As the millennium approaches, the United States is on the verge of major health care reform. While swallowing scarce national resources, our health care system produces unenviable results and major inconsistencies. In 1992, $838.5 billion were spent on health care, biting more than 14 percent out of our gross national product. From 35 to 37 million Americans, or approximately 14 percent of the populationn, are uninsured. Our health care system is inherently inconsistent: We have the highest birthweight-specific survival rate of (...) any country in the world, yet we rank 19th worldwide in infant mortality rate, i.e., state-of-the-art medical technology allows us to save a 500-gram infant, yet the mother of that infant may not have had access to basic, minimal prenatal care. (shrink)

The production of genetic knowledge -- Scientific and economic strength of genetic reductionism -- Policy implications : discourses of genetic enlightenment as new disciplinary devices -- Genetic conceptualizations of normality and the idea of genetic justice -- Beyond genetic universality and authenticity, the lure of the genetic underclass -- Previews of the future as background -- Economic and actuarial perspective on genetics and insurance -- Practical and normative arguments against genetic exceptionalist legislation -- The changing social role of private insurance (...) : risk as a new representational regime. (shrink)

IntroductionBorderline personality disorder patients are often subjected to inpatient compulsory care due to suicidal behaviour. However, inpatient care is usually advised against as it can have detrimental effects, including increased suicidality.AimTo investigate what motives psychiatrists have for treating borderline personality disorder patients under compulsory care.Materials and MethodsA questionnaire survey was distributed to all psychiatrists and registrars in psychiatry working at mental health emergency units or inpatient wards in Sweden. The questionnaire contained questions with fixed response alternatives, with room for comments, (...) about the respondents’ motives for practising compulsory care of borderline personality disorder patients. The responses were analysed quantitatively with descriptive statistics, and comments were analysed with qualitative descriptive content analysis.ResultsThe psychiatrists’ views were divided on when it was justified to treat borderline personality disorder patients under compulsory care, as were their views on borderline personality disorder patients’ decision competence. When there was an assessed risk of harm, 53% were positive to compulsory care of decision-competent borderline personality disorder patients and another 31% because they considered the patients to be decision incompetent in such situations. Adding the risk of harm caused many respondents to alter their assessment of the patient from decision competent to decision incompetent.ConclusionThe large variations in doctors’ opinions indicate that the care of borderline personality disorder patients is arbitrary. Further, the assessed risk of harm increases the use of compulsory care, even though such care is advised against in clinical guidelines, has questionable legal support, and could lead to an increased suicide risk over time. (shrink)

This paper aims to clarify the status of capability in Sen’s idea of justice. Sen’s name is so widely associated with the concept of capability that commentators often assume that his contribution to the study of justice amounts to a capability theory, albeit underdeveloped. We argue that such a reading is misleading. Taking Sen’s reticence about operationalization seriously, we show that his contribution is inconsistent with a capability theory. Instead, we defend the idea that the capability approach plays a heuristic (...) role: capability is a step in his argument against alternative materials, but is not meant as a definitive end. Sen defends a critical perspective primarily to encourage public reasoning and respect for agency as regards the definition of what should count in the evaluation of social states. (shrink)

Ethnopedology is the study of local knowledge of soil and land management in an ecological perspective. It is an emerging hybrid discipline that is a component of ethnoecology and stands to offer much for land-based studies. This paper reviews the field of ethnopedology in Latin America and compares some of the many case studies from that region. Various literature sources are considered, including the ethnographical, ethnohistorical, archaeological, geographical, agronomic, ethnoecological, and development studies. Our review invokes the theory of ethnoecology that (...) focuses on the linkages between kosmos, corpus, and praxis of local land-users. The main topics covered are the ethnohistorical and archaeological evidence of ethnopedology, local soil and land classification, local land management systems, local perceptions and beliefs of soil and land resources, and local soil fertility management. After analysing past and present research trends, recommendations are given on how ethnopedological studies can contribute to enhance sustainable land use and management in Latin America. (shrink)

Une enigme litteraire - celle, posee par les textes prefaciels de Vitruve dans leur signification et leur date - qui se resout par une histoire de mots, l'histoire des mots latins du livre, dont la langue francaise et nombre de langues ...

Despite being fundamental to democracy, the normative concept of the people, i.e. the demos, is highly unclear. This article clarifies the legitimacy of the demos’ boundaries by structuring the debate into three strains of justification: first, normative membership principles; second, its democratic functionality and the necessity of cohesion for this essential function; and third, a procedural understanding of the demos. It will be shown that normative principles can only justify its expansion towards the ideal of an unbounded demos. On the (...) other hand, the democratic function of the demos can be understood as a criterion for its restriction. This, however, is only possible on the basis of an existing polity and not for the initial constitution of the demos. Consequently, a legitimate demos has to take both inclusionary and exclusionary tendencies into account. These tendencies need to be weighed against each other in the democratic process, which leads to a fundamentally procedural understanding of the legitimacy of the demos. (shrink)

International institutions have become increasingly important not only in the relations between states, but also for individuals. When are these institutions legitimate? The legitimacy standards fo...

