As predicted by Duverger’s Law, the UK has two-party competition in each electoral district. However, there can be different patterns of two-party competition in different districts (currently there are five), so that there have usually been more than two effective parties in the Commons. Since 1874 it has always contained parties fighting seats in only one of the non-English parts of the Union. These parties wish to change the Union by strengthening, weakening, or dissolving it. By calculating the Penrose power (...) index for all parties in the House of Commons for all General Elections since 1874, we identify the occasions on which a party that wished to modify the Union was pivotal. We explain various acts (e.g, the Crofters Act 1886; the first three Irish Home Rule Bills; the Parliament Act 1911) and non-acts (e.g. the failure to enact female suffrage before 1914) by reference to the Penrose indices of the non-English parties. The indices also explain how and why policy towards Scotland, Wales and Northern Ireland changed, and did not change, in the 1970s. (shrink)

The new wave of ‘foundation models’—general-purpose generative AI models, for production of text (e.g., ChatGPT) or images (e.g., MidJourney)—represent a dramatic advance in the state of the art for AI. But their use also introduces a range of new risks, which has prompted an ongoing conversation about possible regulatory mechanisms. Here we propose a specific principle that should be incorporated into legislation: that any organization developing a foundation model intended for public use must demonstrate a reliable detection mechanism for the (...) content it generates, as a condition of its public release. The detection mechanism should be made publicly available in a tool that allows users to query, for an arbitrary item of content, whether the item was generated (wholly or partly) by the model. In this paper, we argue that this requirement is technically feasible and would play an important role in reducing certain risks from new AI models in many domains. We also outline a number of options for the tool’s design, and summarize a number of points where further input from policymakers and researchers would be required. (shrink)

Topics in Cognitive Science, Volume 13, Issue 1, Page 187-205, January 2021.

Journal of Philosophy of Education, EarlyView.

A report by the Nuffield Council on Bioethics, contrary to the Declaration of Helsinki, permits most important research initiatives in developing countries.The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not (...) giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world. (shrink)

Industrialisation, urbanisation and economic development have produced unprecedented improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into a new geological epoch, the Anthropocene—one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role—the environmental threats that will shape human health in this century represent a ‘perfect moral storm’ challenging the ethical theories of the last. The US conservationist Aldo (...) Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the ‘land community’, the ecosystems we live within and depend upon; moving us from ‘conqueror’ to ‘plain member and citizen’ of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself—in a way irreducible to the welfare of its members—it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the ‘stability’ of the community requires intergenerational justice. The resulting vision of justice in healthcare—one that takes climate and environmental justice seriously—could offer health workers an ethic fit for the future. (shrink)

Friedrich Wilhelm Joseph Von Schelling (1775-1854) was a colleague of Hegel, Holderlin, Fichte, Goethe, Schlegel, and Schiller. Always a champion of Romanticism, Schelling advocated a philosophy which emphasized intuition over reason, which maintained aesthetics and the creative imagination to be of the highest value. At the same time, Schelling's concerns for the self and the rational make him a major precursor to existentialism and phenomenology. Schelling has exercised a subterranean influence on modern thought. His diverse writings have not given rise (...) to a system or school of thought; rather, individual philosophers have been influenced by the resonance of his ideas and their influence on contemporary ideas and movements. The New Schelling brings together a wide-ranging set of essays which elaborate the connections between Schelling and other thinkers - such as Marx, Nietzsche, Freud, Sartre, Deleuze, and Lacan - and argue for the unexpected modernity of Schelling's work. (shrink)

Cohen (2023), Rahimzadeh and colleagues (2023), and Porsdam Mann and colleagues (2023) have written thorough and well-canvassed pieces about the ethical and conceptual challenges of large language...

