In his essay on paternalism and personal identity, Wilkinson draws on Derek Parfit’s Reasons and Persons (1984) to call for a reappraisal of the role of paternalism in healthcare decision-making in situations in which patients with capacity make decisions which are likely to have harmful consequences for themselves.1 The imperative to respect autonomy, coupled with JS Mill’s insistence that the state is justified in interfering with an individual’s liberty only in situations in which she harms or threatens to harm (...) another person, leaves clinicians with little room to constrain decisions in which a patient’s choice may seriously harm her. Parfit reduces personal identity to the continuity of psychological and physical traits across the lifecourse, and suggests that, since these sets of characteristics change significantly over time, it may make more sense to view a person at different time points as different ‘selves’, rather than as the same person. Parfit’s defence of paternalism involves arguing that, given this inevitable lack of continuity, causing harm to one’s future self is analogous to harming another person and that intervening to prevent this may be justifiable in accordance with the Harm Principle.2 The issue of personal identity has received considerable attention in the philosophical literature and it remains a vexed question. Parfit’s argument, along with the thought experiments on …. (shrink)

Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe (...) different forms of paternalism arising from a reductionist view of personal identity. I outline an Identity Relative Paternalistic Intervention Principle for determining when we should disallow refusal of treatment where the harm will be accrued by a future self, and consider objections including vagueness and non-identity.Identity relative paternalism does not always justify intervention to prevent harm to future selves. However, there is a stronger ethical case for doing so than is often recognised. (shrink)

Controversial cases in medical ethics are, by their very nature, divisive. There are disagreements that revolve around questions of fact or of value. Ethical debate may help in resolving those disagreements. However, sometimes in such cases, there are opposing reasonable views arising from deep-seated differences in ethical values. It is unclear that agreement and consensus will ever be possible. In this paper, we discuss the recent controversial case of Vincent Lambert, a French man, diagnosed with a vegetative state, for whom (...) there were multiple court hearings over a number of years. Both family and health professionals were divided about whether artificial nutrition and hydration should be withdrawn and Lambert allowed to die. We apply a ‘dissensus’ approach to his case and argue that the ethical issue most in need of scrutiny is different from the one that was the focus of attention. (shrink)

The elements which every schoolboy learns on beginning Latin Verse Composition include a number of rules which seem arbitrarily designed to make the game harder. In hexameters, he is told, he must have a masculine caesura either in the third foot or in the second and fourth, and end normally with a disyllabic or a trisyllable; in pentameters he must end with a disyllabic; and in neither line may a single monosyllable stand at the end. Rarely, in my experience, is (...) any reason given him by way of redress, and he will search for one in vain in most of the school text-books, in introductions like Postgate's to Tibullus and Propertius, and in histories of Latin literature like Wight Duff's and Mackail's. This reticence may be due to the dissensions of experts on this subject and on the subject of Latin accentuation in general, but the theory that predominates in England, among those who hold a theory at all, explains so many of the phenomena that it deserves to be more widely and precisely known. The most detailed exposition of it is by E. H. Sturtevant, who summed up his analyses in a pair of articles in the Transactions of the American Philological Association in 1923–4. While his careful work is invaluable as marshalling the statistics and evidence, it errs on the side of excessive minuteness, and leaves room not merely for some additions, but for a different kind of treatment concerned less with bare statistics and more with poetic principles and historical development. Since Latin Verse Composition plays such an important part in English higher classical education, it seems desirable that a less technical and more accessible account should be available for English readers. Such an account I attempt to give here, keeping separate as far as possible the exposition and the consideration of the criticisms and rival theories that have been advanced. (shrink)

During the debates about the legalization of Voluntary Assisted Dying in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to (...) understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants’ moral commitments included personal, professional, and political commitments. In some cases, one’s CO was specific to Victoria’s current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context. (shrink)

Memory can play two quite different roles in grief. Memories involving a deceased loved one can make them feel either enjoyably present, or especially and painfully absent. In this paper, we consider what makes it possible for memory to play these two different roles, both in grief and more generally. We answer this question by appeal to the phenomenological nature of vivid remembering, and the context in which such memories occur. We argue that different contexts can make salient different aspects (...) of memory's phenomenological nature, thus making what is remembered sometimes feel pleasantly 'present' again, and sometimes painfully absent. (shrink)

It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulative health promotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful defences of (...) counter-manipulative health promotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulative health promotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulative health promotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

This paper is about even in downward entailing contexts. Karttunen and Peters (1979) have shown that there are two different sets of implicatures of even in such contexts. They argue that the two sets of implicatures are derived by allowing even to take scope either higher or lower than a negative polarity licenser. Rooth (1985) argues that even is lexically ambiguous, that is, there is a negative polarity even. I argue against Rooth's ambiguity theory and show that within Rooth's theory (...) of focus, a scope theory of even has better empirical coverage. I also answer objections to the scope theory raised by Rooth (1985) and Karttunen and Karttunen (1977). (shrink)

