BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

Thirty years after Lewis's paper, this book brings together some of the most important recent work connecting—or, in some cases, disputing the connection ...

Among the many philosophers who hold that causal facts1 are to be explained in terms of—or more ambitiously, shown to reduce to—facts about what happens, together with facts about the fundamental laws that govern what happens, the clear favorite is an approach that sees counterfactual dependence as the key to such explanation or reduction. The paradigm examples of causation, so advocates of this approach tell us, are examples in which events c and e— the cause and its effect— both occur, (...) but: had c not occurred, e would not have occurred either. From this starting point ideas proliferate in a vast profusion. But the remarkable disparity among these ideas should not obscure their common foundation. Neither should the diversity of opinion about the prospects for a philosophical analysis of causation obscure their importance. For even those philosophers who see these prospects as dim—perhaps because they suffer post-Quinean queasiness at the thought of any analysis of any concept of interest—can often be heard to say such things as that causal relations among events are somehow “a matter of” the patterns of counterfactual dependence to be found in them. (shrink)

Action explanations like ‘I am heading to the ferry because the bridge is closed,’ are supposed to require restatement: ‘I am... because I believe the bridge is closed,’ because (i) the objective claim may be false though the intended explanation is correct, and (ii) because objective circumstances have to be cognitively mediated if they are to bear on action. This supposition is rejected here. Restatements cannot withdraw the objective claim without withdrawing the explanation. In the context of reason‐giving, belief statements (...) do not function as assertions about the inner life. The fact that belief statements may be true though the belief itself is false creates the illusion of distinctive subject matters. The illusion is exploited by conceptions of belief positing stored representations. Even if there were such representations, retrieved for the sake of expressing previously acquired beliefs, the expression of belief must endorse p and cannot merely advert to the existence and content of a representation. The reverse of the standard philosophical view about restatement is actually correct. Wherever an agent correctly adduces a belief that an objective circumstance obtains in explaining his action, a de‐psychologizing restatement that merely makes the objective claim must be ascribable to the agent. (shrink)

Borg (2009) surveys and rejects a number of arguments in favour of semantic internalism. This paper, in turn, surveys and rejects all of Borg's anti-internalist arguments. My chief moral is that, properly conceived, semantic internalism is a methodological doctrine that takes its lead from current practice in linguistics. The unifying theme of internalist arguments, therefore, is that linguistics neither targets nor presupposes externalia. To the extent that this claim is correct, we should be internalists about linguistic phenomena, including semantics.

A plausible thought about vagueness is that it involves semantic incompleteness. To say that a predicate is vague is to say (at the very least) that its extension is incompletely specified. Where there is incomplete specification of extension there is indeterminacy, an indeterminacy between various ways in which the specification of the predicate might be completed or sharpened. In this paper we show that this idea is bound to founder by presenting an argument to the effect that there are vague (...) predicates which cannot be sharpened in such a way as to meet certain basic constraints (of penumbral connection and public accessibility) that must be imposed on the very notion of a sharpening. (shrink)

This is an encyclopedia article about epistemic closure principles. The article explains what they are, their various philosophical uses, how they are argued for or against, and provides an overview of the related literature.

Rationalizations of deliberation often make reference to two kinds of mental state, which we call belief and desire. It is worth asking whether these kinds are necessarily distinct, or whether it might be possible to construe desire as belief of a certain sort — belief, say, about what would be good. An expected value theory formalizes our notions of belief and desire, treating each as a matter of degree. In this context the thesis that desire is belief might amount to (...) the claim that the degree to which an agent desires any proposition A equals the degree to which the agent believes the proposition that A would be good. We shall write this latter proposition ‘A◦’ (pronounced ‘A halo’). The Desire-as-Belief Thesis states, then, that to each proposition A there corresponds another proposition A◦, where the probability of A◦ equals the expected value of A. (shrink)

For nearly half a century, Quentin Skinner has been the world's foremost interpreter of Thomas Hobbes. When the contextualist mode of intellectual history now known as the “Cambridge School” was first asserting itself in the 1960s, the life and writings of John Locke were the primary topic for pioneers such as Peter Laslett and John Dunn. At that time, Hobbes was still the plaything of philosophers and political scientists, virtually all of whom wrote in an ahistorical, textual-analytic manner. Hobbes had (...) not been the subject of serious contextual research for decades, since the foundational writings of Ferdinand Tönnies. For Skinner, he was thus an ideal subject, providing a space for original research on a major figure, and an occasion for some polemically charged methodological manifestos. Both of these purposes animated his 1965 article “History and Ideology in the English Revolution,” and his 1966 article “The Ideological Context of Hobbes's Political Thought”. The latter of these remains to this day one of the most widely cited scholarly articles in the fifty-year run of Cambridge's Historical Journal. Among other results of these early efforts was the scholarly controversy during which Howard Warrender chided Skinner for having reduced the “classic texts in political philosophy” to mere “tracts for the times”. (shrink)

Based on a conference held Apr. 4-5, 2008 at Amherst College.