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

Many countries are looking back at the pandemic and reflecting on what could have been done better. The UK COVID-19 Inquiry rumbles on 1 and other influential groups such as the British Medical Association have already reviewed the British response to the pandemic and made recommendations about what should happen in the future. 2 The UK is not alone in looking for lessons from the pandemic with a view to preparing for the next one. Countries with a very different COVID-19 (...) experience, such as Australia and New Zealand, have also commenced national inquiries with a view to becoming better prepared for the next pandemic. 3 4 While many of the issues revolve around public health and government responses, there are also profound ethical issues that demand reflection on the conceptual resources we use when responding to new ethical challenges. The _Journal of Medical Ethics_... (shrink)

This is the first book that explains how you actually go about doing good bioethics. John McMillan develops an account of the nature of bioethics; he reveals how a number of methodological spectres have obstructed bioethics; and then he shows how moral reason can be brought to bear upon practical issues via an 'empirical, Socratic' approach.

The lore is that standard information theory provides an analysis of information quantity, but not of information content. I argue this lore is incorrect, and there is an adequate informational semantics latent in standard theory. The roots of this notion of content can be traced to the secret parallel development of an information theory equivalent to Shannon’s by Turing at Bletchley Park, and it has been suggested independently in recent work by Skyrms and Bullinaria and Levy. This paper explicitly articulates (...) the semantics latent in information theory and defends it as an adequate theory of information content, or natural meaning. I argue that this theory suggests a new perspective on the classic misrepresentation worry for correlation-based semantics. (shrink)

A “Zanzibar” is an island of measurement values that internally cohere, but are detached from independent contact with reality. One manifestation of Zanzibars is through “bandwagon effects,” the tendency of contemporaneous measurements to agree. Bandwagons illustrate how the otherwise virtuous drive towards coherence can have negative epistemic consequences. I argue that precision is an epistemic virtue that mitigates against bandwagon effects and illustrate this claim with a case study from the history of measurements of c. This precision-first reasoning motivates the (...) practice of blind data analysis in bleeding edge precision measurement, where outcomes can point the way to new physics. (shrink)

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment have conducted visits and written reports criticising the surgical castration of sex offenders in the Czech Republic and Germany. They claim that surgical castration is degrading treatment and have called for an immediate end to this practice. The Czech and German governments have published rebuttals of these criticisms. The rebuttals cite evidence about clinical effectiveness and point out this is an intervention that must be requested (...) by the sex offender and cannot occur without informed consent. This article considers a number of relevant arguments that are not discussed in these reports but which are central to how we might assess this practice. First, the article discusses the possible ways in which sex offenders could be coerced into castration and whether this is a decisive moral problem. Then, it considers a number of issues relevant to determining whether sex offenders are harmed by physical castration. The article concludes by arguing that sex offenders should not be coerced into castration, be that via threats or offers, but that there is no reason to think that this is occurring in the Czech Republic or Germany. In some cases, castration might be useful for reconfiguring a life that has gone badly awry and where there is no coercion, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment are mistaken about this being degrading treatment. (shrink)

It will be remembered that the introductory chapter to this paper differentiated between human therapeutic cloning and embryonic stem cell research, with the former concept encapsulating the latter one. In turning to examine the current system of regulation found within the United Kingdom this has particular relevance as it is only the practice of therapeutic cloning – the creation and use of an embryo – which engages with the regulative measures adopted.

The ideas of philosopher John Rawls should be appropriated for the information age. A literature review identifies previous contributions in fields such as communication and library and information science. The article postulates the following neo-Rawlsian propositions as co-ordinates for the development of a normative theory of the information society: that political philosophy should be incorporated into information society studies; that social and technological circumstances define the limits of progressive politics; that the right is prior to the good in social morality; (...) that the nation state should remain in sharp focus, despite globalization; that liberty, the first principle of social justice, requires updating to deal with the growth of surveillance and other challenges; that social wellbeing is a function of equal opportunities plus limited inequalities of outcome, in information as well as material resources; and that political stability depends upon an overlapping consensus accommodating both religion and secularism. Although incomplete, such co-ordinates can help to guide policy-makers in the twenty-first century. (shrink)

