Free choice permission, a crucial test case concerning the semantics/ pragmatics boundary, usually receives a pragmatic treatment. But its pragmatic features follow from its semantics. We observe that free choice inferences are defeasible, and defend a semantics of free choice permission as strong permission expressed in terms of a modal conditional in a nonmonotonic logic.

Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. “Drug vaccines” aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, “cocaine and nicotine vaccines” have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining how (...) these vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use. (shrink)

Stress induction reduces people's ability to modify their instrumental choices following changes in the value of outcomes, but the mechanisms underpinning this effect have not been specified because previous studies have lacked crucial control conditions. To address this, the current study had participants learn two instrumental responses for food and water, respectively, before water was devalued by specific satiety. Choice between these two responses was then measured in extinction, reacquisition and Pavlovian to instrumental transfer tests. Concurrently during these (...) tests, a negative emotional appraisal group evaluated aversive images, whereas a control group evaluated neutral images, at the same time as choosing between the two instrumental responses. Negative emotional appraisal abolished the impact of water devaluation on instrumental choice in the extinction test, but did not affect instrumental choice in the reacquisition or PIT tests. These findings suggest that negative emotional appraisal selectively impaired participants’ ability to retrieve the expected value of outcomes required to make goal-directed instrumental choices in the extinction test, and that this effect was not due to task disengagement, nullification of the devaluation treatment or impaired knowledge of response-outcome relationships. (shrink)

It is a remarkable fact about the development of medical ethics from the 1960s until today that there has been a dramatic shift from a position where it was taken for granted that the physician knows best, to a position where much greater emphasis is put on the patient’s treatment preferences. This shift is evident with regard to physician attitudes towards disclosing a cancer diagnosis. For example, in 1961, a survey of cancer physicians showed that almost 90% of the (...) physicians reported that their usual policy was not to tell their patients that they had cancer . The survey was repeated in 1979, and it showed a complete reversal in attitudes over this 20-year period. 90% reported that their usual policy was to tell their patients that they had cancer .One common way of justifying the new approach is to claim that patients have a right to make their own treatment decisions, referring to the basic value of patient autonomy. However, it is immediately obvious that physicians should not respect all choices made by patients. Consider the following case: A thirty-eight-year-old man with mild upper respiratory infection suddenly developed severe headache, stiff neck, and high fever. He went to an emergency room for help. The diagnosis was pneumococcal meningitis, a bacterial meningitis almost always fatal if not treated. If treatment is delayed, permanent neurological damage is likely. A physician told the patient that urgent treatment was needed to save his life and forestall brain damage. The patient refused to consent to treatment saying he wanted to be allowed to die .Very few, if any, physicians would respect this person’s treatment choice. The reason is that this patient is not competent to make his own decisions. Respect for autonomy only requires that the choices of patients who are competent to make their own decisions are honoured. Judgements about which patients are competent to make their own decisions therefore become crucial. (shrink)

Cancer is a group of diseases that are complicated by various treatment choices available. Information exchange between a patient and physician is critical in helping people to understand what is happening to them and what options for therapy are recommended and available. When information is not exchanged, information control by one or both of the participants occurs. Information needs to be taken into account by both health care professional and patients in making decisions during the crucial phases (...) of care. The phases of care presented are a diagnosis, treatment, the decision, and a recurrence. Factors that influence effective information exchange among patient-provider systems are discussed. (shrink)

_Unequivocal Justice_ challenges the prevailing view within political philosophy that broadly free market regimes are inconsistent with the basic principles of liberal egalitarian justice. Freiman argues that the liberal egalitarian rejection of free market regimes rests on a crucial methodological mistake. Liberal egalitarians regularly assume an ideal "public interest" model of political behavior and a nonideal "private interest" model of behavior in the market and civil society. Freiman argues that this asymmetrical application of behavioral assumptions biases the analysis and (...) undercuts ideal theoretical treatments of every major liberal egalitarian principle, including political liberty, economic sufficiency, fair opportunity, and social equality. This book reexamines the institutional implications of each of these principles in nonideal conditions, making novel philosophical use of political psychology and public choice economics along the way. (shrink)

Medieval philosophy is primarily associated today with university-based disputations and the authorities cited in those disputations. In their own time, however, scholastic debates were recognized as just one part of wide-ranging philosophical and theological discussions. A Hidden Wisdom breaks new ground by drawing attention to another crucial component of these conversations: the Christian contemplative tradition. The thirteenth–fifteenth centuries in particular saw a dramatic increase in the production and consumption of mystical and contemplative literature in the ‘Christian West’, by laypeople (...) as well as religious scholars, women as well as men. A Hidden Wisdom focuses on five topics of particular interest to both scholastics and contemplatives in this period—namely, self-knowledge, reason and its limits, love and the will, persons, and immortality and the afterlife. This focus centers on the (often overlooked) contributions of medieval women and demonstrates that when we reunite scholasticism with its contemplative counterpart, we gain not only a more accurate understanding of the scope of medieval Christian philosophy and theology but also an increased awareness of a deeply practical tradition that builds up as well as tears down, generates as well as deconstructs. The book’s treatment of topics and figures is meant to be representative rather than exhaustive—a tasting menu rather than a comprehensive study. The choice of topics offers a series of ‘hooks’ for philosophers to connect their own interests to issues central to medieval contemplative philosophy, while also providing medievalists in other disciplines a fresh lens through which to view these texts. (shrink)

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

This dissertation is focused on the validity of “the data” that are collected in psychotherapy research for the purpose of evidencing treatment efficacy. In the ‘Evidence Based Treatment’ paradigm, researchers rely on the so-called ‘gold standard methodology’ to gather sound and trustworthy evidence, which increasingly influences the organization of mental health care worldwide. In the gold standard, data are collected by quantified self-report measures, to assess the presence and severity of symptoms before and after treatment. When the (...) pre-post difference is larger for a group of people that received the treatment of interest and a group of people who received no or an alternative treatment, the treatment of interest is called effective. In this methodological procedure, researchers tend to assume that when this gold standard methodology is conducted properly, “the data” will speak for themselves. However, when evidence is based on data, that evidence is principally limited by that data. In other words: output depends on input. That implies that when input is flawed, output will be flawed, even when the very best methods of analysis would be used. So what if “the data” yield validity issues despite being collected by validated measures? When “the data” do not straightforwardly evidence treatment effects, will the subsequent steps in the analysis of these data be enough to secure that the evidence in the end does evidence treatment efficacy? In this dissertation, the focus is turned to validity of “the data” that are concretely provided by patient-participants by scoring their own experienced symptoms in self-report questionnaires, in function of evidencing treatment efficacy. A series of empirical case studies were conducted to scrutinize how patient-participants in a randomized controlled psychotherapy study experienced the process of data collection, and how these experiences affected the data that they provided. Each of the studied patient-participants experienced a substantial effect of the questionnaire administration on their complaints. This impacted the level of complaints, but also changed the way in which the complaints were understood at all, and how patient-participants perceived themselves. Thus, rather than neutrally measuring symptoms, questionnaire administration changed the experienced complaints ‘performatively’, which turned measurement into a clinical intervention of its own. Consequently, what is measured cannot straightforwardly be called ‘treatment efficacy’, as it may be entangled with, enabled by or even obstructed by effects of measurement and research. Therefore, the act of measurement itself can pose a vital threat to the validity of “the data”. This way, the empirical case studies exhibited that data can yield validity problems despite the use of validated measures. Consequently, the validity of a measure as such is no guarantee for the validity of data. Nonetheless, in gold standard research, the data are straightforwardly taken as input for analyses of general treatment efficacy. The question is what happens with those validity issues on the level of individual data, when they pursue their journey towards becoming evidence. In this dissertation, it was argued that the validity issues are not sufficiently solved in the methodological steps after data collection, so when data are invalid in the beginning, these validity issues will simply become part of the data set that forms the input for analysis of the final evidence. This urges that validity issues should be solved on the level of individually provided data, as the validity issues will otherwise become inherent to “the data”. Put formally: valid data is a precondition for evidence in EBT. In conclusion, it is crucial for a sound evidence-base to scrutinize the validity of data in function of the overall goal and utility of the research. For this, it is important not to take “the data” as speaking for themselves, but to regard them as clinical narratives, which are framed in a specific format to be communicated between researcher and respondent in a research context. This emphasizes that the choice for a certain format determines what can be evidenced, so it is vital that these choices indeed allow for obtaining evidence that is useful and valid to serve the clinical goal of EBT. (shrink)

It has been claimed that beneath the government rhetoric of patient choice, no real choice exists either in law or in National Health Service policy. Thus, choice is considered to be a fallacy in that patients are not able to demand specific treatment, but are only able to express preferences amongst the available options. This article argues that, rather than considering choice only in terms of patient autonomy or consumer rights, choice ought to be seen as serving other functions: (...) Choice serves as a mechanism of destabilisation, i.e., as a lever for change. This is apparent at the level of patient and doctor, and at the level of patient and health authority, but even more so, at the level of government. Patient choice, rather than benefiting the individual, can have effects on a wider scale. It encourages change and reform in healthcare practices and in the NHS institutions. (shrink)