This study reconsiders the purported benefits of community found in Community Supported Agriculture (CSA). Using an online survey of members who belong to CSAs in New York, between November and December 2010, we assess members’ reasons for joining a CSA, and their perceptions of community within their CSA and beyond. A total of 565 CSA members responded to the survey. Results show an overwhelming majority of members joined their CSA for fresh, local, organic produce, while few respondents joined their CSA (...) to build community, meet like-minded individuals or share financial risk with farmers. Members reported that they do not derive a strong sense of community from either their CSA or other forms of community, yet they volunteered at their CSA and appear to be engaged in activities within their communities, though the frequency of the latter is unknown. These data suggest New York CSAs are oriented toward the instrumental and functional models, which emphasize the economic aspects of farming rather than collaborative models, which foster community (Feagan and Henderson 2009). (shrink)

Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses contracts as (...) a defence of the authentic self, and (5) Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding BPD patients. Hence, Ulysses contracts including compulsory care should not be used for this group of patients. (shrink)

Introduction Compulsory care is controversial, since respect for the patient’s autonomy is a standard requirement in health care. Many psychiatrists have experienced that patients with borderline personality syndrome sometimes demand compulsory care for themselves in order not to exert self-harm—like Ulysses contracts. The aim of this study was to examine the possible existence and extent of borderline personality syndrome-patient demands for Ulysses contracts regarding compulsory care in acute psychiatry, and how external influences and demands could affect the caregivers’ decisions about (...) compulsory care. Method An anonymous questionnaire, with three questions with fixed answers, was distributed to 42 licensed medical doctors on call at the psychiatric emergency unit in the city of Stockholm. Thirty-three questionnaires were answered, giving a response rate of 79%. Results Ninety-four percent of the respondents recognized the phenomenon of borderline personality syndrome patients requesting compulsory care, 21% stated that this request had affected their clinical decision, and 55% had used compulsory care for other reasons than the patient’s best interest. Discussion The results indicate that compulsory care is sometimes given in the form of Ulysses contracts for borderline personality syndrome patients. Also, compulsory care is sometimes used for other reasons than the borderline personality syndrome patient’s best interest. Psychological mechanisms affect the decisions of both patients and caregivers. More research should be done concerning to whom, why, and with what consequences compulsory care is prescribed. (shrink)

Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to guide clinicians when deciding on (...) compulsory care for BPD patients and reduce the use of potentially harmful care. The arguments analysed are (a) the patients lack decision competence, (b) the patients lack authenticity, (c) compulsory care saves the patient from suicide, (d) compulsory care safeguards against litigation, complaints, or doctor's anxiety, (e) compulsory care is a practical solution in emergencies, and (f) it is better for the caregiver to ‘err on the safe side’. We conclude that compulsory care is not ethically justified in most cases unless the clinician has probable reason to believe that the patient lacks decision capacity by suffering from a severe mental co-morbidity and stands to benefit from such care. (shrink)

This paper discusses how the general and abstract concept of legitimacy applies to international institutions, using the United Nations Security Council as an example. We argue that the evaluation of the Security Council’s legitimacy requires considering three significant and interrelated aspects: its purpose, competences, and procedural standards. We consider two possible interpretations of the Security Council’s purpose: on the one hand, maintaining peace and security, and, on the other, ensuring broader respect for human rights. Both of these purposes are minimally (...) morally acceptable for legitimacy. Second, we distinguish between three different competences of the UNSC: 1) the decision-making competence, 2) the quasi-legislative competence, and 3) the referral competence. On this basis, we argue that different procedural standards are required to legitimise these competences, which leads to a more differentiated understanding of the Security Council’s legitimacy. While maintaining that the membership structure of the Council is a severe problem for its legitimacy, we suggest other procedural standards that can help to improve its overall legitimacy, which include broad transparency, deliberation, and the revisability of the very terms of accountability themselves. (shrink)