Bentham’s famous remark was a response to the assertation of natural rights that did not depend on law or some other foundation for their normative force.1 Whatever we make of that claim, it flags a problem for making and evaluating rights-based arguments in medical ethics. He wasn’t trying to say that rights are all meaningless, nor that we can readily do without them. Rather, it’s an objection to a particular way of asserting rights where they are taken to express free (...) standing claims that don’t require further defence or justification. Whether or not the rise of human rights in medical law has enriched the ability of the courts to deal with complex issues in a nuanced way is debatable, but there’s no doubting their prominence and unavoidability.2 For medical ethics, rights analysis requires paying heed to the kind of rights in play when arguing about ethics, as well as what’s distinctive about rights analysis. For many, rights operate as strong moral assertions intended to override other, less weighty, considerations and Ronald Dworkin claimed that we should view rights as a way of expressing particularly important claims that should constrain the state in its actions.3 Rights imply duties and focussing on a right's correlative duty can …. (shrink)

The Journal of Medical Ethics has published a few papers over recent years that explore the ethical implications of ectogenesis.1–4 It is an as yet undeveloped but theoretically possible method by which a fetus can be gestated outside of the womb, and while the prospects of ‘full’ ectogenesis seem some way off, there are techniques that suggest ‘partial’ ectogenesis could be closer. This issue’s Feature Article considers two of the principal arguments that have been developed in favour of ectogenesis being (...) permissible and available.5 Cavaliere observes that the equality and freedom promoting aspects of ectogenesis will only benefit a small number of women, and she argues that it’s the broader political perspective ectogenesis advances that’s valuable. By equality she has in mind the workplace, the burdens of bearing, as well as equality among fertile, infertile, trans and lesbian women. In this context, …. (shrink)

Lord Scarman’s judgment about when someone under the age of 16 years should have the right to make their own medical decisions emphasised the decision-making abilities of the particular child. He said: > …the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.1 That created a duty on (...) healthcare practitioners to assess whether a particular minor has decision-making abilities at a degree that would enable them to understand the decision to a high extent, sufficient hopefully that they would ‘own’ the decision. In December of 2020, the High Court considered whether young people with gender dysphoria and seeking access to puberty blocking therapy, were likely to pass Scarman’s mature minor test and cast doubt on their ability to fully understand that decision, thereby making it less likely that a healthcare practitioner would decide they are a mature minor for that therapy. The High Court said: > It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child …. (shrink)

Contexte : Dans les systèmes de santé universitaires complexes, les projets d’amélioration de la qualité (AQ) destinés à améliorer les soins et l’apprentissage prolifèrent, mais il existe des différences considérables quant à la manière dont ces projets sont supervisés sur le plan éthique, voire même s’ils le sont. À la suite d’un volume élevé de projets soumis à l’un de nos comités d’éthique de la recherche (CER), mais considérés comme n’étant pas de la recherche et donc non éligibles à un (...) examen, des questions ont commencé à se poser au sein de notre organisation sur la manière dont les dimensions éthiques des projets d’AQ pourraient être évaluées et sur les approbations institutionnelles qui pourraient être nécessaires pour garantir la conformité avec les normes émergentes. Méthodes : Une enquête environnementale à méthodes mixtes a conduit à une analyse quantitative rétrospective des projets d’AQ de notre organisation, associée à des consultations qualitatives approfondies avec le personnel, les médecins et les apprenants de l’ensemble de notre réseau de santé. Les exemptions de CER ont été analysées à l’aide de diagrammes d’exécution afin d’évaluer les volumes de base des projets d’AQ, et des analyses thématiques ont été menées sur les notes de terrain de 133 consultations avec les parties prenantes. Résultats : Au cours d’une période de 34 mois, 117 lettres d’exemption du CER ont été émises pour des projets d’AQ. Les consultations ont mis en évidence la nécessité d’un processus d’évaluation éthique clairement défini pour les projets d’AQ, de structures de gouvernance appropriées et de possibilités d’identifier et d’atténuer les risques. Les personnes interrogées ont également évoqué l’impératif éthique de mener des initiatives d’AQ. Le présent document explique comment ces thèmes ont contribué à l’élaboration et à la mise en place de notre comité d’examen de l’amélioration de la qualité (CEAQ). Conclusion : Depuis 2020, plus de 840 projets ont été examinés par notre CEAQ, dans le but d’atténuer les risques pour les patients, le personnel et les équipes de projet d’AQ dans l’ensemble de l’UHN. (shrink)

