In Valuing Health, Dan Hausman argues that well-being is not measurable, at least not in the way that science and policy would require. His argument depends on a demanding conception of well-being and on a pessimistic verdict upon the existing measures of subjective well-being. Neither of these reasons, I argue, warrant as much skepticism as Hausman professes.

BackgroundAn increasing number of studies utilize intracranial electrophysiology in human subjects to advance basic neuroscience knowledge. However, the use of neurosurgical patients as human research subjects raises important ethical considerations, particularly regarding informed consent and undue influence, as well as subjects’ motivations for participation. Yet a thorough empirical examination of these issues in a participant population has been lacking. The present study therefore aimed to empirically investigate ethical concerns regarding informed consent and voluntariness in Parkinson’s disease patients undergoing deep brain (...) stimulator (DBS) placement who participated in an intraoperative neuroscience study.MethodsTwo semi-structured 30-minute interviews were conducted preoperatively and postoperatively via telephone. Interviews assessed participants’ motivations for participation in the parent intraoperative study, recall of information presented during the informed consent process, and participants’ postoperative reflections on the research study.ResultsTwenty-two participants (mean age = 60.9) completed preoperative interviews at a mean of 7.8 days following informed consent and a mean of 5.2 days prior to DBS surgery. Twenty participants completed postoperative interviews at a mean of 5 weeks following surgery. All participants cited altruism or advancing medical science as “very important” or “important” in their decision to participate in the study. Only 22.7% (n = 5) correctly recalled one of the two risks of the study. Correct recall of other aspects of the informed consent was poor (36.4% for study purpose; 50.0% for study protocol; 36.4% for study benefits). All correctly understood that the study would not confer a direct therapeutic benefit to them.ConclusionEven though research coordinators were properly trained and the informed consent was administered according to protocol, participants demonstrated poor retention of study information. While intraoperative studies that aim to advance neuroscience knowledge represent a unique opportunity to gain fundamental scientific knowledge, improved standards for the informed consent process can help facilitate their ethical implementation. (shrink)

The paper develops a philosophical account of emotions experienced and communicated on the internet, and, in particular, in the context of social media use. A growing body of research across disciplines has investigated the distinctive features of emotions in the digital age, and a key question in this regard concerns whether online emotions are the same kind of phenomena as those undergone offline. In this paper, I contribute to addressing this question by suggesting that the structure and characteristic features of (...) internet-mediated emotions can be accounted for within the perspective of Peter Goldie’s narrative theory of emotion. To do so, I first offer a reconstruction of Goldie’s conception of emotions as complex, dynamic, episodic and structured phenomena. I then move to show how the experience of emotions on social media like Facebook displays the characteristics which are at the core of Goldie’s account, proceeding to suggest that this enables us to better understand some of the features of emotions undergone on the internet. More specifically, I argue that the intensity, persistence and contagiousness of some online emotions can be better understood if we adopt Goldie’s framework. (shrink)

This paper examines Cécile Fabre’s cosmopolitan reductionist approach to war. It makes three main points. First, I show that Fabre must ‘thin down’ justice’s content in order to justify the cosmopolitan claim that the same rights and duties bind people everywhere. Second, I investigate Fabre’s account of the values at stake in national sovereignty and territorial integrity. Can cosmopolitanism explain why it is permissible to fight in defense of one’s political community? I doubt it. I argue that Fabre’s reductionist approach (...) cannot justify national self-defense in many cases. Finally, I explore the role that authoritative institutions play in specifying the rights and duties we have under cosmopolitan justice. I believe Fabre takes an overly simple view of the relationship between rights, duties, and authoritative institutions. A more complex account may leave less space for private war on the part of individuals than she does. (shrink)

The burgeoning science of well-being makes no secret of being value laden: improvement of well-being is its explicit goal. But in order to achieve this goal its concepts and claims need to be value adequate; that is, they need, among other things, to adequately capture well-being. In this article I consider two ways of securing this adequacy—first, by relying on philosophical theory of prudential value and, second, by the psychometric approach. I argue that neither is fully adequate and explore an (...) alternative. This alternative requires thorough changes in the way philosophers theorize about well-being. (shrink)