This is a new critical latin edition, with facing English translation, of Peter Abelard’s ethical treatise, sometimes entitled "Know Thyself." The book is one in the series of Oxford Medieval Texts. Accompanying the latin text and simple, easy reading translation is a most helpful introduction by Luscombe which points out the historical importance of this little treatise as among the first finely articulated attempts at bringing the classical concerns with human virtues and character together with the theological concerns of a (...) believing Christian. Ethics deals with the problem of how we may properly speak of the moral formation of a person. Abelard’s treatment is more weighted toward the attitudes of man than the nature of his deeds. What is worked out, with the help of many suggestive examples and frequent reference to the religious practices of the twelfth-century church, is a crucial theory of intention and a definition of sin. He holds that our intention, measured to the standards of divine law, determines the morality of our actions : "We consider morals to be the vices or virtues of the mind which make us prone to good or bad works." Good and bad emerge from the struggle where there is consent to an act virtuously or viciously motivated. Morality does not come from the inclination since the constitution of man includes both his virtues and his vices; nor does it come from his acts since all acts are indifferent, before God, to good or bad. It is the intent or consent to act that is determinant. Sin, the other major theme, complementary to intention, is defined as contempt for God, i.e., "to do by no means on his account what we believe we ought to do for him." He founds his notions of morality on God as that good, the source and whole, such that "although... there is a number of good things so that goodness exists in plurality, it does not follow therefore that goodness is greater." By working out these notions, Abelard delivers an innovative morality of conduct for a man beset with a character marked with both virtues and vices, emphasizing man’s faculty of choice and underscoring his ability to know and be responsible to the divine law. Besides the introduction and text, Luscombe has included a description of the manuscripts used in preparing the text and indices of quotations, allusions, and manuscripts.—W. A. F. (shrink)

The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes in the information accumulation models. These (...) are discussed by comparing the traditional and new models of data accumulation. Big data analytics is fast becoming a crucial component for the modelling of transmission—aiding infection control measures and policies—emergency response analyses required during local or international outbreaks. However, the application of big data analytics in infectious diseases is coupled with a number of ethical impacts. Four key areas are discussed in this paper: automation and algorithmic reliance impacting freedom of choice, big data analytics complexity impacting informed consent, reliance on profiling impacting individual and group identities and justice/fair access and increased surveillance and population intervention capabilities impacting behavioural norms and practices. Furthermore, the extension of big data analytics to include information derived from personal devices, such as mobile phones and wearables as part of infectious disease frameworks in the near future and their potential ethical impacts are discussed. Considered together, the need for a constructive and transparent inclusion of ethical questioning in this rapidly evolving field becomes an increasing necessity in order to provide a moral foundation for the societal acceptance and responsible development of the technological advancement. (shrink)

The subject of this investigation is the role of conventions in the formulation of Thomas Reid’s theory of the geometry of vision, which he calls the ‘geometry of visibles’. In particular, we will examine the work of N. Daniels and R. Angell who have alleged that, respectively, Reid’s ‘geometry of visibles’ and the geometry of the visual field are non-Euclidean. As will be demonstrated, however, the construction of any geometry of vision is subject to a choice of conventions regarding the (...) construction and assignment of its various properties, especially metric properties, and this fact undermines the claim for a unique non-Euclidean status for the geometry of vision. Finally, a suggestion is offered for trying to reconcile Reid’s direct realist theory of perception with his geometry of visibles.While Thomas Reid is well-known as the leading exponent of the Scottish ‘common-sense’ school of philosophy, his role in the history of geometry has only recently been drawing the attention of the scholarly community. In particular, several influential works, by N. Daniels and R. B. Angell, have claimed Reid as the discoverer of non-Euclidean geometry; an achievement, moreover, that pre-dates the geometries of Lobachevsky, Bolyai, and Gauss by over a half century. Reid’s alleged discovery appears within the context of his analysis of the geometry of the visual field, which he dubs the ‘geometry of visibles’. In summarizing the importance of Reid’s philosophy in this area, Daniels is led to conclude that ‘there can remain little doubt that Reid intends the geometry of visibles to be an alternative to Euclidean geometry’;1 while Angell, similarly inspired by Reid, draws a much stronger inference: ‘The geometry which precisely and naturally fits the actual configurations of the visual field is a non-Euclidean, two-dimensional, elliptical geometry. In substance, this thesis was advanced by Thomas Reid in 1764...’, 2 The significance of these findings has not gone unnoticed in mathematical and scientific circles, moreover, for Reid’s name is beginning to appear more frequently in historical surveys of the development of geometry and the theories of space., 3Implicit in the recent work on Reid’s ‘geometry of visibles’, or GOV, one can discern two closely related but distinct arguments: first, that Reid did in fact formulate a non-Euclidean geometry, and second, that the GOV is non-Euclidean. This essay will investigate mainly the latter claim, although a lengthy discussion will be accorded to the first. Overall, in contrast to the optimistic reports of a non-Euclidean GOV, it will be argued that there is a great deal of conceptual freedom in the construction of any geometry pertaining to the visual field. Rather than single out a non-Euclidean structure as the only geometry consistent with visual phenomena, an examination of Reid, Daniels, and Angell will reveal the crucial role of geometric ‘conventions’, especially of the metric sort, in the formulation of the GOV. Consequently, while a non-Euclidean geometry is consistent with Reid’s GOV, it is only one of many different geometrical structures that a GOV can possess. Angell’s theory that the GOV can only be construed as non-Euclidean, is thus incorrect. After an exploration of Reid’s theory and the alleged non-Euclidean nature of the GOV, in 1 and 2 respectively, the focus will turn to the tacit role of conventionalism in Daniels’ reconstruction of Reid’s GOV argument, and in the contemporary treatment of a non-Euclidean visual geometry offered by Angell. Finally, in the conclusion, a suggestion will be offered for a possible reconstruction of Reid’s GOV that does not violate his avowed ‘direct realist’ theory of perception, since this epistemological thesis largely prompted his formulation of the GOV. (shrink)

: Our paper discusses the epistemic attitudes of particle physicists on the discovery of the Higgs boson at the Large Hadron Collider. It is based on questionnaires and interviews made shortly before and shortly after the discovery in 2012. We show, to begin with, that the discovery of a Standard Model Higgs boson was less expected than is sometimes assumed. Once the new particle was shown to have properties consistent with SM expectations – albeit with significant experimental uncertainties –, there (...) was a broad agreement that ‘a’ Higgs boson had been found. Physicists adopted a two-pronged strategy. On the one hand, they treated the particle as a SM Higgs boson and tried to establish its properties with higher precision; on the other hand, they searched for any hints of physics beyond the SM. This motivates our first philosophical thesis: the Higgs discovery, being of fundamental importance and establishing a new kind of particle, represented a crucial experiment if one interprets this notion in an appropriate sense. By embedding the LHC into the tradition of previous precision experiments and the experimental strategies thus established, underdetermination and confirmational holism are kept at bay. Second, our case study suggests that criteria of theory preference should be understood as epistemic and pragmatic values that have to be weighed in factual research practice. The Higgs discovery led to a shift from pragmatic to epistemic values as regards the mechanisms of electroweak symmetry breaking. Complex criteria, such as naturalness, combine epistemic and pragmatic different values, but are coherently applied by the community. (shrink)

In this paper, Lévinas’s criticisms and reformulations of Sartre’s phenomenology of imagination, in the early text “Reality and its Shadow,” are explored in detail. Levinas's own views on imagination and art are shown to be intimately linked to his critique of Sartrean temporality, insofar as they rely on a renewed phenomenological examination of sensation. As a result, understanding Lévinas’s discussion of the image provides benefits for grasping his notion of the instant and its importance for some of his own positions (...) vis-à-vis temporality, e.g. on the future and death. The manner in which Lévinas takes issue with Sartre through a phenomenology of the image and and its composition in sensation is first investigated by looking at Lévinas’s novel choice to situate his descriptions of the image with respect to the function and power of art. Nevertheless, despite this crucial decision on Lévinas’s part, departing from earlier phenomenological accounts, there are clear parallels can be drawn between Lévinas’s and Sartre’s descriptions of the image. The similarites and differences between their treatments of the image and the role played therein by the materiality of sensation are then elucidated in terms of the ‘amphiboly’ of the image, distinguishing the image in both its representational and anti-representational characteristics. From there, we proceed to examine the amphiboly of the image according to its temporality attributes, seeing how for Lévinas and Sartre the temporality of the image, as that of an instant, relates to the temporality of consciousness in general. (shrink)