Decisions about allocation of limited healthcare resources are frequently controversial. These decisions are usually based on careful analysis of medical, scientific and health economic evidence. Yet, decisions are also necessarily based on value judgements. There may be differing views among health professionals about how to allocate resources or how to evaluate existing evidence. In specific cases, professionals may have strong personal views (contrary to professional or societal norms) that treatment should or should not be provided. Could these disagreements rise to (...) the level of a conscientious objection? If so, should conscientious objections to existing allocation decisions be accommodated? In the first part of this paper, I assess whether resource allocation could be a matter of conscience. I analyse conceptual and normative models of conscientious objection and argue that rationing could be a matter for conscience. I distinguish between negative and positive forms: conscientious non-treatment and conscientious treatment. In the second part of the paper, I identify distinctive challenges for conscientious objections to resource allocation. Such objections are almost always inappropriate. (shrink)

Do people who cause themselves to be ill (e.g. by smoking) forfeit some of their rights to healthcare? This paper examines one argument for the view that they do, the restoration argument. It goes as follows. Smokers need more health‐resources than non‐smokers. Given limited budgets, we must choose between treating everyone equally (according to need) or reducing smokers' entitlements. If we choose the former, non‐smokers will be harmed by others' smoking, because there will be less resources available for them than (...) if no‐one smoked. This is unfair: why should non‐smokers suffer because of others' unhealthy lifestyle choices? We should therefore choose the latter and reduce smokers' entitlements. This paper criticises the restoration argument on the following grounds. In order to avoid generating unpalatable conclusions elsewhere, it must be combined with a principle according to which activities which are sufficiently ‘socially valuable’ (e.g. parenting) are immune from restoration claims. This however means that what was supposed to be one of the argument's most attractive features, its compatibility with ‘liberal neutrality’ with respect to the value of different lifestyles, doesn't really exist. Hence, the restoration argument is nowhere near as attractive as it at first appears to be. (shrink)

This study sets out to explore what a diverse selection of New Zealand organizations are saying on their websites regarding socially responsible businesspractices in relation to employees. We take an inductive, phenomenological oriented approach to investigate the rich content of organizations’ website communications about employee-related CSR issues and practices. We find that all firms communicated some information regarding employees but this was often sparse and lacking in detail. Amongst the most common types of information organizations relayed were statements regarding the (...) work environment, including the nature of work and learning and development opportunities. We also respond to concerns over the descriptive and atheoretical nature of many stakeholder-based CSR studies by applying Brickson’s (2007) identity framework to explore linkages between organizational identity orientation and particular clusters of employee-related CSR practices uncovered in our content analysis. Our results provide tentative support for the thesis that how organizations conceive themselves as relating to stakeholders is associated with particular clusters of employee-related CSR practices. (shrink)

Contributing to both ageing research and queer-feminist scholarship, this article introduces feminist philosopher Margrit Shildrick’s queer notion of the monstrous to the subject of ageing and the issue of dealing with frailty within ageing research. The monstrous, as a norm-critical notion, takes as its point of departure that we are always already monstrous, meaning that the western ideal of well-ordered, independent, unleaky, rational embodied subjects is impossible to achieve. From this starting point the normalizing and optimizing strategies of ageing research (...) – here exemplified through the concept of successful ageing and the treatment of Alzheimer’s disease – can be problematized. The notion of the monstrous instead suggests a view on ageing and ‘monstrous’ embodiment which provides room for other, different ways of being recognized as an embodied subject, and for dealing with difference, vulnerability and frailty. (shrink)

Due to aging populations and the prolonging of working lives, the number of senior workers will increase. Therefore, this study investigates the use of SOC strategies across organizational levels as a means for senior workers to maintain workability and age successfully at work. The need to expand the perspective of the SOC model beyond the individual level, when applied to a work context, has been emphasized theoretically in the literature, nevertheless, SOC strategies have so far only been examined at the (...) individual level. This study is the first to explore SOC strategies at the organizational, leadership, and group level. We focus on senior employees and the SOC strategies they use to balance out demands and limited resources. Based on 23 semi-structured interviews with senior employees and immediate managers at two hospitals, and two dairies, we explore which specific SOC strategies are used at each level and reflect on the applicability of broadening the perspective of the SOC model when applying it to a work context. Based on the empirical findings and the discussion of the empirical exploration of SOC strategies beyond the individual level, we argue that it is advantageous to further pursue this line of inquiry and include the group, leadership, and organizational level when applying the SOC model in a work setting. (shrink)

Allan Bell calls on hermeneutics to enliven the relation between discourse analysts and the materials they study, exploring the image of the analyst ‘standing before’ a corpus, prepared to be transformed by it. The ingredient of desire must be added to the account, as well as the embodied scenario of interpretation. These elements are mobilized to situate Bell’s rereading of Babel and of empire.