The Brentanian idea that every state of consciousness involves a consciousness or awareness of itself (Brentano 1874), which has been a central tenet of the phenomenological school, is a current topic in contemporary philosophical debates about consciousness and subjectivity, both in the continental and the analytic tradition. Typically, the self-awareness that accompanies every state of consciousness is char­acterized as pre-reflective. Most theorists of pre-reflective self-awareness seem to converge on a negative characterization: pre-reflective self-awareness is not a kind of reflective awareness. (...) Whereas reflective self-awareness is attentive and descriptive, pre-reflective self-awareness is non-attentive and non-descriptive.This paper aims to show that the reflective/pre-reflective dichotomy overlooks a finer-grained distinction. The first part is devoted to arguing that the typical use of the adjective ‘pre-reflective’ conflates two properties (non-attentiveness and non-descriptiveness), which are in fact separable. Accordingly, not only can there be non-descriptive and non-attentive self-consciousness (i.e. pre-reflective self-awareness), but also non-descriptive but attentive self-consciousness. I call the latter primitive introspection. The second part of the paper is devoted to arguing that, whereas both pre-reflective self-awareness and primitive introspection enable the subject to apprehend the phenomenology of their experience, the kind of apprehension each allows for is different. By analyzing the notion of apprehension in terms of information acquisition and personal-level availability of information, it is proposed that, although both pre-reflective self-awareness and primitive introspection allow for acquisition of the maximal amount of information about the experience, only primitive introspection makes all such information personal-level available. (shrink)

In this paper, I explore some of the ambivalent potential of Graham Harman’s post-humanist object-oriented ontology for thinking about human beings as objects, and for how to be with human beings as objects. In particular, I consider the work of feminist phenomenologists attuned to objectification as both having a tradition of object-orientation and as already contesting the idealism that Harman opposes. Objectified human beings inhabit a site of ontological duality, often knowing themselves as objects for others, who thus experience the (...) ontological and epistemological disruptions that can emerge from the human activity of objectification. Absence of these analyses in OOO constitutes an important oversight, since the analyses draw attention not only to object relations among human beings, but thereby also point to ways of understanding human concept relations with non-human objects. (shrink)

Background Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities. Objectives To identify the subjective concepts of the health of (...) non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals’ responsibilities and rights concerning health. Research design A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring. Participants and research context Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany. Ethical considerations Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16). Findings Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it. Discussion Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals’ subjective concepts of health. Conclusion Individuals’ concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively. (shrink)

There are (at least) two ways to think of the differences in basic concepts and typologies that one can find in the different scientific practices that constitute a research tradition. One is the fundamentalist view: the fewer the better. The other is a non-fundamentalist view of science whereby the integration of different concepts into the right abstraction grounds an explanation that is not grounded as the sum of the explanations supported by the parts. Integrative concepts are often associated with idealizations (...) that can successfully set the stage for different phenomena to be compared or for explanations of different phenomena to be considered as jointly increasing our understanding of reality beyond that which each explanation provides separately. In this paper, our aim is to argue for the importance of the notions of an ?affordance? and ?scaffolding? as integrative concepts in the cognitive sciences. The integrational role of the concept of affordance is closely related with the capacity of affordances to generate the scaffoldings leading to the integration. The capacities of affordances that turn them into (stable) scaffoldings explain why such notions are often used interchangeably (as we shall see). On this basis, we aim to show that the concepts of affordance and scaffolding provide the sort of epistemic perspective that can overcome common complaints about the limits and unity of the cognitive sciences once claims about extended cognition are taken seriously. (shrink)

This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a (...) specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility. (shrink)

In this paper I critically investigate an unorthodox attempt to metaphysically explain in virtue of what there are states of affairs. This is a suggestion according to which states of affairs exist thanks to, rather than, as is the common view, in spite of, the infinite regress their metaphysical explanation seems to engender. I argue that, no matter in which form it is defended, or in which theoretical framework it is set, this suggestion cannot provide us with the explanation we (...) crave. (shrink)