### ­ In Who shall go first? A multicriteria approach to patient selection for first clinical trials of cardiac xenotransplantation, Kögel et al recommend the inclusion of patients who (1) have a (high) medical need for an allograft, (2) have the capacity to benefit from a xenograft, (3) have a ‘real’ choice between enrolment in a first-in-human clinical trial and an alternative life-sustaining treatment option and (4) have no clear record of previous non-compliance.1 As the authors discuss, patient selection (...) must promote the goal of gaining reliable and valid knowledge about the risks and benefits of cardiac xenotransplantation. While the four criteria outlined above certainly promote this goal, we argue it is crucial to add a fifth criterion emphasising the need to include diverse populations, particularly regarding sex, age, ethnicity and socioeconomic background.i In this commentary, we present two arguments for our claim and discuss the impact of neglecting diversity from the first trials on. ### The scientific rationale for including diverse populations First, including diverse populations in the first clinical trials of cardiac xenotransplantation enhances the scientific value of the data by assessing safety and efficacy among various populations. Treatment response can differ among patient (sub)groups as a result of genetic, physiological and socioeconomic factors.2 By including diverse populations from the first trials on, researchers can identify these …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"But I Don’t Feel It":Values and Emotions in the Assessment of Competence in Patients With Anorexia NervosaJochen Vollmann (bio)Keywordscompetence assessment, mental capacity, informed consent, psychiatry, anorexia nervosaThe respect of the self-determination of patients obliges physicians to obtain the patient's consent before providing medical treatment. One important condition for a valid informed consent is the patient's competence to make autonomous health care decisions. Therefore, a proper assessment of competence (...) to make health care decisions is crucial particularly in patients with mental disorders (Vollmann 2000; Helmchen and Vollmann 2001). In recent years, several empirical studies on the assessment of competence in patients suffering from different mental disorders have been performed using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; Grisso and Appelbaum1998). This assessment tool is based on legal standards of competence such as understanding, reasoning, appreciation, and expressing a choice. Since its first publication, the MacCAT-T has been widely accepted as a "gold standard" of competence assessment in the psychiatric literature. In recent years the MacCAT-T has been applied to patients suffering from depression, schizophrenia, dementia, angina pectoris, and normal controls (for overview, see Welie [2001] and Bauer and Vollmann [2002]).Tan and her colleagues (2006) use the MacCAT-T the first time to assess competence to make treatment decisions in patients with anorexia nervosa. Coming from clinical practice, the authors have noticed that the MacCAT-T might not work in this group of patients. Therefore, they use semi-structured interviews in addition to the MacCAT-T to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. They use grounded theory techniques for a qualitative analysis of the data as well as five brief, self-administered questionnaires to ascertain levels of psychopathology.The results of the study show that anorexia nervosa can have complex and variable effects on concentration, beliefs, and thought processing without affecting the ability to perform well on the MacCAT-T. At the same time, participants also report a change in their value system as well as in their personal identity. The authors argue that the results of their studies suggest that the competence to refuse treatment might be compromised in [End Page 289] people with anorexia nervosa in ways that are not captured by the MacCAT-T. This is an interesting finding in patients with anorexia nervosa, because in all other studies with patients suffering from mental disorders such as dementia, depression, and schizophrenia, the MacCAT-T identified more patients as limited in their competence to make health care decisions in comparison with other methods of competence assessment such as clinical judgment (Vollmann et al. 2003). The authors argue on the basis on their qualitative, semistructured interviews that anorexia nervosa–specific difficulties with a thought process and the change of values are missed by the MacCAT-T.Furthermore, Tan and her associated could not find a relationship between the participants' scores on the psychopathological scales, the MacCAT-T scores, and their difficulties expressed during the qualitative interviews, although the small size of the study precludes statistical analysis. In an earlier study, clinical dementia scales but not neuropsychological testing correlated with formal (MacCAT-T) and clinical assessment of competence. Therefore, psychopathological factors might play a different role in different subgroups of patients suffering from different mental problems. However, the idea of an objective neuropsychological model of competence assessment, again, finds no support in the presented empirical data.The qualitative data from patients with anorexia nervosa underline the problem of the cognitive bias of the MacCAT-T assessment and the illusion of value-free categories. It has been argued that the cognitive focus for the MacCAT-T is in itself a normative convention and that the MacCAT-T is missing the complexity of the process to make health care decisions in real life. Therefore, values and emotions should be considered in addition to cognitive functions in assessing competence to make health care decisions (Breden and Vollmann 2004; see also "Mental capacity" 2004). Although many authors agree that the cognitive approach of capacity assessment is important but not sufficient for the assessment of competence to make health care decisions, it remains an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Confidentiality and Its LimitsMaude Laliberté, John D. Lantos, and Sonia GowdaMultiple sclerosis is believed to be an autoimmune disease of the central nervous system. However, according to Italian physician Paolo Zamboni, it is related to cerebrospinal vascular insufficiency. Zamboni claims that MS can be treated by remedying this condition with venous angioplasty. This surgery is offered as treatment for MS in various countries—Poland, Bulgaria, and Costa Rica, for (...) example. But the Medical Board of Quebec, Canada, does not allow its members to perform the surgery and strongly advises patients against seeking it elsewhere. This opposition is based on the lack of evidence to support the procedure and the serious risks associated with it (including venous thrombosis, stroke, and pulmonary embolism). As a result, many Canadian MS patients have traveled to other countries to receive the surgery. Quebec physicians have been reluctant to provide surgical follow-up for patients who undergo the surgery in other countries due to the lack of information regarding the procedure. No alternative treatments are effective to partially or completely cure MS, and so the treatments available in Canada aim only to manage its symptoms.Jade is a forty-year-old Canadian woman with MS. She is on long-term disability leave, complains of growing fatigue and muscle stiffness, and has painful sensations in her limbs. She has been followed by an interdisciplinary team in a specialized hospital in Quebec for the past twenty years, since she was diagnosed. At her last appointment, Jade told her physical therapist that she recently underwent the experimental Zamboni surgery in Poland, despite her physician’s strong recommendation not to. Jade fears her physician’s reaction, so she asks the physical therapist to keep this information from the rest of her medical team.Jade is shy and tends to distrust health care professionals. It took many years for her physical therapist to gain her trust and to develop a positive therapeutic relationship with her. However, the physical therapist knows that serious complications can occur in patients who have had Zamboni’s surgery. Not telling Jade’s physician about the surgery could result in harm; Jade could have complications that are not recognized. Providing the information to the rest of the team would allow them to adjust her treatment to respond to the surgery and give her information and postoperative education that she will need. Moreover, keeping this secret could threaten team cohesion and trust if they find out about it later.Jade decided to undergo a risky surgery against her doctor’s advice in the hope of improving her quality of life. This was her autonomous choice. How should the physical therapist respond?CommentaryMaude Laliberte (bio)Laws and professional codes of ethics direct clinicians to respect their patients’ autonomy through confidentiality and informed consent unless there are compelling reasons not to do so. Health professionals are deeply committed to helping patients; above all, they want to avoid harming them. Therefore, a key component of this case is the possibility that respecting Jade’s desire to conceal information from the team may put her at direct risk if any postoperative complications are not detected, and at indirect risk if Jade’s trust in her medical team is undermined to the point where she turns away from them.The physical therapist must determine if the possible physical risks to Jade are imminent and serious enough to go against her autonomous choice. One risk that can occur following Zamboni’s surgery is inflammation of a vein caused by a blood clot. This is a life-threatening situation (although it may not be a likely complication for Jade). But the physical therapist can teach Jade to recognize the physical signs that can alert her to this problem, giving her ample time to seek treatment. Thus, even though she may be in danger from a life-threatening risk, there may be ways to manage it besides violating her confidentiality.The respect for autonomous choice is a crucial aspect of our democratic values. It promotes a process of exchange in the therapeutic alliance: the professional guides and informs the patient, but the patient is a partner in care planning and treatment. An important... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Concepts and Theories of AddictionLennart Nordenfelt (bio)Keywordsaddiction, disease, will power, autonomy, holistic view of healthThe article "A Liberal Account of Addiction" is a good piece of analytic philosophy applied to psychiatry. It is well-informed both with regard to empirical matters and philosophical conceptualization. The arguments are often—but, as I will show, not always—quite convincing. The conclusions of the paper also have crucial consequences for practice, for the (...) treatment of patients, and for social policy.The authors argue that current scientific understandings of the problem of addiction are fundamentally flawed. They distinguish between two main positions in science: The Disease View and the Willpower View. According to the Disease View, drug-seeking behavior is the direct result of some physiological change in the drug seeker's brain. According to the Willpower View, the addict is no longer rational; he or she uses drugs as a result of a fundamentally non-voluntary process.The authors dismiss the Disease View in the following way. They first note that drug addicts are in many ways rational planners. The addicts may have to think a lot to find the best ways to find the heroin, cigarettes, or alcohol, and they normally act according to this planning. They are not in any simple sense "caused" to act in a particular way. Moreover, referring to recent neurological literature, the authors note that the changes caused by drug addiction—which have to do with activating reward pathways in the brain—are identical with the outcomes of many other human activities that we do not call addiction. "In fact, any pleasurable experience causes dopamine to be released within the brain, activating these reward pathways" (Foddy and Savulescu 2010, 4). These experiences can be the result of coffee drinking, sexual activity, and physical exercise. Thus, the physical changes in the brain are not effects peculiar to the pharmacology of the drugs; they are instead the effects of the pleasure that the subject has experienced.The argument against the Willpower View is lengthy and more involved. The proponent of the Willpower View must argue that there is some flaw in the subject's autonomy. The drug addict is in some sense unable to avoid taking the drug. The authors of the present article scrutinize this idea on the basis of distinguishing between different senses of autonomy: Substantive autonomy and procedural autonomy. They state that we must here be talking about procedural autonomy, namely, autonomy regarded as dependent only on our capacity to process information and make choices in accordance with our preferences. We cannot, as in the case of substantive autonomy, require that the preferences themselves be reasonable. [End Page 27] In such a case, many of our ordinary actions would be judged non-autonomous.The most reasonable Willpower accounts rely on the idea that addicted people in some sense lack self-control. The authors cite different interpretations of the concept of lacking self- control and they conclude that "none of these … theories can say that addicts are necessarily lacking in self-control unless they also make unreasonable normative or false factual claims about the nature of drug- or pleasure-oriented choices" (Foddy and Savulescu 2010, 10). For instance, according to one interpretation the subject does not endorse his own desire for drugs, but takes the drug anyway. According to another interpretation, the addict regrets taking the drug after having done so. Against such claims the authors claim that many addicts indeed endorse their desires for drugs and many addicts do not regret their addictive behavior.So what is the positive account proposed by the authors? They put forward what they call a Liberal View. It contains three claims about addiction: First, we do not know whether an addict values anything more than the satisfaction of his addictive desires; second, we do not know whether an addict behaves autonomously when he uses drugs; and third, addictive desires are just strong regular desires.According to the Liberal View, one has to accept that the addicts may have drug taking as their highest priority and that they do not have any reduced procedural autonomy. The authors say: "Once we abandon normative bias, we must accept... (shrink)

Problems in the field of health law often force tradeoffs between uniformity and particularity in health care decision-making. Patients are highly diverse in terms of their basic health status, willingness to accept risk or uncertainty in new treatments, and ability to pay for care. And health care experts - doctors, research scientists, insurance company reviewers, and health economists - are similarly diverse in their perception of the best treatment and payment structure choices. In a world with such persistent (...) heterogeneity of opinions and preferences, a society's choice between centralized rules for treatment and payment and a more diffuse decisional regime is both crucial and controversial. Opt for a uniform national rule - say, a federal statute governing treatment standards, drug approval, or health finance - and many beneficial autonomous transactions between doctors and patients are squelched, with possible detrimental effects on population health and medical innovation. (shrink)

