“ erbitten oder erwarten – auch wenn dies aus medizinischer Sicht über eine Anwendung von Sedierung als letztes Mittel hinausgeht? Wir argumentieren hier dafür, dass Zusage wie Anwendung einer Begleitsedierung ethisch und rechtlich nicht nur als ultima ratio, sondern grundsätzlich zulässig sind. Eine klare Verpflichtung zu sedieren sehen wir darüber hinaus bei akutem Leiden jeder Art, während in einigen anderen Konstellationen Vorbehalte individueller Ärzte gegenüber vermeintlich verfrühten oder unnötigen Sedierungen respektiert werden müssen. Vor dem Hintergrund des ethischen und juridischen Grundrechts auf ein selbstbestimmtes Sterben plädieren wir allerdings dafür, auch solche Vorbehalte zu überdenken. Die medizinischen Leitlinien sollten entsprechend überarbeitet werden. (shrink)

_Querying Consent_ examines the ways in which the concept of consent is used to map and regulate sexual desire, gender relationships, global positions, technological interfaces, relationships of production and consumption, and literary and artistic interactions. From philosophy to literature, psychoanalysis to the art world, the contributors to _Querying Consent_ address the most uncomfortable questions about consent today. Grounded in theoretical explorations of the entanglement of consent and subjectivity across a range of textual, visual, multi- and digital media, _Querying Consent_ considers (...) the relationships between consent and agency before moving on to trace the concept’s outcomes through a range of investigations of the mutual implication of personhood and self-ownership. (shrink)

Next SectionBackground There is an established link between depression and interest in hastened death in patients who are seriously ill. Concern exists over the extent of depression in patients who actively request euthanasia/physician-assisted suicide (PAS) and those who have their requests granted. Objectives To estimate the prevalence of depression in refused and granted requests for euthanasia/PAS and discuss these findings. Methods A systematic review was performed in MEDLINE and PsycINFO in July 2010, identifying studies reporting rates of depression in requests (...) for and cases of euthanasia/PAS. One author critically appraised the strength of the data using published criteria. Results 21 studies were included covering four countries. There was considerable heterogeneity in methods of assessing depression and selecting patients. In the highest quality studies, in the Netherlands and Oregon, 8–47% of patients requesting euthanasia/PAS had depressive symptoms and 2–17% of completed euthanasia/PAS cases had depressive symptoms. In the Netherlands, depression was significantly higher in refused than granted requests, and there was no significant difference in the rate of depression between euthanasia cases and similar patients who had not made a request for euthanasia. Conclusion It is unclear whether depression increases the probability of making a request for euthanasia/PAS, but in the Netherlands most requests in depressed patients are rejected, leaving a depression rate in cases that is similar to the surrounding population. Less evidence is available elsewhere, but some level of depression has been identified in patients undergoing euthanasia/PAS in all the countries studied. Whether the presence of depression is ever compatible with an ethical decision on euthanasia/PAS is discussed. (shrink)

What role does audience uptake play in determining whether a speaker refuses or consents to sex? Proponents of constitution theories of uptake argue that which speech act someone performs is largely determined by their addressee’s uptake. However, this appears to entail a troubling result: a speaker might be made to perform a speech act of sexual consent against her will. In response, we develop a social constitution theory of uptake. We argue that addressee uptake can constitute a speaker’s utterance of (...) ‘no’ as a speech act of consent under some conditions, but that this does not prevent us from judging that an addressee committed rape. Second, we claim that addressee uptake is not the only form of uptake that matters—the uptake of other members of the discursive community matters too, and can override the addressee’s uptake, constituting the speaker’s utterance as the speech act it was intended to be. (shrink)