Americans increasingly cite moral values as a factor in how they vote, but when we define morality simply in terms of a voter's position on gay marriage and abortion, we lose sight of the ethical decisions that guide our everyday lives. In our encounters with friends, family members, nature, and nonhuman creatures, we practice a nonutilitarian morality that makes sacrifice a rational and reasonable choice. Recognizing these everyday ethics, Anna L. Peterson argues, helps us move past the seemingly irreconcilable (...) conflicts of culture and refocus on issues that affect real social change. Peterson begins by divining a "second language" for personal and political values, a vocabulary derived from the loving and mutually beneficial relationships of daily life. Even if our interactions with others are fleeting and fragmentary, they provide a viable alternative to the contractual and atomistic attitudes of mainstream culture. Everyday ethics point toward a more just, humane, and sustainable society, and to acknowledge moments of grace in our daily encounters is to realize a different way of relating to people and nonhuman nature—an alternative ethic to cynicism and rank consumerism. In redefining the parameters of morality, Peterson enables us to make fundamental problems such as the distribution of wealth, the use of public land and natural resources, labor and employment policy, and the character of political institutions the preferred focus of debate and action. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion that women have been inadequately (...) represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

Der interdisziplinar angelegte Sammelband diskutiert die materiellen und historischen Verfasst- und Bedingtheiten von Modellen und Modellvorstellungen. Die hier versammelten historischen Miniaturen beleuchten nicht nur das Verhaltnis von Modell und Risiko, sondern werfen zugleich Schlaglichter auf den in wissenshistorischer Perspektive vergleichsweise vernachlassigten Gebrauch von Modellen in Kulturen der Vormoderne. Modelle, so die den Band pragende Kernthese, dienen der Bewaltigung epistemologischer Risiken. Sie machen das Unwagbare wagbar, gewahren Zugriff auf das Potenzielle und Kontingente, vermitteln zwischen der Faktizitat des Gegebenen und der sie (...) erfassenden Theoriebildung. Eben weil Modelle erst im dynamischen Zusammenspiel mit ihrer epistemischen Umgebung Bedeutung erhalten, stellt sich die Frage, inwiefern historische Modellbildung und -anwendung durch differierende asthetische, kulturelle oder politische Momente gepragt sind, die ihre jeweilige Transfer- und Vermittlungsfunktion mitbestimmen. In den Beitragen dieses Bandes werden anhand von Fallstudien ganz unterschiedliche epistemologische Konfigurationen im Spannungsfeld von Modell + Risiko untersucht. (shrink)

Fast and intensive development of natural science (especially quantitative physics) and computer science make us think about the philosophy of nature. In this article we would like to show that a new subject of the philosophy of nature is the virtual world. The first step was to analyse some words like the following: virtuality, potentiality, reality. In this context we propose a definition of the virtual world as a real view created or reconstructed by intellectual or technical simulation. The next (...) step was analyzed the objects and levels of virtual world. We emphasise the technical-communicational level and computer technology associated with it (the Internet, chat, blog, virtual shops); the second level is the biological level which is connected with the objects produced by the brain (thinking, imagination, research projects); the third level is the theoretical level with the virtual elements. On the ground of this classification we have shown that the virtual world and the objects are not homogeneous. The last part of this paper presents the beginning of the virtual world (creation or reconstruction in the intellectual and technical simulation). Our analyses are connected with Plato and his idealism, Aristotle and his realism, and Popper’s/Penrose’s proposition. (shrink)

Fazekas and Overgaard () present a novel, multidimensional model that explains different ways in which conscious representations can be degraded. Moreover, the authors discuss possible mechanisms that underlie different kinds of degradation, primarily those related to attentional processing. In this letter, we argue that the proposed mechanisms are not sufficient. We propose that attentional mechanisms work differently at various processing stages; and factors that are independent of attentional ones, such as expectation, previous experience, and context, should be accounted for if (...) we are aiming to construct a comprehensive model of conscious visual perception. (shrink)