This dissertation originated in a reasoned conviction that character is of crucial importance for moral theory; that its neglect in the modern period is regrettable. Considerations of character can illuminate judgments of the rightness of actions and the goodness of ends. Indeed, good character is one of the greatest goods. Further, the understanding of character and its development provides an essential link between moral theory and social philosophy. ;The particular content of this dissertation is Kant's theory of character. Recent (...) scholars have illuminated his treatment of character and the virtues; although these interpretations are valuable, there remains a need for the systematic articulation of the theory as a whole. ;My procedure has been to establish preliminary criteria for any theory of character, in the form of questions to which any adequate theory must given cogent answers, and then to discover Kant's answers to those questions. After the theory has been articulated, its adequacy is assessed. ;In Chapter One I review recent literature, contrasting act-centered with agent-centered approaches, and propose tentative criteria for theory of character. Chapters Two and Three present the rudiments of Kant's theory, and Chapter Three addresses standard criticisms. Chapter Four presents Kant's view of the development of character in its social context, and Chapter Five the problem which Kant's view of women's character presents for his theory as a whole. The final chapter evaluates its strengths and weaknesses. ;Although Kant's theory is shown to be flawed by his underlying conception of human nature, and by his inconsistent view of female character, I shall argue that it is basically sound. His analysis of character as related to choice, reason, freedom and society is comprehensive, and his emphasis on the importance of the moral agent, rather than on outcomes or general rules, makes him preeminently a philosopher of character. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Descartes’s Dualism by Marleen RozemondSteven J. WagnerMarleen Rozemond. Descartes’s Dualism. Cambridge: Harvard University Press, 1998. Pp. xx + 279. Cloth, $24.00.Rozemond gives particular attention to questions of mind-body distinctness vs. union and to the status of sensory ideas. Her historical emphasis, backed by impressive scholarship, is Descartes’s relation to the late scholastics. Rozemond is clear, alert to detail, and fair-minded. While the text is too long (esp. in (...) chapters 4–5), this study is indeed rich, its scope and architecture justified.Any good reading of a philosopher is defined—both enhanced and limited—by certain decisions. I have mentioned one of Rozemond’s: her account of Descartes’s dialogue with such predecessors as Suárez and Fonseca sheds important light. It makes one ask, further, whether standard histories are not just as wrong to ignore scholastic concerns in, say, Hobbes, Spinoza, and Locke. Yet Rozemond is less helpful with issues that make more sense when we read forward from the 1640s, not back. An historian also sets a level of philosophical engagement. One chooses between presenting a meaningful narrative, and struggling with the endless problems of detail that can both doom [End Page 678] a philosophical position and give it life. Rozemond inclines toward narrative, often stopping just short of hard questions. Yet she shows curiosity and intelligence throughout. As in the first case, another decision would not have been better or worse but simply yielded a different kind of history.Fundamental is a third choice. A philosopher’s thought may appear as an orderly structure; or as a mix of fixed points and shifting, inconsistent tendencies. Most of us are trained to the former style of representation (although we let philosophers “develop” over time). Rozemond’s Descartes, too, turns out this way. He occupies definite positions. Within each position he knows whether Ρ is a premise for Q, vice versa, or neither. This way of presenting a body of thought, i.e., as a determinate structure admitting logical assessment, is an indispensable tool for historians. Its value in any particular case is, however, a matter of judgment. Rozemond attacks textual problems with skill, often improving decisively on the competition, but the going looks smoother than it is. Sometimes she carries the privilege of selective reading too far. At other times, she overlooks the poor mutual fit of separately smooth solutions, or rests with an outcome that could not have satisfied Descartes. Some examples:1. There is an old question how far Descartes goes towards proving dualism in the Second Meditation, how much is left for the Sixth. Rozemond basically champions the Second Meditation. Although some texts favor this, she ignores important contrary passages. Her reconstruction of the “argument from separability” also fails completely to carry over to Descartes’s alternate proof (AT VII, 85–6) from the indivisibility of mind.2. Rozemond identifies (“pure”) intellection with thought or mind (56). This leaves a problem how sensation could be a mode of thought, given that for her sensations differ from pure thoughts in being ‘modes of the mind as united to the body’ (201, emphasis mine). She remarks that sensations are not ‘straightforward modes of the mind’; yet her earlier chapters have no place for obscure modal hybrids and indeed require the tidy metaphysical scheme that is now denied.3. Although Rozemond handles Descartes’s anti-empiricism well, the discussion of empty space (95–7) no sooner suggests than it drops a crucial question. Descartes traces belief in the void to a childhood prejudice according to which all bodies are perceptible; rejecting the prejudice is supposed to remove support for the hypothesis of the void. But can Descartes really pick up the doctrine of childhood prejudice, an anti-Aristotelian weapon, and turn it against the radically different atomist framework? Rozemond passes on the attendant philosophical and textual problems (cf. 133–7).4. Rozemond’s extensive treatment of sensory perceptions and qualities rewards study (particularly on the importance, for dualism, of problems about body). But she misses the chance for more. Her Descartes firmly “places sensory qualities in the mind.” The real one struggled repeatedly over whether sensory ideas can or must... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Jacob Burckhardt, Religion, and the Historiography of “Crisis” and “Transition”Thomas Albert Howard*A great historical subject, the representation of which should be the high point of a historian’s life, must cohere sympathetically and mysteriously to the author’s innermost being.Jacob Burckhardt 1If you are to venture to interpret the past you can do so only out of the fullest exertion of the vigor of the present: only when you can put (...) forth your... qualities in all their strength will you divine what is worth knowing and preserving in the past.Friedrich Nietzsche 2The renowned nineteenth-century Swiss-German historian Jacob Burckhardt (1818–97) was a masterful historian of crises and transitional periods. Two of his major works, The Age of Constantine the Great (1852) and The Civilization of the Renaissance in Italy (1860), bear out this claim. In his Constantine Burckhardt deals with the transition from late pagan antiquity to the early Christian Middle Ages, and in his more famous Renaissance he deals with the transition from the late Middle Ages to the beginnings of secular modernity. In the [End Page 149] latter, as is well known, he established one of the most compelling and creative theses in the history of modern historiography, virtually creating the “idea of the Renaissance” that has long influenced both scholarly and popular conceptions of that period. 3What elicited Burckhardt’s interest in crises and transitions in general and in these two periods of crisis and transition in particular? In this article, I shall argue that there is a strong relationship between Burckhardt’s own historical experience in the early and mid-nineteenth century and his choice of subject and mode of analysis in these two monumental works. In theoretical terms one observes a “dialectical” form of objectivity in the execution of Burckhardt’s historiographical tasks: a structural affinity or kinship between subject (Burckhardt, his historical experience) and object (late antiquity, Renaissance) predisposes Burckhardt to his theme/argument and thus provides a key to understanding the genesis and the character of insights that he offers in these two works. 4 To establish this point I shall focus on the category of religion, on Burckhardt’s own experience of questions of religious truth and skepticism in the nineteenth century, and on his treatment of religion in these two works.The Young Jacob Burckhardt and ReligionReligion is a crucial but often neglected aspect of Jacob Burckhardt’s thought. 5 Like a number of nineteenth-century German intellectuals, Burckhardt was a Pfarrersohn, a “pastor’s son.” 6 He grew up in a profoundly conservative Protestant environment in Basel, nicknamed “pious Basel” for its dogged resistance to the “ideas of 1789” and for its earlier heritage of Reformation and pietist religiosity. During Burckhardt’s youth in fact, his father was a children’s minister and head-deacon (Obersthelfer) before becoming in 1838 the city cathedral’s Antistes, the highest and most prestigious ecclesiastical office in Basel. In short, as his biographer Werner Kaegi has noted, Burckhardt’s early [End Page 150] upbringing and education were strongly shaped by the world of his father, a world of “old Protestant piety.” 7Following his father’s example, Burckhardt started out on the clerical track, studying theology at the University of Basel. However, during his Theologie-studium (1837–39) he experienced a profound crisis of faith brought on by an encounter with German historical biblical criticism and liberal theology represented in the person of W. M. L. de Wette (1780–1848). A radical theologian and biblical scholar, de Wette had wound up in Basel in 1822 after being dismissed from the University of Berlin for holding views considered heterodox and politically threatening by the conservative Prussian government. 8 In a letter to his friend Johannes Riggenbach written in August 1838 Burckhardt tells how de Wette’s critical theology had unseated his faith. “In my eyes,” Burckhardt wrote,de Wette’s system grows in stature every day; one simply must follow him, there is no alternative; but every day a part of our traditional church doctrine melts away under his hand. Today, finally, I realized that he regards the birth of Christ simply as a myth... (shrink)

The manuscripts of Harriot discussed in this paper are essentially rough notes marginal to his systematic treatment of algebra, of which a small part was published posthumously. The central theme is the sign-rule for multiplication; but the incidentals open up an aspect of symbolism in mathematics entirely new for the time. A more restricted aspect of the same theme was touched on by Commandino in his Euclid, quoted by Harriot as rightly blaming ‘those that thinke that minus per minus (...) shal produce plus’; Commandino's authority was Cardano, in a similarly marginal departure from his great Ars magna, the de Aliza, which Harriot also cites in the same reference. The ostensible motivation, to preserve intact the Euclidean tradition in geometry, plays a very minor role in Harriot's notes. The basic aim, to elude the fatal link with imaginaries, they do touch on. More dimly underlying the arguments are the crucial logical facets of the problem, which Harriot faced with a greater conceptual clarity, formulating in words, however, only his own conclusion: the choice of sign-rule is the user's—a fact not fully recognised by mathematicians generally until the 19th century. (shrink)