Deleuze does not mention Schopenhauer very frequently. Certainly Schopenhauer does not appear to be in the counter-canon of life-affirming philosophers that Deleuze so values – indeed, far from it. Nor does he appear to be even a favoured ‘enemy’ as he describes Kant, or as he sometimes appears to view Hegel. In Jones and Roffe’s collection on Deleuze’s historical antecedents, Deleuze’s Philosophical Lineage, Schopenhauer is mentioned exactly once (in the chapter on Hume) and certainly not in the dignified role of (...) one of the twenty leading influences on Deleuze. Nevertheless, I think Schopenhauer’s break from Kant is crucial for understanding not only Deleuze’s account of Nietzsche, but also for a proper grasp of the core Deleuzian distinction between the actual and the virtual, at least in its guise as the distinction between desiring-production and social production in Anti-Oedipus. (shrink)

The threat of malpractice litigation in the United States is encouraging physicians again to assume responsibility for their patients. The fundamental ethical problem, however, is that this approach denies the patient's moral agency. In this essay, responsibility to patients, rather than for them, is discussed as an alternative to the emerging neo-paternalism. Responsibility to avoids the ethical problems of assuming responsibility for moral agents and could reduce the threat of litigation as well.

The Doctrine of Specific Nerve Energies has been and continues to be enormously influential in the physiology, psychology, and philosophy of perception. In simple terms, the Doctrine states that we directly perceive in the first instance the activity of our nerves, rather than properties in the external world. The canonical early statement of the Doctrine by the physiologist Johannes Peter Müller had profound influence on both the phi- losophy and psychology of the 19th and early 20th centuries, especially as reformulated (...) and transmitted by Müller’s student Helmholtz. A common assumption of historical and ongoing debate about the Doctrine has been its supposedly idealist or skeptical implications. What is not commonly recognized is that Müller himself ad- vanced a realist interpretation along lines that would be recognized today as a form of epistemic structural realism. This paper analyzes Müller’s structuralist epistemology in detail and reconstructs his articulation and defense of the Doctrine of Specific Nerve Energies in its canonical form. Part II argues for the continued im- portance of the Doctrine and its structuralist interpretation for contemporary psychology, philosophy of per- ception, and history of philosophy of science. (shrink)

There’s no doubt that medical ethics should be ‘grounded’, in the sense that it aims to make a practical, normative contribution to significant ethical issues in medicine. There are a number of ways in which ethics can do that, two of which feature in this issue of the Journal of Medical Ethics. One way is by responding to significant new policy or legal developments that will have an impact on clinical practice. This issue discusses two legal developments that matter to (...) patients and healthcare professionals: the sanctions applied to Dr Bawa-Garba and the Supreme Court’s ruling on the withdrawal of artificial nutrition and hydration. A second way of grounding ethical analysis in the reality and complexity of ethical issues is by using empirical methods. There are two papers in this issue from Canada that illustrate how the subtleties of complex ethical issues can be teased out via qualitative methods. Medical tourism is an important and rapidly developing phenomenon that raises a set of interesting and tricky ethical issues.1 It has been discussed in the Journal of Medical Ethics before and its implications for end of life, dentistry and other health interventions have been explored.2 3 Reproductive tourism occurs in many countries and the complications it can create for issues such as the citizenship of resulting children have been discussed at some length in the JME.4 5 Reproductive tourism is a good example of an area where it is particularly important for ethical analysis to be grounded in the facts and reality of a situation and an empirical approach to ethics is therefore a good option for this topic. In this issue, Couture et …. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals and ethicists (...) working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