It has been speculated, by Chomsky and others, that our capacity for scientific understanding is not only enabled but also limited by a biologically endowed science forming faculty . I look at two sorts of consideration for the SFF thesis and find both wanting. Firstly, it has been claimed that a problem‐mystery distinction militates for the SFF thesis. I suggest that the distinction can be coherently drawn for cases, but that the purported‘evidence’for even a fairly lose general demarcation of problems (...) and mysteries is not best explained by a SFF. Secondly, I consider in detail a range of cognitive considerations for the SFF thesis and contend that it is at best moot whether science can be so construed as to make it feasible that it is a faculty competence. (shrink)

The interaction between science and technology in the Industrial Revolution has been debated by various authors over the years. Most recently, Ursula Klein has described eighteenth-century chemistry as an interconnected system of science and technology because of the inherently productive nature of chemical experimentation. The technology used in the nineteenth gaslight industry follows the pattern that Klein describes: gaslight technology was derived from the academic studies of eighteenth-century pneumatic chemists. The foundation of the technology in science included first, a knowledge (...) about inflammable gases and their properties, and second, various instruments and processes developed for the study of gases. Although inflammable exhalations had been known long before the eighteenth-century, it was only with the work of Priestley, Volta, Berthollet, and other chemists that their properties and characteristics, including the multiplicity of species of inflammable gases, became known. The instruments and processes of pneumatic chemistry that were incorporated into gaslight apparatus were the retort, the pneumatic trough, lime purification of carbon dioxide and hydrogen sulphide, and finally the gasometer. The first important instance of lighting with inflammable gases, that of J. P. Minckelers in 1785, demonstrates that pneumatic chemistry formed part of an interconnected network of science and technology, as does the work of other early gaslight pioneers such as Philippe Lebon, Zachäus Winzler, and William Murdoch. Lebon came to gaslight through the investigation of distillation processes, and later thought of using the inflammable gas produced in this way. Zachäus Winzler, an Austrian chemist, recreated Lebon's thermolamp from the instruments in his laboratory after hearing descriptions of it. In the case of William Murdoch, he incorporated the pneumatic apparatus that James Watt had built for Thomas Beddoes. (shrink)

This article addresses the question of what God's ultimate purposes might be for creating the world, focusing particularly on what His purpose might have been in creating the world via a seemingly partly chance-driven evolutionary process. It argues that God's creation of human beings and other living organisms through an evolutionary process allows for richer and deeper sorts of interconnections between humans and non-human creation than would otherwise be possible. These interconnections are of significant value, mainly because they allow for (...) creation to become more deeply united with ourselves, in fact so united that there exists a deep communion between us and the rest of creation. This communion is not only an intrinsic good, but it enriches us, since part of this communion is creation becoming part of our very self, and thus we consciously share in the richness of creation. (shrink)

Action research has repeatedly demonstrated how it can facilitate problem solving and change in many settings through a process of collaboration which is driven by the community at the heart of the research. The ethical review of action research can be challenging for action researchers and research ethics committees. This paper explores how seven ethical principles can be used by action researchers and research ethics committees as the basis for ethical review. This paper concludes by offering some suggestions for a (...) way forward for both action researchers and research ethics committees. (shrink)

The word 'archaic' derives from the Greek arkhaios, which in turn is related to the word archē, meaning 'principle', 'origin', or 'cause'; the notion of ecstasy, or ekstasis, implies standing outside or beyond oneself, a self-transcendence. How these two concepts are articulated and co-implicated constitutes the core question underlying this edited collection, which examines both the present day and antiquity in order to trace the insistent presence of the ecstatic amid the archaic. Presented in three parts, the contributors to this (...) diverse book take the concept of the archaic in an entirely new direction. Part I, 'Ecstasy and the psychological', covers topics including Jung, Freud, ancient psychotherapy, desire, and theatre. Part II, 'Ecstatic-archaic history', considers Ludwig Klages, Orestes and Dionysus. Finally, Part III, 'Ancient ecstatic in other worlds', examines Luo Guanzhong's Three Kingdoms and Enki at Eridu. The collection offers a distinctive contextualisation of the dimension of the archaic in relation to the ecstatic experience. The Ecstatic and the Archaic will appeal to readers interested in the relationship between ancient and postmodern worlds, and in how the past manifests itself in the present. It will be of great interest to academics and students of Jungian and post-Jungian ideas, classical religions and the history of ideas, as well as practitioners of analytical psychology and psychoanalysis. (shrink)

Most content externalists concede that even if externalism is compatible with the thesis that one has authoritative self-knowledge of thought contents, it is incompatible with the stronger claim that one is always able to tell by introspection whether two of one’s thought tokens have the same, or different, content. If one lacks such authoritative discriminative self-knowledge of thought contents, it would seem that brute logical error – non-culpable logical error – is possible. Some philosophers, such as Paul Boghossian, have argued (...) that this would present a big problem for externalism, forcing the externalist to overhaul our norms of rationality. I consider several externalist strategies to block this possibly unhappy epistemological consequence, but I argue that they all fail. (shrink)