For a long time, Daniel Dennett, like many philosophers, has been trying to understand how to make room for free will in a world of ordered causes. A core feature of Dennett's view on these matters is that the world is deterministic and his approach to this project has been to show how determinism really is our friend rather than our enemy . His most recent foray into this arena is the ambitious book, Freedom Evolves, where he once again seeks (...) to make clear that determinism does not threaten any of the freedoms worth wanting' that is, free will is compatible or consistent with determinism and that free will is a capacity that has evolved just as we as a species have evolved. My primary concern in this essay will not be on evolutionary theory and its role in the evolving capacity for free will. Rather, I will focus my attention on two features of Dennett's recent book that seem most closely related to understanding the nature of freedom. The first feature is his view, and accompanying arguments, that a deterministic world is no obstacle to free will. Here, he is at pains to argue two theses crucial to his project: that determinism does not imply inevitability, and that determinism does not imply that there are no genuine options. The second feature is his discussion of incompatibilism { the view that free will is inconsistent with determinism - through what many acknowledge as the best incompatibilist account of free will going these days, that of Robert Kane . Here, Dennett pursues three theses: that Kane's account does not need the indeterminism that inspired itscreation, that Kane cannot harness indeterminism in any way distinguishable from determinism, and that Kane's requirement that decisions be made by agents 'here and now' roughly up to them at the time of choice is unmotivated at best and incoherent at worst. If Dennett were to score a knockout on these three points against Kane, it would indeed look bad for any incompatibilist relying on indeterminism. In discussing Dennett's treatment of Kane, I also will raise some critical questions for Kane. Independent of Dennett's worries, incompatibilism is not home free. (shrink)

Preliminary assessment of Aristotle’s treatment of justice suggests that he would consider unjust Jesus’s injunction to turn your other cheek to one who has unjustly struck you. Further consideration, however, shows that obeying such an injunction would qualify, even by Aristotle’s criteria, as a more just response than reciprocating the blow. Turning one’s cheek provides the assailant an opportunity to make a choice that could improve his character, which improvement is crucial to the political good that is the (...) primary concern of justice in the full sense. Remaining concerns about rectification are obviated by considering how the megalopsukhos navigates honor. (shrink)

This paper discusses an important phase in Ludwig Wittgenstein’s analytic philosophy through a comparative examination of the profound correspondences that exist between his concept of silence and the poetics of another crucial authorial figure of the 20th century: James Joyce. Based on the hypothesis that there are striking resemblances between their early works, that is, between Joyce’s realistic short-story collection Dubliners and Wittgenstein’s Tractatus Logico-Philosophicus, the article employs mostly close-reading, analytical-interpretative and comparative methods. It argues that silence was an (...) intentional intellectual, aesthetic and ethical choice of both these authors, their way to preserve the autonomy of metaphysics and to honour the beauty of the unspoken. Starting from their common critical treatment of the habitual and largely alienated speech, the discussion connects Wittgenstein’s philosophical attitudes regarding the imprecision and inadequacy of every-day language and Joyce’s notion of ‘spiritual paralysis’ of the city-life, which he saw as the main motive for writing his collection about fin-desiècle Dublin. On the grounds of their shared views about the limits of words, behind which there are worlds that cannot be properly uttered, the idea of silence – or the highly significant narrative absence – grows to permeate the work of both. In the case of Wittgenstein, it is a call for a new philosophy, or anti-philosophy, which in negating metaphysics in effect preserves its independence from a discursive speech which cannot express it, whereas in the case of Joyce, correspondingly (and almost simultaneously), it is a quest for a new literary mode that will foreground a particular Modernist allusiveness, rhetoric of omission and deliberately incomplete, gnomonical narrative structures. (shrink)