This article’s aim is to understand if and how the efforts to accumulate and organize clinical data transformed the regulation of pharmaceutical care. The authors analyze how the employment of databases by collectives of physicians and researchers shape both clinical and policy practice—and thereby reshape the relation between clinical work and policy. Since the late 1990s, Dutch government has supported the development of clinical databases for specific expensive medicines to gain oversight about actual medicine use. To be able to produce (...) evidence for appropriate medicine use, the collectives set regulations in clinical practice. These internal regulations provide a framework for establishing “appropriate medicine use”, steering reimbursement decisions. However, internal regulation and policy rules differ in how quickly they can change. While the employment of databases in clinical practices results in a constant adjustment of the protocols, policy makers require the databases to provide for static moments of “proven appropriate medicine use” in order to account for and define a fixed and closed formulary. Subsequently, the employment of the databases did not deliver on the promise of oversight and control due to different clinical and policy requirements. Nevertheless, the databases did stimulate appropriate medicine use and reimbursement in clinical practice. (shrink)

This essay explores the relationship between Kant's and Kierkegaard's treatment of morality and religious faith. In Religion Within the Limits of Reason Alone Kant invokes Christian categories in an effort to resolve certain contradictions which arise in consequence of the introduction of the notion of radical evil. I initially argue that Kant's Enlightenment confidence in the autonomy of ethical selfhood ultimately entails the subordination of these categories to the demands of rational ethical subjectivity. I then suggest that Kierkegaard's defence of (...) the independence of Christian faith, against the encroachments of Kantian Enlightenment humanism, largely proceeds on a foundation of shared epistemological principles, such that the Kierkegaardian existential individual's paradoxical Christian faith offers no genuine alternative, but rather a radically subjectivized extension of Kant's demythologized version of orthodox Christian principles. (shrink)

This text is a transcription of Rouvroy’s presentation on 7th October 2014 at the “Digital Studies” seminar series at the Centre Georges Pompidou. This seminar series, organised by the French philosopher Bernard Stiegler, question the influence of digital technologies on knowledge from an epistemological point of view and from the way they alter academic disciplines.

The tension between the authority of states and the authority of international institutions is a persistent feature of international relations. Legitimacy assessments of international institutions play a crucial role in resolving such tensions. If an international institution exercises legitimate authority, it creates binding obligations for states. According to Raz’s well-known service conception, legitimate authority depends on the reasons for actions of those who are subject to it. Yet what are the practical reasons that should guide the actions of states? Can (...) states be bound by international institutions on all kinds of issues or are certain issues exempted because of sovereignty considerations? This paper argues that self-regarding reasons cannot ground political authority with the respective demand for compliance. Since reasons for states concern individuals both inside and outside of their jurisdiction and other state peoples, self-regarding reasons for states, which form a domain of personal pursuits or sovereign decisions, are highly restricted. (shrink)

Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected (...) benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide. (shrink)

Courts are often criticised as undemocratic. The backlash against international courts in the last decade is also partly driven by this concern. Human rights courts’ legitimacy is particularly challenged because they aim to protect human rights against the very states that need to comply with and implement the courts’ judgements. Therefore, several international courts have developed mechanisms of deference to states. One especially interesting tool is the European Court of Human Rights’ margin of appreciation doctrine. This paper proposes that the (...) margin of appreciation can ensure the conditions of personal autonomy by protecting human rights while respecting the democratic decisions of states. Yet, states’ decisions should only be respected insofar as they realise political autonomy. Understanding the margin in this way allows us to critically evaluate arguments made under this label. The paper reviews developments in the ECtHR practice with regard to (a) different cases that use the margin of appreciation doctrine, (b) appeals to a European consensus, and (c) the procedural turn in its review and assesses whether and how they can be justified in the light of considerations about personal and political autonomy. (shrink)

Increasing the number of Aboriginal students graduating from university is a goal of many Canadian universities. Realizing this goal may present challenges to the orientation and methodology of university curricula that have been developed without consideration of the traditional epistemologies of Aboriginal peoples. In this article, three scholars in the Faculty of Education at the University of Victoria take up this issue by dialoguing with each other about the possibilities of incorporating Aboriginal perspectives into their courses. These conversations are woven (...) together into the narrative form of a four-act play in which the authors caricature their personalities to highlight their initial resistances and eventual reconsiderations. As non-Aboriginal instructors from different cultural backgrounds, the authors confront issues of respect, responsibility, and (mis)representation as they struggle with the dilemmas involved in cross-cultural understanding. Through this journey they come to imagine a world where cultural differences, including the traditional epistemologies of Aboriginal peoples, present possibilities for greater understanding of each other and more authentic expressions of our humanity. (shrink)

This article focuses on two memoirs written by Cornelia Sorabji in the 1930s – India Calling (1934), and a subsequent book, India Recalled (1936) – in order to explore how discourses of space and place shaped the representations of femininity which structure these texts. Specifically, I will examine Sorabji's apprehensions of femininity in relation to the Muslim and Hindu women she viewed as her legal ‘clients.’ I am equally interested in these texts as evidence of how memory works as a (...) practice of history – how events as they were recalled and recorded in the volatile 1930s and, especially in the wake of the Katherine Mayo controversy, how they helped shape the versions of the respectable feminine produced in her public writing of the period. (shrink)