This paper has as its topic two recent philosophical disputes. One of these disputes is internal to the project known as decision theory, and while by now familiar to many, may well seem to be of pressing concern only to specialists. It has been carried on over the last twenty years or so, but by now the two opposing camps are pretty well entrenched in their respective positions, and the situation appears to many observers (as well as to some of (...) the parties involved) to have reached a sort of stalemate. The second of these two disputes is, on the other hand, very much alive. While it has been framed in decision theoretic terms, it is definitely not a dispute internal to that enterprise. It is, rather, a debate about the very coherence of the notion of objective value, and as such touches on issues of central importance to, for example, meta–ethics and moral psychology. (shrink)

Knowledge entails the truth of the proposition known; that which is merely believed may be false. If I have beliefs about your beliefs, then I may believe that some of your beliefs are false. I may believe, for example, that you mistakenly believe that it is now raining outside. This is a coherent belief for me, though not for you. You cannot coherently believe that you believe falsely that it is raining, and this despite the fact that your having that (...) false belief is clearly a logical possibility. The proposition is, for you, a kind of doxastic blindspot. (shrink)

CHAPTER ONE THE SEARCH FOR GOD He who separates the study of philosophy from holy religion errs no less than the man who would separate the pursuit of ...

Giubilini and Minerva ask why birth should be a critical dividing line between acceptable and unacceptable reasons for terminating existence. Their argument is that birth does not change moral status in the sense that is relevant: the ability to be harmed by interruption of one's aims. Rather than question the plausibility of their position or the argument they give, we ask instead about the importance to scholarship or policy of publishing the article: does it to any extent make a novel (...) or needed addition to the literature? Giubilini and Minerva's argument is remarkably similar to one advanced by Michael Tooley in ‘Abortion and Infanticide,’ almost 40 years ago. There have been immense changes in the intervening 40 years: in the ability to diagnose conditions early in pregnancy, in genetics and in the availability of in vitro fertilization; in understanding of the capabilities of persons with disabilities; in law; in economic support and access to healthcare for pregnant women and their children; in social customs and arrangements; and even in philosophy, with developments in feminist thought, bioethics and cognitive science. Some of these changes have been for the better, but others, such as the unravelling of social safety nets, have arguably been for the worse. Any or all of these changes might give rise to moral reasons for the relevance of birth that were not available 40 years ago. These changes might also be relevant to the identification of cases, if any, in which ‘after-birth abortion’ might be considered. If context is relevant to the applicability of moral reasons—as for theorists of justice in the non-idealised world it surely should be—it is questionable whether a view of the birth-line that ignores contextualising change can be adequate. (shrink)

A counterfactual is a conditional statement in the subjunctive mood. For example: If Suzy hadn’t thrown the rock, then the bottle wouldn’t have shattered. The philosophical importance of counterfactuals stems from the fact that they seem to be closely connected to the concept of causation. Thus it seems that the truth of the above conditional is just what is required for Suzy’s throw to count as a cause of the bottle’s shattering. If philosophers were reluctant to exploit this idea prior (...) to 1970, it was because of a widespread feeling that the truth-conditions of the counterfactual conditional were not sufficiently well understood. The development of a formal semantics for counterfactuals by Robert Stalnaker [1968] and David Lewis [1973b] stands as a major recent achievement in philosophical logic. (shrink)

In “The Search for Environmental Rights,” Joseph Sax argues that each individual should have, as a right, freedom from environmental hazards and access to environmental benefits, but he makes clear that environmental rights do not exist and their recognition would truly be a novel step. Sax states that environmental rights are different from existing human rights and argues that the closest analogy is welfare interests. In arguing for environmental rights, I follow Sax’s direction and draw from the work of those (...) who are the most relevant in establishing environmental rights. I consider Joel Feinberg’s notion of welfare interests, Henry Shue’s notion of basic rights, and James Nickel’s right to a safe environment. I draw from Mill’s harm principle, the superfund legislation, and the Clean Air Act to illustrate the existing ethical and legal bases for establishing environmental rights. Finally, I discuss positive and negative duties that such rights might carry. (shrink)

How can an environmental ethic be developed that encompasses the concerns of both free market proponents and environmentalists? In this article we approach the environment-market debate using Adam Smith’s writings in The Theory of Moral Sentiments, The Wealth of Nations, and Lectures on Jurisprudence. Smith’s guiding principle for solving prominent conflicts of self-interest is that government intervention is required when the economic activities of some cause harm to others. The solution that follows from Smith’s analysis is a governmentfunded, independent, democratically (...) controlled, and democratically accountable mediating structure that derives impartial decisions and is authorized to impose its just and fair decisions on affected parties. In practical terms, this analysis provides the ethical foundation for the wide-ranging development of stakeholder panels composed of public interest group representatives and business representatives and empowered to develop solutions to public conflicts arising out of environmental problems. (shrink)

The acid rain issue came into prominence because scientists kept telling the world of acid rain's potential devastating effects. Yet, the acid rain debate was marked by mistrust between American and Canadian scientists. The signing of the Air Quality Accord in 1991 appears to have quelled this divisiveness and promises to bring about a new era of scientific cooperation. Using surveys of acid rain scientists in the United States and Canada across three time periods, this study finds both similarities and (...) differences between how Canadian and American scientists view many of the issues surrounding the acid rain debate. (shrink)