Arthur Kaufmann is one of the most prominent figures among the contemporary philosophers of law in German speaking countries. For many years he was a director of the Institute of Philosophy of Law and Computer Sciences for Law at the University in Munich. Presently, he is a retired professor of this university. Rare in the contemporary legal thought, Arthur Kaufmann's philosophy of law is one with the highest ambitions — it aspires to pinpoint the ultimate foundations of law by explicitly (...) proposing an ontology, a general theory of knowledge and concept of a person. Kaufmann's work derives, first of all, from the thinking of Gustav Radburch, his teacher, and then from ideas of Karl Engish and Hans-Georg Gadamer. The philosophy undertakes to pursue the ultimate foundation of law, law which is understood by Kaufmann, first of all, as a "concrete judgement" that is, what is right in a concrete situation. Justice belongs to the essence of law and "unjust law" is contradictio in adiectio. Kaufmann opposes all those theories, which as the only foundation for establishing just law (Recht) adopt legal norms (Gesetz). In Kaufmann's opinion , such theories are powerless in the face of all types of distortions of law rendered by political forces. He suggests that the basic phenomenon which needs to be explained and which cannot be disregarded by a philosopher of law is so-called "legal lawlessness" ("Gestzliches Unrecht"). "Legal lawlessness" which forms a part of life experience for the people of twentieth century totalitarian states. It proved "with the accuracy of scientific experiment" that the reality of law consists of something more than bare conformity with legal norms. The existence of lex corrupta indicates that law contains something "non-dispositive" which requires acknowledgment of both law-maker and judge. Kaufmann, accepting the convergent concept of truth and cognition, assumes that "non-dispositive" content, emerging as the conformity of a number of cognitive acts of different subjects (inter-subjective communicativeness and verifiability), indicates the presence of being in this cognition. The questions "What is law?" and "What are the principles of a just solution?" lead straight to the ontology of law, to the question about the ontological foundations of law. Kaufmann discerns the ontological foundations of law in the specifically understood "nature of things" and, ultimately, in a "person". He proposes a procedural theory of justice, founded on a "person". In my work, I undertake to reconstruct the train of thought which led Kaufmann to the recognition of a "person" as the ontological foundation of law. In the first part, the conception of philosophy adopted by Kaufmann, initial characteristics of law — of reality which is the subject of analysis, as well as, the requirements for proper philosophical explanation of law posed by Kaufmann are introduced. In the second, Kaufmann's reconstruction of the process of the realisation of law is presented. Next, the conception of analogy which Kaufmann uses when explaining law is analyzed. In the fourth part, Kaufmann's conception of ontological foundations of law is discussed. A critical analysis is carried out in which I demonstrate that the theory of the ontological foundation of law proposed by Kaufmann and the concept of a person included in it do not allow a satisfac¬tory explanation of the phenomenon of "legal lawlessness" and lead to a number of difficulties in the philosophical explanation of law. Finally, the perspectives of a proper formulation of the issue of the ontological foundations of law are drafted in the context of the analyzed theory. My interest is centered on the conception of philosophy adopted by Kaufmann, according to which the existence of the reality is inferred on the basis of a certain configuration of the content of consciousness, whereas at the point of departure of philosophy of law, the data to be explained is a certain process, which is, basically, a process of cognition, while the reality appears only as a condition for the possibility of the occurrence of the process. I wish to argue that the difficulties which appear in the explanation of law are a consequence of the assumed fundamental philosophical solu¬tions, which seem to be characteristic, though usually not assumed explicitly, in philoso¬phy and theory of law dominant at present in continental Europe. Thereby, I wish to show the significance of ontological and epistemological solutions to the possibility of a proper formulation of the problems posed by philosophy and theory of law. Kaufmann proclaims himself in favour of a philosophy which poses questions about the ultimate foundations of understanding of the reality. In epistemology, he assumes that answers to the questions "What is reality like?" and ultimately "What is real?" are inferred on the basis of uniformity of a cognitive acts of different subjects. Cognition of the reality is accomplished exclusively through the content of conceptual material. The two fundamental questions posed by philosophy of law are "What is just law?" and "How is the just law enacted?" The latter is a question about the process of achieving a solution to a concrete case. Since, in Kaufmann's opinion, law does not exist apart from the process of its realisation, an answer to the question about the manner of realisation of law is of fundamental significance to answering the question: "What is law?" and to the explanation of the question about the ontological grounding of law, which is, as well, the foundation of justice. The proper solution has to take into account the moment of "non-dispositive" content of law; its positiveness understood as the reality and, at the same time, it has to point to the principles of the historical transformation of the content. Law, in the primary meaning of the word, always pertains, in Kaufmann's opinion, to a concrete case. A legal norm is solely the "possibility" of law and the entirely real law is ipsa res iusta, that which is just in a given situation. Determination of what is just takes place in a certain type of process performed by a judge (or by man confronted with a choice). Kaufmann aims to reconstruct this process. A question about the ontological foundation of law is a question about the ontological foundations of this process. In the analyzed theory it is formulated as a question about the transcendental conditions, necessary for the possibility of the occurrence of the process: how the reality should be thought to make possible the reconstructed process of the realisation of law. Kaufmann rejects the model for finding a concrete solution based on simple subsump¬tion and proposes a model in which concrete law ensues, based on inference by analogy, through the process of "bringing to conformity" that which is normative with that which is factual. Kaufmann distinguishes three levels in the process of the realisation of law. On the highest level, there are the fundamental legal principles, on the second legal norms, on the third — concrete solutions. The fundamental principles of law are general inasmuch as they cannot be "applied" directly to concrete conditions of life, however, they play an important part in establishing norms. A judge encounters a concrete situation and a system of legal norms. A life situation and norms are situated on inherently different levels of factuality and normativeness. In order to acquire a definite law both a norm (system of norms) and a life situation (Lebenssachverhalt) should undergo a kind of "treatment" which would allow a mutual conformity to be brought to them. Legal norms and definite conditions of life come together in the process of analogical inference in which the "factual state" ("Tatbestand") — which represents a norm, and in the "state of things" ("Sachverhalt") — which represents a specific situation are constructed. A "factual state" is a sense interpreted from a norm with respect to specific conditions of life. The "state of things" is a sense constructed on the basis of concrete conditions of life with respect to norms (system of norms). Legal norms and concrete conditions of life meet in one common sense established during the process of realisation of law. Mutatis mutandis the same refers to the process of composition of legal norms: as the acquisition of concrete law consists in a mutual "synchronization" of norms and concrete conditions of life, so acquisition of legal norms consists of bringing to conformity fundamental principles and possible conditions of life. According to Kaufmann, both of these processes are based on inference through analogy. As this inference is the heart of these processes it is simultaneously a foundation finding just law and justice. How does Kaufmann understand such an inference? As the basis for all justice he assumes a specifically interpreted distributive justice grounded on proportionality. Equality of relations is required between life conditions and their normative qualification. Concrete conditions of life are ascribed normative qualification not through simple application of a general norm. More likely, when we look for a solution we go from one concrete normative qualified case to another, through already known "applications" of norms to a new "application". The relation between life conditions and their normative qualifica¬tion has to be proportional to other, earlier or possible (thought of) assignments of that which is factual to that which is normative. Law as a whole does not consist of a set of norms, but only of a unity of relations. Since law is a, based on proportion, relative unity of a norm and conditions of life, in order to explain law in philosophical manner, the question about ontological base of this unity has to be asked. What is it that makes the relation between a norm and conditions of life "non-dispositive"? What is the basis for such an interpretation of a norm and case which makes it possible to bring a norm and conditions of life into mutual "conformity"? This is a question about a third thing (next to norms and conditions of life), with respect to which the relative identity between a norm and conditions of life occurs, about the intermediary between that which is normative and that which is factual and which provides for the process of establishing of norms, as well as, finding solutions. It is the "sense" in which the idea of law or legal norm and conditions of life have to be identical to be brought to mutual "conformity". In Kaufmann's opinion such a sense is nothing else but the "nature of things" which determines the normative qualification of the reality. Since establishment of this "sense" appears to be "non-dispositive" and controlled inter-subjectively (namely, other subjects will reach a similar result) so, in conformity with the convergent concept of truth, the "nature of things" must be assigned a certain ontological status. According to Kaufmann this is a real relation which occurs between being and obligation, between the conditions of life and normative quality. However, it should be underlined that from the point of view of the analyzed system the "nature of things" is a correlate of constructed sense, a result of a construction which is based on the principle of consistent understanding of senses ("non-normative" and "normative") and is not a reality which is transcendent against the arrangement of senses. In Kaufmann's theory, inference from analogy appears to be a process of reshaping the concepts (senses) governed by tendency to understand the contents appearing in relations between that which is factual and that which is normative in a consistent way. The analogical structure of language (concepts) and recognition of being as composed of an essence and existence is an indispensable requirement for the possibility of the realisation of law, based on specifically understood inference from analogy. It is necessary to assume a moment of existence without content which ensures unity of cognition. Existence emerges thus as a condition of the possibility of cognition. According to Kaufmann, the "nature of things" is the heart of inference through analogy and the basis for establishment of finding of law. Inference from the "state of things" to a norm or from a norm to the "state of things" always means inference through the "nature of things". The "nature of things" is the proper medium of objective legal sense sought in every cognition of law. In Kaufmann's view, the question whether the "nature of things" is ultima ratio of interpretation of law or is only a means of supplement gaps in law or whether it is one of the sources of law, is posed wrongly. The "nature of things" serves neither to supplement the gaps nor is it a source of law as, for example, a legal norm may be. It is a certain kind of "catalyst" necessary in every act of making law and solving a concrete case. Owing to "nature of things" it is possible to bring to a mutual conformity the idea of law and possible conditions of life or legal norms and concrete conditions of life. In Kaufmann's conception the "nature of things" is not yet the ultimate basis for understanding the "non-dispositiveness" of law. The relation between obligation and being is determined in the process of the realisation of law. Both the process itself and that which is transformed in this process are given. A question about the ontological bases of "material" contents undergoing "treatment" in the process of the realisation of law and about being which is the basis of regularity of the occurrence of the process arises. Only this will allow an explanation that the result of the process is not optional. Thus, a question about reality to which law refers and about the subject realising the law has to be formed. To this, Kaufmann gives the following answer: that which is missing is man but not "empirical man" but man as a "person". A "person" understood as a set of relations between man and other people and things. A "person" is the intermediary between those things which are different — norm and case are brought to conformity. A "person" is that which is given and permanent in the process of the realisation of law. It determines the content of law, is "subject" of law; this aspect is described by Kaufmann as the "what" of the process of realisation of law. A "person" consists of precisely just these relations which undergo "treatment" in the process. On the other hand, a "person" is "a place" in which the processes of realisation of law occur, it is the "how" of normative discourse, a "person" is that which determines the procedure of the process, being "outside" of it. This aspect of a "person" is connected with the formal moment of law. A "person" being, at the same time, the "how" and the "what" of the process of the realisation of law, is also, to put it differently, a structural unity of relation and that which constitutes this relation (unity of relatio and relata). According to this approach a "person" is neither an object nor a subject. It exists only "in between". It is not substance. Law is the relation between being and obligation. That which is obligatory is connected with that which is general. That which is general does not exist on its own, it is not completely real. Accordingly, a "person" as such is also not real. It is relational, dynamic and historical. A "person" is not a state but an event. In Kaufmann's opinion, such a concept of a "person" helps to avoid the difficulties connected with the fungibility of law in classical legal positivism. A "person" is that which is given, which is not at free disposal and secures the moment of "non-dispositiveness" of law. Kaufmann concludes: "The idea (»nature«) of law is either the idea of a personal man or is nothing". Theory points at the structure of realising law and explains the process of adoption of general legal norms for a concrete situation. The analysis has shown however, that in this theory a satisfactory answer to the question about the ultimate foundations of law is not given. It seems that in the analyzed theory the understanding of human being takes place through understanding of law. What is good for man as a "person", what is just, what a "person" deserves may be determined only against the existing system of law. A "per¬son" adopted as a basis of law is the reality postulated in the analysis of the process of the realisation of law. It is a condition of possibility of this process ( explaining, on one hand, its unity and, on the other hand, the non-dispositive moments stated in this process). A "person" in the discussed theory is entirely defined by the structure of law, it can be nothing more than that which is given in law, what law refers to, what law is about. Being, which is a "person", is constituted by relations between people and objects, the relations which are based on fundamental links between norms and conditions of life established in a process of bringing them to conformity. It has to be assumed that man as a "person" is a subject of law only as far as realising law "treats" given senses according to their current configuration. The system of law is a starting point and it describes in content what man is as a "person". Moreover, being a "person" is the condition for entering legal relations. Consistently, Kaufmann writes that "empirical man" is not the subject of law, man is not "out of nature" a "person". People become "persons" due to the fact that they acknowledge each other as "persons" — acknowledging, at the same time, law. This acknowledgement is a con¬dition of existence, of the possibility of the occurrence of process of realisation of law and of constituting legal relations which ultimately constitute a "person". Kaufmann assumes, that law tends towards a moral aim: it may and must create an external freedom, without which the internal freedom to fulfil moral obligations cannot develop. However, this postulate is not based on the necessary structure of human being. From the point of view of his system, it is nothing more than only a condition for the possibility of the occurrence of the process of the realisation of law — lack of freedom would destroy the "how" of this process. Thus, the postulate to protect the freedom of personal acts has to be interpreted, in accordance with the analyzed theory, as a postulate, the fulfilment of which aims ultimately at the accomplishment of the very same process of realisation of law itself and not the realisation of a given man. Kaufmann considers a "person" to be an element which unites the system of law as a whole. Law is a structure of relations, which are interdependent and inter-contingent. Consequently, a "person" which is to form the ontological basis of law has to be entity consisting of all relations. Being also the "how" of the process of realisation of law, if a "person" is to warrant its unity, it has to be a common source for all procedures. Hence, a single "person" would constitute a subject of law. Man appears to be only a moment of a certain entirety, realisation of which should be an aim of his actions. Law, creating a "person" as an object and subject of law becomes a primary entity. In the analyzed theory, the basis for determination of aims which law sets to man is not the allocation of man-subject to something which improves him but rather, such relation is only just constituted by law. A question appears, why should aims set in law also be the aims of "empirical man"? Why is this "empirical man" to be punished in the name of a "person" understood in such a way? If, however, it is assumed that what is man is determined by a system which is superior to him, then man has to be understood only as a part of a whole and there are no grounds to prohibit istrumental treatment of man and so the road to all aspects of totalitarianism might be opened. A problem of the application of created theory to the reality arises, the reality which the theory pretends to explain. Ultimately in his theory Kaufmann does not give any systemic grounds for a radical questioning of the validity of any legal norms. Every new norm becomes an equal part of system of norms. It is only its interpretation and application to given conditions of life that may be disputable, however, this refers to all norms without exception. Cohesive inter-pretation of norms and applications is necessary and sufficient for the acquisition of just law. New norms have to be interpreted in the light of others, correspondingly, the other norms require reinterpretation in the light of the new ones. Contradiction in interpretation of a norm does not form a basis for questioning norms but may serve only to question the manner of their interpretation (understanding). Therefore, no grounds exist to assume any legal norm as criminal or unjust, and in consequence, to question any consistently realised system based on formally, properly established norms, as "legal lawlessness". As law and a "person" do not exist without the process of realisation of law, the role of legal safety becomes crucial as the condition for the possibility of the occurrence of the process of realisation of law. Denying legal safety would be tantamount to negation of law in general (also of moral law) as negation of safety takes away, at the same time, the basis for occurrence of the process of realisation of law. Moreover, any lack of legal safety would also mean lack of a basis for the existence of man as a "person". Kaufmann's thesis, that civil disobedience is legalized only when it has a chance to lead to success, consistent with his concept of the foundations of law, seems to point directly to conclusions which deny the facts taken under consideration and doubtlessly Kaufmann's own intentions, since it would have to be assumed that accordingly there are no grounds to question a legal system in force based on violence which secures its operation. Force finally seems to determine which one of the mutually irreconcilable normative systems constitute law and which does not. A legitimate position is one which leads to success, it is the weaker system which is negated. If so, then basically violent imposition of law is not an act directed against the law in force but, to the contrary, realisation of law. In the context of the new system the former system of law may be talked about as unjust solely in the sense of being incapable of being consistently united with the new. However, at the base, ultimately, lies force which reaffirms differences and excludes from the process of realisation of law certain norms and their interpretations. Kaufmann was aiming at grounding of that which is "non-dispositive" in a certain given framework of interpretation. Nevertheless, he does not provide foundations for the understanding of phenomena, which he undertakes to explain at a point of departure. Instead of explaining them the theory negates the possibility of their existence. The reality postulated in regard to "non-dispositive" moments of the reconstructed process of acquiring law consist of a specifically understood "person", which appears in Kaufmann's conceptions as a condition of the possibility of the realisation of law. According to this approach understanding of a "person" may be only a function of law. To understand "legal lawlessness" and foundations of justice it is necessary to look for such theory of law in which understanding of man as a "person" and being is not a function of understanding of law (in which a "person" is not only a condition for possibility of reconstructed process of realisation of law; for possibility of cognition processes). It seems necessary to start from theory of being and a "person" based on broader experience than the one assumed by Kaufmann and reconstruct the ontological foundations of the process of realisation of law only in such perspective. Kaufmann points out that that to which law refers is ipsa res iusta a concrete relation of man to other people and things. This relation, in his theory, appears to be basically only just constituted by law (normative senses "applied" to conditions of life). Therefore, understanding the relation between a given man and other people and things which constitute the aim of his actions, that is understanding of good, is enacted against the background of constitution of senses; constitution which is a result of a process aiming towards consistent understanding of particular contents (of nor¬mative and non-normative senses). "Being" is secondary towards constructed senses it is only their correlate. The primary relation consists of relation of a man to law (system of norms), while the secondary relation is one of man to something which is the aim of his action (relation between man and good). Considering such approach it is difficult to envision a satisfying answer to the fundamental question: why does law put concrete man under any obligation to obey it? The source of this problem can be seen in reduction of the base for understanding good to content of obligation formulated in auto-reflection. Such reduction seems to be a consequence of Kaufmann's adoption of "convergent concept of truth" and in con¬sequence his recognition of indirect, essentialistic grasp of reality formulated in concepts as the basic and only foundation of theory of being and of law. In view of such an approach, analogy of law, concepts and being is the condition for the possibility of the process of transformation of senses which aims at consistent interpretation of all law. Existence is postulated with respect to the possibility of unity of experience and cognition. However, also a different approach to understanding of the problem of being and good is possible. In spontaneous cognition being is affirmed, first of all, not as a certain, non-contradictory, determined content, but as something existing. Together with a cer¬tain content (passed indirectly through notions) existence of being is co-given. The basis for unity of being is not formed by the consistence of content, as it is in the case of the theories departing from the analysis of cognition processes, but by an act of existence realising content (essence). Such an approach makes it also possible to go beyond the convergent concept of truth. It is worth mentioning that allocation of an agent to good is realised not only by the content of duty. A statement that something is good is primary with respect to determination of this good in content. The recognised good always bears some content, however, there are no reasons to base the concept of good exclusively on indirect, formulated in concepts cognition. As primary, can be adopted the relation of man to good and not of man to law. Determination in content appears to be only an articulation of aspectual cognition of being, as an object of action. In such a case the basis for relative unity of norm and conditions of life is not the "nature of things" understood as correlate of sense but it is relation to good based on internal constitution of man as potential, not self-sufficient being. It does not mean, that the moments of the process of realisation of law singled out by Kaufmann are not important to determination of what is just. He, quite rightly, points to significant role played by norms in the evaluation of concrete situations, in man's search for closer specification in content of good innate to him. The structure of process of determining law for a concrete situation, to a great degree corresponds to the processes of determining law which take place not only in the legal sciences. Kaufmann's analyses of the process of realisation of law show the complexity of the structure of these processes and point towards important moments allowing a better understanding of law and man. Nevertheless, these analyses cannot be a basis for construction of philosophical theory of law, theory which hopes to point out the ultimate, ontological foundations for understanding law. Kaufmann's results may become fully valid only in a more general perspective including broader experience at the point of departure. (shrink)