John Rawls begins a Theory of Justice with the observation that "Justice is the first virtue of social institutions, as truth is of systems of thought… Each person possesses an inviolability founded on justice that even the welfare of society as a whole cannot override"1 (p.3). The COVID-19 pandemic has resulted in lock-downs, the restriction of liberties, debate about the right to refuse medical treatment and many other changes to the everyday behaviour of persons. The justice issues it raises are (...) diverse, profound and will demand our attention for some time. How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are discussed in this issue of the Journal of Medical Ethics. The debate about ICU triage and COVID-19 is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how triage decisions should be made.6 They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to COVID-19 triage situations. Their argument seems to highlight instances of what is called the McNamara fallacy. US Secretary of Defense Robert McNamara used enemy body counts as a measure …. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

A clinical ethics fit for the Anthropocene—our current geological era in which human activity is the primary determinant of environmental change—needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold’s essay ‘The Land Ethic’ is probably the most widely-cited source in environmental philosophy; but Leopold’s work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that “A thing is right when it tends to preserve the integrity, stability, and beauty of (...) the biotic community. It is wrong when it tends otherwise.” I argue that a Land Ethic helps to re-frame problems in clinical ethics that more common philosophical approaches struggle to handle, and that it can be incorporated into clinical ethics without succumbing to “environmental fascism”. I motivate viewing problems in clinical ethics from the perspective of the ‘integrity of the biotic community’, then illustrate how this perspective can offer guidance where more commonly-invoked theories—such as consequentialism and Kantian-inspired approaches—struggle, using antimicrobial resistance in nosocomial infection as a case study. The Land Ethic equips us to understand human values as arising within and inseparable from a social-ecological context, and by treating communities as valuable in themselves rather than just through the aggregate welfare of their individual participants, we can avoid problems with the ‘repugnant conclusion’ and utility monster that plague utilitarian accounts. (shrink)

The question of whether any of us can truly be held responsible for what we do is an issue that occupied the ancient Greeks and continues to entertain our leading thinkers. Whether we can be held responsible for our health, or lack thereof, has additional layers of complexity because of the way in which what we do over time impacts our health. Those of us who have ever self-deceptively wondered about the apparent shrinking of our belt or at the fact (...) that the stairs seem to have multiplied are familiar with the idea that our health can change gradually over time as a result of successive choices that we have made. While there are one-off behaviours that can have an impact on health, for example, a single exposure to a very high level of radiation, in general, ill health develops over time, within an environment and complex set of interactions with other people. The implications of that complexity are central to this issue’s Feature Article by Brown and Savulescu.1 They note that there is debate over whether responsibility should play a role in the allocation of healthcare, and, rather than taking a view on that issue, make a number of suggestions about how the concept of responsibility used in healthcare can be enriched by attending to the complex relationship between behaviour and health. …. (shrink)