Research in phenomenology and philosophy of psychiatry has suggested that psychopathological disturbances of experience often involve an alteration of one's ‘sense of possibility’, dependent upon the presence of specific ‘existential feelings’ (Ratcliffe 2012). In this paper I provide an extended account of how the engagement with certain narratives can lead to a transformation of one's sense of possibility by eliciting affective experiences that are not consonant with the person's existential feelings. More precisely, I claim that, even when the experience of (...) some types of emotion is generally precluded by a restricted sense of possibility, such emotions may be aroused by particular self-narratives, and I explore how this dynamic can give rise to enduring and wide-ranging affective changes. (shrink)

The purpose of our article is to present a qualitative empirical study from the ethical viewpoint. It aims at the theoretical conceptualization concerning the managers' decision-making of personnel dismissals in downsizing organizations. First we present and seek to motivate our research task. The importance of real business ethical issues as a starting point of business ethics research is emphasized. Second the main normative ethical theories and ethical decision-making models are presented. These form the loose framework for describing and interpreting research (...) interviews. After this the empirical findings are set forth. This part suggests that the managers explain the dismissals from different decision-making roles emphasizing different ethical orientation. The roles are called a rational and an independent manager, a marionette and an emotional individual. Our study suggests that the role of empathy in morality reveals an interesting and a necessary research topic for business ethics research. (shrink)

Those giving birth within modern maternity systems are recognised as facing a number of barriers to person-centred care. In this paper, I argue that in order to best facilitate the conditions for positive change, work needs to be done to provide a more granular articulation of the specific barriers. I then offer a nuanced and contextually aware articulation of one key component of the overall failure to ensure person-centred care: medical authority and the expectation of conformity. Articulating these barriers with (...) increased specificity is valuable, as it creates a stronger foundation from which to challenge existing problems which serve to constrain the autonomy of birthing individuals. The analysis offered in this paper also underscores the need for change at an institutional, rather than individual, level. (shrink)

ABSTRACT This paper investigates from a phenomenological perspective the origins of self-illness ambiguity. Drawing on phenomenological theories of affectivity and selfhood, I argue that, as a phenomenon which concerns primarily the ‘personal self’, self-illness ambiguity is dependent on distinct alterations of affective background orientations. I start by illustrating how personhood is anchored in the experience of a specific set of non-intentional affects – i.e. moods or existential feelings – alterations of which are often present in mental ill-health. Also through the (...) exploration of the phenomenology of acute and long-term anxiety, I suggest that self-illness ambiguity originates in the presence of moods or existential feelings that are in tension with the ones that structure the person’s experience prior to the onset of the illness or when its symptoms are not experienced. More specifically, I claim that due to their ability to ‘block’ or ‘suspend’ some of the person’s affective and cognitive responses, such affective orientations may unsettle one’s self-defining evaluative perspective, leading to uncertainty and doubting about one’s personal self. (shrink)

The paper analyzes the two types of self-deception, usually labeled straight and twisted self-deception. In straight cases the self-deceptive belief coincides with the subject’s desire. In twisted cases, by contrast, the self-deceptive belief opposes the subject’s desire as in the example of Othello’s conviction of Desdemona’s infidelity. Are both these contrasting types of deceptive beliefs cases of SD? The argument of this paper shall answer this question in the positive, yet in different way from the unitary explanation of straight and (...) twisted SD proposed by Alfred Mele. The causal account of SD claims to provide a unitary and simple explanation for both straight and twisted SD, and considers such a unitary explanation as a specific virtue of the causal view. Within the same causal model, the difference between straight and twisted self-deception is explained by a difference in the motivational state that in twisted cases is dominated by emotions. The paper will critically examine this claim, and advance an alternative explanation based on a different view of self-deception where emotions play a role alongside wishes both in straight and in twisted case. (shrink)