I would say very simply that the function of the intellectual is this: to put at the disposal of others, to put in common, this greater set of critical analytical tools, to make those tools freely available, and this naturally demands being rooted in reality that is in movement, a reality in which the researcher herself puts certain choices into practice, in which she can deem some matters to be more crucial than others. And the hope is, depending (...) on the choices made by all of those who are today committed to transforming that which exists, that there effectively comes about the wide-ranging social transformation of which we are in need.Costa’s definition of the intellectual is both inspiring and radical. Her.. (shrink)

Consumer autonomy is a fundamental topic for marketing ethics scholars. Nonetheless, autonomy’s philosophical treatment may have compromised its conceptual clarity. After reviewing the relevant ethics literature on consumer autonomy, the benefits of formally defining consumer autonomy are illustrated, and a novel formalization is adapted from potential performance theory mathematics. The goal is to transfigure a hitherto amorphous topic via a mathematical formalization that defines true autonomy, actual autonomy, reliability of wills, and reliability of product choice. The crucial and (...) surprising result: an action that decreases true autonomy can increase actual autonomy if that action engenders a sufficient increase in one or both types of reliability. Relating the insights from the formalization to the long-standing debates in consumer autonomy suggests fruitful avenues for future research. (shrink)

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in (...) the criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Under Confucian Eyes: Writings on Gender in Chinese History, and: Women in DaoismZhou YiqunUnder Confucian Eyes: Writings on Gender in Chinese History. Edited by Susan Mann and Yu-yin Cheng. Berkeley: University of California Press, 2001. Pp. xiii + 310.Women in Daoism. By Catherine Despeux and Livia Kohn. Cambridge, MA: Three Pines Press, 2003. Pp. viii + 296.Anyone who looks for a quick taste of what is exciting and (...) important about the research of the past two decades on Chinese women's history should pick up the reader edited by Susan Mann and Yu-yin Cheng. In eighteen chapters, each with a translator's preface and an introduction to the selected text, Under Confucian Eyes: Writings on Gender in Chinese History covers the period from the Tang to the Qing (when the Confucian orthodoxy steadily became entrenched), includes twelve genres, foregrounds women's own voices, and repeatedly introduces the non-Han peoples to the spotlight. The guiding standard for the choice of the diverse, rich, and in many cases new historical materials in the book is that they form a "dialogue" with and provide a "counterpoint, critique, or confirmation" of Confucian values and norms about gender roles (p. 5). The clearheaded and balanced attention to not only "counterpoint" and "critique" but also "confirmation" produces a dynamic and nuanced picture of Chinese gender relations that is radically different from the old stereotypes and yet remains firmly grounded in the reality of a society where Confucianism provided the most important system of values and institutions against which almost all other ideas and practices in traditional China have to be understood.The most crucial confirmed point is perhaps the high value set on family and household in Confucianism, which serves here to explain the considerable power and influence that Chinese women were able to wield despite their confinement in the inner quarters. The funerary biographies by Chen Liang (chapter 4), Luo Rufang (chapter 6), and Zhang Xuecheng (chapter 14), all eminent Confucian scholars, commemorate [End Page 684] women who upheld their families with principle, courage, and practical wisdom and attribute to them their kinsmen's success and sometimes sheer survival. As evidence from the other end is a letter that Gu Ruopu, a seventeenth-century matriarch and poet, wrote to her sons, in which she asserts "every fiber and every grain that this family owns are the fruits of my industry and hardship over several decades" and offers household instructions with indisputable authority (chapter 9). Always keeping in mind the assertiveness and authority of a matriarch like Gu and the deep admiration and emotion shown in the three biographies by the male elite will help us understand the recognition of women's functions and contributions in Confucian ethics and put in the right perspective the alternative means of self-fulfillment for Chinese women that is abundantly featured in the same volume.In its broad representation of alternative value systems, multiple voices in a single author or text, and formerly ignored populations and practices, the book offers an excellent sampling of the recent research agendas in Chinese women's history. Religion provides a prime example of the areas where the discovery and celebration of diversity and multiplicity are the order of the day. The two Daoist and Buddhist hagiographies (chapters 1, 2) and a rare extant autobiography of a Buddhist laywoman (chapter 8) set religious salvation above and against the obligations of family life.These voices of discontent form a contrast with the biographies by Luo Rufang and Zhang Xuecheng (chapters 6, 14), which either suggest a possible resolution of the conflict within the domestic context or insinuate highly ambiguous meanings of religion for contented Chinese mothers and wives. Besides religious and spiritual cultivation, communities such as poetry societies are shown as providing women with strong intellectual and emotional support beyond the kinship network (chapters 11, 12), and literary authorship creates an illusory world in which a frustrated woman of talent seeks communion with former worthies (chapter 16). Romantic love is likewise shown to be in a position to contend with family relationships, as suggested by the contrasting treatments of love letters and family letters in the seventeenth-century epistolary... (shrink)

This essay is my review of economist Mark Skousen’s book, The Big Three in Economics. In it, he discusses the economic work of Adam Smith, Karl Marx, and John Maynard Keynes. He gives even-handed treatments of the major contributions of each, for example, Smith’s reputation refutation of mercantilist policies and Smith’s crucial insight into the role that division of labor plays in economic growth. My only complaint is that Skousen doesn’t adequately explain his choice of Marx as a great (...) economist. What enduring contributions did he make to the field? Why name him rather than (say) David Ricardo? (shrink)

Crisis resolution and home treatment (CRHT) teams have been introduced into mental health care in the UK because, in general, patients do not want to be admitted to hospital, treatment at home is cheaper and in the only randomized controlled trial conducted so far there was no difference in symptomatic outcome. However, because of compulsory gate-keeping by CRHT teams, some patients no longer have the option of going to hospital if they want to. This aspect of the introduction (...) of CRHT teams has not been discussed so far, but it certainly warrants further examination. Intervention through CRHT teams may in fact increase compulsory admissions and serious and untoward incidents, although this is not certain. Sufferers from psychosis are the patient group most likely to be compulsorily admitted to hospital and they are generally considered less responsible for serious and untoward incidents. Therefore, a possible solution could be to offer a choice to some patients, namely those with a psychotic disorder, on whether they want to be admitted or not. At least one should investigate what the consequences of this policy would be, if it were to be adopted in a test region. This example shows that in developing policies for rationing health care, it can be important to look at subgroups and not just at average results when determining the best course of action. (shrink)