Socially responsible publishers, such as the BMJ Publishing Group, have demonstrated a commitment to health equity and working towards rectifying the structural racism that exists both in healthcare and in medical publishing.1 The commitment of academic publishers to collecting information relevant to promoting equity and diversity is important and commendable where it leads to that result.2 However, collecting sensitive demographic data is not a morally neutral activity. Rather, it carries with it both known and potential risks. Among these are issues (...) around privacy or data misuse, as well as more basic concerns about how, when or why people should be categorised in certain ways and/or prompted to conceive of themselves or their identities in certain terms.3 If such data are to be collected, therefore, their effectiveness in achieving the stated ends must have a sufficiently compelling evidence base so as to justify the various risks involved. And where possible, these risks must also be identified and minimised. As Varcoe et al 4 argue, > While most leaders and healthcare workers and some patients [in their study] envisioned potential benefits associated with having ethnicity data, these benefits were seen as largely contingent upon action being taken to [actually] ameliorate inequities. Overwhelmingly, however, leaders from ethno-cultural communities and patients of diverse identities anticipated potential harm arising both from having ethnicity data and the process of collection. The analysis illustrates that in today’s sociopolitical context, collecting ethnicity data in clinical contexts may engender considerable harm, particularly for racialized, vulnerable patients. (p1569) Varcoe et al refer to ‘ethnicity’ data, which as they note is an ambiguous concept, potentially encompassing such diverse notions as ancestry, language, religion or culture. It is also a term that is in some contexts—for example, the USA—often used interchangeably with a different, more highly charged term: ‘race’. Data …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 91-92 [Access article in PDF] Jaspers and Defining Phenomenology John McMillan IT IS POSSIBLE TO DISTINGUISH a number of positions that you might take on the importance of phenomenology for the study of the mind. The strongest position is to think that phenomenology is sufficient for understanding the mind. This is a position that would be very hard to defend and it (...) is unlikely that Gupta and Kay want to endorse such a view. It is clear that Jaspers did not believe this; although he thought that first-person experience was undervalued, his project was an attempt to make sense of different kinds of explanation, all of which contribute to our understanding of the mind.A second position is to deny that phenomenology gives us anything that is of use in understanding the mind and psychopathology. Philosophers have developed a number of such positions, from the eliminativism of Churchland (1981) to the heterophenomenology of Daniel Dennett (1989, 1991).A third position is to hold that phenomenology is one of the methods that are useful for understanding the mind and psychopathology. Along with neuroscience and other more behavioral approaches to behavior, phenomenology is an important component of an adequate understanding of the mind. This position appears to be that endorsed by Jaspers, Gupta, Kay, and the authors they discuss. It is also the position that Grant Gillett and I defend in Consciousness and Intentionality (2001). Gupta and Kay's paper presents an argument about where the boundaries between phenomenology and other approaches to the mind and psychopathology ought to be drawn. Gupta and Kay, following Jaspers, think that the boundaries of the phenomenological ought to be drawn around those approaches that employ empathy and the presuppositionless stance and do not include objective phenomena.Given that the paper is primarily about what phenomenology means and that it endorses the way that Jaspers used the term, it is fairly important that we have a definition from Jaspers. Gupta and Kay give a description of some of Jaspers's methods for getting at subjective phenomena, but do not give an account of what Jaspers thinks the aim of phenomenology is. In other words, one way to classify something as phenomenological is its methods and another is by what the point of the exercise is. In General Psychopathology, Jaspers (1997) says that phenomenology is an empirical method for investigating "individual psychic experience" (p. 55). We can think of this as a claim about the objective of phenomenology and then consider the merits of different phenomenological methodologies in terms of their success in achieving this objective. This opens up the possibility that a theory may be genuinely phenomenological because it has a plausible method for getting at psychic lived experience but does not use all of the methods advocated by Jaspers.Gupta and Kay are correct that Jaspers does stress the importance of the presuppositionless [End Page 91] stance, the importance of empathy and the importance of not simply relying on objective phenomena. However, it is not obvious why an approach to understanding the mind or psycho- pathology must satisfy these conditions to be phenomenological. Imagine the following kind of situation: when I am observed to hit my big toe against a brick and give a yelp, it is possible to infer something about my psychic lived experience. There is not much is room for doubt about my first-person experience and, although you might ask me questions about my pain, they are unlikely to add much to what you can simply read from my behavior. This example may appear a little crude because the first-person experience in this case is not especially complex and is not that interesting as a entrance to the inner workings of an individual's mental life. It is not hard to come up with other examples where we can read the first-person experience from behavior in a fairly accurate and informative way. A father gazing at his young child while she is sleeping in his arms may be having a number of thoughts that we would not know about... (shrink)

The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience—an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response. The putative mechanism of action of psychedelics as meaning enhancers raises normative (...) ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick’s Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick’s standards. (shrink)