The democratic criteria for representation in the European Union are complex since its representation involves several delegation mechanisms and institutions. This paper develops institutional design principles for the representation of peoples and individuals and suggests reform options of the European Union on the basis of the theory of multilateral democracy. In particular, it addresses how the equality of individuals can be realised in EU representation while guaranteeing the mutual recognition of peoples. Unlike strict intergovernmental institutions, the EU requires an additional (...) and independent legislative chamber in which individuals are directly represented. However, strict equality of individuals cannot be the guiding principle for this chamber. In order to avoid the overruling of peoples through supranational majorities, it is necessary to bind the chamber's composition by a principle of degressive proportionality. The representation of peoples, on the other hand, needs to be connected to their domestic democratic institutions. (shrink)

Many cognitive accounts of emotional processing assume that emotions have representational content that can be influenced by beliefs and desires. It is generally thought that emotions also have non-cognitive, affective components, including valence and arousal. To clarify the impact of cognition on these affective components we asked participants to rate sentences along cognitive and affective dimensions. For the former case, participants rated the believability of the material. For the latter case, they provided valence and arousal ratings. Across two experiments, we (...) show that valence and arousal are differently influenced by beliefs, suggesting that these two largely independent affective components of emotion differ in their cognitive penetrability. While both components depended upon overall comprehension of sentence meaning, only valence was influenced by the consistency of the sentences with participants’ beliefs (i.e., whether it was believable or unbelievable). We discuss the implications of these findings for understanding cognition–emotion relationships. (shrink)

Various levels of feminist criticism of Hegel's account of woman and family, both contentious and sophisticated, are examined. While finding much that is telling and valid in them, the author finds much that is uncomprehended and much that stands to be learned about the issues in question were the texts allowed to speak for themselves.

In vitro meat is presented by innovators as the most realistic and sustainable solution to the problems of current meat production and consumption. The innovators argue that in vitro meat could be more environmentally friendly, animal friendly, healthier, and safer than conventional meat. The paper elaborates different reactions of experts and stakeholders from science, civil society, economy, and politics to the innovators’ reasoning. The semi-structured interviews were conducted for the project “Visions of in vitro meat. Analysis of technical and societal (...) aspects and visions of in vitro meat” funded by the German Ministry of Education and Research. In this paper we will show how our interview partners positioned themselves in relation to the innovators’ vision on IVM and which other visions they brought into the discussion about IVM and the future of meat. The project was based on a concept of visions as socio-epistemic practices that are increasingly recognised as important elements in innovation and transformation processes. The analysis of these visions conducted in interviews with experts and stakeholders provided new knowledge for the conceptualisation and appraisal of in vitro meat beyond the innovators’ rhetoric. (shrink)

The well known Bell experiment with two actors Alice and Bob is considered. First the simple deduction leading to the CHSH inequality under local realism is reviewed, and some arguments from the literature are recapitulated. Then I take up certain background themes before I enter a discussion of Alice’s analysis of the situation. An important point is that her mind is limited by the fact that her Hilbert space in this context is two-dimensional. General statements about a mind’s limitation during (...) a decision process are derived from recent results on the reconstruction of quantum theory from conceptual variables. These results apply to any decision situation. Let all the data from the Bell experiment be handed over to a new actor Charlie, who performs a data analysis. But his mind is also limited: He has a four-dimensional Hilbert space in the context determined by the experiment. I show that this implies that neither Alice nor Charlie can have the argument leading to the CHSH inequality as a background for making decisions related to the experiment. Charlie may be any data analyst, and he may communicate with any person. It is argued that no rational person can be convinced by the CHSH argument when making empirical decisions on the Bell situation. (shrink)

The Gods of our Ancient World are migrating toward the South. Pushed back by supermarkets, television shows and the rights of man divorced from himself, they have ended up taking refuge in the last Christian region that faces Islam: in Andalusia that is one of their last lands of asylum. They have left traces of their passage in our museums upon which we construct pyramids in order to feign our veneration for them. Now and then they accompany the silence of (...) a symphony to the rhythm of the high priest's baton. However, in the South they are alive. Accommodating themselves to the din of household appliances and of tourism, they appear sometimes in all the splendor of the Midi during the passage of the virgins of peace and bleeding christs. But most frequently they hide in the midst of the Andulusian festival, under the flanks of the fighting bulls or in taverns that are filled with raucous songs. Be it that they intrude upon a play in order to transform it into a ritual; be it that they honor art and sensuality in their celebrations — they choose for their appearances the blurred boundary between the world of the sacred and of the profane. (shrink)