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. (...) Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed. (shrink)

Opioid treatment agreements are written agreements between physicians and patients enumerating the risks associated with opioid medications along with the requirements that patients must meet to receive these medications on an ongoing basis. The choice to use such agreements goes beyond the standard informed consent process, and has a distinctive symbolic significance. Specifically, it suggests that physicians regard it as important to hold their patients accountable for adhering to various protocols regarding the use of their opioid medications. After laying (...) out a taxonomy of accountability relationships between physicians and patients, I argue that opioid treatment agreements are only justifiable for physicians to use in their provision of care if they improve public health outcomes, which has yet to be demonstrated. (shrink)

I call an experiment “crucial” when it makes possible a decisive choice between conflicting hypotheses. Joharmsen's selection for size and weight within pure lines of beans played a central role in the controversy over continuity or discontinuity in hereditary change, often known as the Biometrician-Mendelian controversy. The “crucial” effect of this experiment was not an instantaneous event, but an extended process of repeating similar experiments and discussing possible objections. It took years before Johannsen's claim about the genetic stability (...) of pure lines was accepted as conclusively demonstrated by the community of geneticists. The paper also argues that crucial experiments thus interpreted contradict certain ideas about the underdetermination of theories by facts and the theory-ladenness of facts which have been influential in recent history and sociology of science. The acceptance of stability in the pure lines did not rest on prior preference for continuity or discontinuity. And this fact permitted a final choice between the two theories. When such choice is characterized as “decisive” or “final”, this is not meant in an absolute philosophical sense. What we achive in these cases is highly reliable empirical knowledge. The philosophical possibility of drawing (almost) any conclusion in doubt should be distinguished from reasonable doubt in empirical science. (shrink)

With the advancement of medical technology, various life-sustaining treatments are available at the end of life. Older adults should be encouraged to establish their end-of-life treatment preferences (ELTP) while they are physically and mentally able to do so. The purpose of this study was to explore ELTP among older adults and to compare those preferences in a subset of individuals who had reported their ELTP in a survey completed the previous year. This was a descriptive study of 191 older (...) adults living in a continuing care retirement community. Approximately half of the participants did not want cardiopulmonary resuscitation, to be put on a respirator, or to receive dialysis. The findings in this study suggest that many older adults do not want aggressive interventions at the end of life, but choose rather those measures that will keep them comfortable. Moreover, treatment choices may change over time. Health care providers should initiate discussions about ELTP at regular intervals (yearly) to assist older adults in dictating their end-of-life care. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from (...) some sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

This paper explores some issues about the choice of variables for causal representation and explanation. Depending on which variables a researcher employs, many causal inference procedures and many treatments of causation will reach different conclusions about which causal relationships are present in some system of interest. The assumption of this paper is that some choices of variables are superior to other choices for the purpose of causal analysis. A number of possible criteria for variable choice are described and (...) defended within a broadly interventionist approach to causation. (shrink)

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for auton omy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty. Patients attempting to choose the best practitioner do not have (...) data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge. The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery sys tem. (shrink)

This paper deals with the interpretation and distribution of universal Free Choice (FC) items, such as English FC any or Spanish cualquiera. Crosslinguistically, universal FC items can be characterized as follows. First, they have a restricted distribution. Second, they express freedom of choice: the sentence You can take any card conveys the information that the addressee is free to pick whichever card she chooses. Under standard assumptions, the truth conditions of sentences like You can take any card are taken to (...) be captured by formalizations in which a universal quantifier ranging over individuals has wide scope over the possibility modal. The crucial observation that informs the account in this paper is that this type of formalization cannot capture the freedom of choice component. I will argue that in order to derive the right interaction between possibility modals and FC items, we need to add an exclusiveness condition to the standard wide scope paraphrases. The same proposal that guarantees freedom of choice will automatically account for the distribution restrictions of FC items. The formal implementation of this proposal is cast in the Hamblin semantics proposed in Kratzer and Shimoyama (Indeterminate phrases: The view from Japanese, 2002). (shrink)

After the US Supreme Court’s reversal of Roe v. Wade, a number of states have immediately banned abortion. Pro-choice activists are responding by promoting medication abortions – a do-it-yourself form of abortion. Women can take pills at home to induce an abortion in the first few weeks of pregnancy. -/- The Biden Administration [1] has backed the abortion pill, too. Attorney-General Merrick B. Garland and Health and Human Services Secretary Xavier Becerra both issued statements endorsing it. -/- “We stand ready (...) to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care,” said the Attorney-General. “In particular, the F.D.A. has approved the use of the medication mifepristone. States may not ban mifepristone based on disagreement with the F.D.A.’s expert judgment about its safety and efficacy.” -/- As the New York Times [1] has noted, this sets the scene for legal battles. The obvious one is: will anti-abortion states prosecute medication abortions? -/- But – based on experience in the United Kingdom - the use of the abortion pill could give pro-life doctors headaches as well. -/- In the past year, UK has witnessed the saga of two Catholic doctors who have been brought in front of the professional regulator, the General Medical Council, after accusations of professional misconduct. Their crime? They had supplied abortion pill reversal (APR) treatment to women. Accusations of this misconduct have been brought forward by pro-choice organisations [2]. -/- The problem is that some women might panic when they discover that they are pregnant or are pressured to make a rash decision. They obtain abortion pills, often without seeing a doctor faceto- face, and soon after taking the first pill, they regret their decision. -/- Is it too late for them to save their pregnancy? Not necessarily. -/- A treatment developed in the US works about half the time. It involves the woman taking progesterone after the first abortion pill to counteract the abortifacient action of the drug. -/- Seventy-three women in the UK are reported to have taken a full APR course, of whom, 38 – more than half — successfully remained pregnant. Admittedly, the procedure is controversial [3], with pro-choice writers denouncing it as unproven, unscientific, and unethical. This has triggered some healthcare practitioners and scholars to analyse the commitments of the pro-choice movement to APR. In a recently published paper in The New Bioethics [4], two colleagues, Dominic Whitehouse and Steven Bow, and I argue that those espousing a pro-choice worldview should actually support abortion pill reversal and that the current evidence indicates that they should actually be doing it. -/- While some pro-choice activists might be happy simply to expand women’s reproductive choices, some might also want to ensure that these choices are safe and effective at achieving the desired outcome, which in principle includes maintaining a pregnancy. -/- We then review the scientific evidence with respect to the ability of APR to halt an abortion, look at the potential impact of APR on mental health, as well as its procedural safety. While highlighting that gold-standard evidence is lacking, we note that APR is associated with about two times higher rate of embryo survival compared to not completing the full early medical abortion course, that there is large agreement in the literature that women who are ambiguous about abortion are at risk of poorer mental health outcomes after abortion (and argue that women who request APR fall into this category), and highlight that there is no evidence that APR is more dangerous than abandoning an initiated early medical abortion. -/- The latter fact is important, as the results of the only randomised-controlled trial of APR have been at times misrepresented in the media [5.6], creating the impression that APR is not safe while most of the adverse effects occurred in the study group that did not receive APR. As our paper argues, with respect to APR the two UK doctors were “champions of women’s choice and should be congratulated, not condemned, by pro-choice advocates”. -/- While the cases against the two doctors have now been dropped (and there have even been accusations against a member of one of these pro-choice organisations that they pressurised a patient into complaining about one of the doctors and twisted the patient’s experience of the treatment [7]), we argue that it is important to set-up systems to facilitate the future provision of APR to protect both patients and healthcare staff. -/- Our conclusion is that, while being open to any change in evidence, those espousing a pro-choice outlook should “support calls for an APR framework that will protect women and the healthcare professionals caring for them” “and certainly not oppose” APR. -/- The debate over abortion pill reversal will be heading to the United States soon. It is quite possible that it will be denounced as dangerous misinformation. It’s not. But pro-life defenders should be prepared to defend their ground. -/- This article was first published by Mercatornet. (shrink)

The idea to use choice functions in the semantic analysis of indefinites has recently gained increasing attention among linguists and logicians. A central linguistic motivation for the revived interest in this logical perspective, which can be traced back to the epsilon calculus of Hilbert and Bernays (1939), is the observation by Reinhart (1992,1997) that choice functions can account for the problematic scopal behaviour of indefinites and interrogatives. On-going research continues to explore this general thesis, which I henceforth adopt. In this (...) paper I would like to address the matter from two angles. First, given that the semantics of indefinites involves functions, it still does not follow that these have to be choice functions. The common practise is to stipulate this restriction in order to get existential semantics right. However, a so-far open question is whether there is any way to derive choice function interpretation from more general principles of natural language semantics. Another question that has not been formally accounted for yet concerns the relationships between choice functions and the ``specificity'' ``referentiality'' intuition of Fodor and Sag (1981) about indefinites. Is there a sense in which choice functions capture this popular pre-theoretical notion? In order to answer these questions, this paper proposes a revision in the treatment of choice functions in Winter (1997), leaving its linguistic predictions unaffected but changing slightly the compositional mechanism. This modification opens the way for proving the following theorem: function variables in the analysis of the noun phrase must denote only choice functions and can derive only the standard existential analysis by virtue of the conservativity, logicality and non-triviality universals of Generalized Quantifier Theory as proposed in Barwise and Cooper (1981), Van Benthem (1984), Thijsse (1983) and others. The same implementation also captures the ``specificity'' notion: indefinites with a non-empty restriction set denote principal ultrafilters in the revised formalization. These are the quantificational correlates to ``referential'' individuals.. (shrink)