This paper explores concepts of multiple and nested identities and how these relate to citizenship and rights, and the implications of identities and rights for active citizenship education. Various theoretical conceptions of identity are analysed, and in particular ideas concerning multiple identities that are used contingently, and about identities that do not necessarily include feeling a strong affinity with others in the group. The argument then moves to the relationship between identity and citizenship, and particularly citizenship and rights. Citizenship is (...) treated non-legalistically, as one of the locations of belonging. The paper draws on three successive categorisations of citizenship rights: by T.H. Marshall in the 1950s, Karel Vasak in the late 1970s and John Urry in the 1990s, and is illustrated in part by the development of European citizenship in parallel to national identity. This is then linked to how contemporary citizenship education might use the exploration of contested rights as a way of developing practical enactive skills of citizenship. (shrink)

If knowledge is socially constructed, then students' discursive attachments should be eminently malleable. Students' radical openness to change, however, is not the defining characteristic of a university classroom. Instead, learners appear to desire coherence of knowledge over revelations of contingency, and pedagogical acts that disrupt existing formations are as likely to produce reactionary responses as revolutionary reorganizations of the self. In this article Chris McMillan argues that neither the constructivist nor the social constructionist readings of critical pedagogy are able (...) to account for this fixity of knowledge. In response he contends that Slavoj Žižek's Lacanian-inspired theory of subjectivity and of the Real can effectively respond to the limitations of these approaches by insisting upon the pedagogical value of the lack within subjectivity. A Žižekian conception of subjectivity is able to respond to this lacuna by positing the negativity of the subject as the agent of transformation and to produce a “pedagogy of the impossible” that evokes the moments of impossibility within discourse embodied by the subject qua the Lacanian Real. (shrink)

Current evidence suggests that the efficacy of psychedelic therapy depends, in part, on the character of psychedelic experiences themselves. One pronounced aspect of psychedelic experiences is alterations to the experience of time, including reports of timelessness or transcending time. However, how we should interpret such reports remains unclear, and this lack of clarity has philosophical and clinical implications. For instance, “true” timelessness may be considered antithetical to having any experience at all, and descriptions of experiences involving “timelessness” are known to (...) be diverse and of varying clinical significance. In this article, we utilize a phenomenological approach to the study of temporality to highlight ambiguities in current constructs used to assess psychedelic experiences. In doing so, we advance some preliminary phenomenological accounts of psychedelic therapy’s mechanisms of action, such as psychedelic temporality acting as a kind of counterpoint for depressive temporality. We conclude by outlining how a dedicated phenomenological research program can provide a nuanced map of psychedelic temporality, guiding future research in a manner that addresses both philosophical and clinical ambiguities. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

The Social Value Judgments consultation document reveals NICE’s failure to understand its role in healthcare prioritisationThe National Institute for Health and Clinical Excellence has published a draft guideline, Social Value Judgments: Guidelines for the Institute and its Advisory Bodies , which outlines the ethical framework that will guide its decision making in the future.1 NICE guidance has a profound effect upon the delivery of health care within the National Health Service so it is crucial that an overarching guideline such as (...) this is suited to the task that it needs to perform. In this paper we argue that NICE has misunderstood the way in which its advice fits into prioritisation decisions. This misunderstanding is amplified by its views about the ethical principles that should apply to prioritisation and, in particular, its failure to appreciate the role of fair processes in prioritisation.The national and international standing of NICE means that the definitive version of Social Value Judgments: Guidelines for the Institute and its Advisory Bodies is likely to have influence beyond the institute itself. There is much to welcome about the document, not least the acknowledgement that there are important ethical dimensions to NICE’s decision making. Indeed, the significance of the document lies in the fact that NICE is attempting to create an explicit ethical framework for funding decisions.There is, however, much that is of concern. Although John Harris has made some important points about the NICE position on age and sex,2 there are other important problems that need to be discussed. First, there appears to be confusion over the nature of the funding decisions taken by NICE and, as a result, the role of its guideline. It is of vital importance that professionals and public alike understand the precise nature of …. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)