In this paper, we argue that there are important differences between playing and non-playing roles in sport. The relevance of sex differences poses genuine philosophical and ethical difficulties for feminism in the context of playing sport. In the case of non-playing roles in general, and officiating in particular, we argue that reference to essential differences between men and women is irrelevant. Officiating elite men?s football is not a role for which ?essential? (psychological and biological) differences are causally implicated neither in (...) competence nor excellence. Reference to such purported differences to justify the exclusion of women from roles such as officiating is unfounded and sexist. (shrink)

This issue of the Journal of Medical Ethics features a special symposium on ‘elective ventilation’ . EV ) was originally described in the 1990s by doctors working in Exeter in the UK.1 At that time there was concern about the large shortfall in organs for transplantation. Patients could become organ donors if they were diagnosed as being brain dead, but this only ever occurred in patients on breathing machines in intensive care who developed signs of brainstem failure. Doctors wondered if (...) there were patients dying outside intensive care who, if they were ventilated, could become brain dead and hence eligible to donate their organs. They embarked on a process of identifying patients who were dying who would not normally be taken to intensive care because their prognosis was judged to be too poor, and then ‘electing’ to insert breathing tubes when they stopped breathing.1 With the consent of family members the patients were supported in intensive care until they were diagnosed as having signs of brain death, or until the family and doctors together judged that this was unlikely to occur.1 The Exeter team saw a 50% increase in their numbers of organs for transplantation.Box 1 Definition of elective ventilation Elective ventilation is the provision to a patient of intensive medical treatment with the sole purpose of facilitating organ donation, in the absence of an expected medical benefit.EV was a controversial practice at the time. There were a number of papers written from points of view defending2 ,3 and criticising it.4 A Department of Health guideline in 1994 concluded that EV was not in the best interests of patients and was therefore unlawful5; subsequently, the practice effectively ceased.2 However, debate about EV has not …. (shrink)

This book brings together the stories of biographers, novelists, scholars, and artists as they have written about the journeys (some literal, some figurative) they have made to their subjects. Contributors include Elizabeth Wood, J.J. Wilson, Leah Glasser, Jane Lazarre, and Alice Walker.

A culturally diverse historical record shows considerable evidence of a significant role for musical sound in healing processes. Very little of this information is used in contemporary medical practice. In part that is a function of paradoxical, inconclusive, and sometimes contradictory research results. Reviewed research literature is categorized as follows: physical healing, psychological healing, spiritual healing, and healing practices of indigenous peoples. The combination of ethnographic, descriptive and clinical data in the literature review demonstrates the complexity inherent to investigating this (...) topic. Most of the clinical research uses quantitative methodologies. Because of the diversity of musical sound, infinitely variable individual responsivity, and the variable significance of a variety of influences, quantitative studies about musical sound healing phenomena are only minimally revealing. It is suggested that whether or not a sound facilitates a healing response depends on how it is experienced. Further, how this happens as well as the distinction between sound and music is in large part a function of the meaning sound is given. This is the first study to examine in detail the meaning of such an experience. This study uses the phenomenological methodology developed by Giorgi to analyze four descriptive protocols detailing first-person responses to a question about musical sound-facilitated physical healing processes. The analysis results in a single general structure of the essential meaning of this experience revealing the relationships for each subject connecting an altered state of consciousness , spiritual awareness, cognitive understanding, history of related experiences and active, intentional choice. Despite their apparent individual differences all subjects used musical sound in ritualistic ways to facilitate an ASC which incorporated visual imagery and spiritual support. Half the subjects used music and sound for themselves, the other half participated in a sound-based ritual for the benefit of someone else. A phenomenological approach further provides a way to demonstrate the subtle interrelationships expressed by the ethnographic, descriptive and clinical data. Broad implications of the results of this study are discussed concluding with some directions for further research and a brief discussion on the value of a phenomenological approach to medical diagnosis and treatment. (shrink)

Infants who are born extremely prematurely can survive if they receive intensive medical treatment. However, they also have a high chance of dying, and a proportion of survivors have long-term health problems and disabilities. In many parts of the world, if parents request it, an extremely premature infant can receive palliative care rather than active survival-focused care at birth. But there are variations between countries as to whether or when this is permitted. To help inform ethical debates across Asia and (...) more widely, we present two contrasting views about parental discretion and the treatment of extremely preterm infants. In questions of this nature, disagreement and dissensus are inevitable. Differences in the outcomes of treatment, the resources available, and the values of society mean that we should not expect a uniform approach. We identify points of potential consensus and compromise despite disagreement. (shrink)

Can metaphysics yield the consolations of philosophy? One possibility, defended by Derek Parfit, is that reflection on the nature of identity and time could diminish both fear of death and grief. In this paper, I assess the prospect of such consolation, focussing especially on attempts to console a grieving third party. A shift to a reductionist view of personal identity might mean that death is less threatening. However, there is some evidence to suggest that such a shift does not necessarily (...) translate into less death anxiety. Moreover, applied to grief at loss of another, such a perspective may be misdirected. A temporally neutral perspective offers a theoretically powerful way of reducing the sense of loss at being separated in time from a loved one. However, it is unclear whether it is psychologically possible to achieve. Even if it were possible, it may not diminish the pain of separation.I identify a serious challenge to philosophical consolation for grief. The greater the consolation that is offered, the greater the risk of losing important attachments and the less it may be psychologically accessible. (shrink)

Cladistic analyses are based on the distinction between primitive and derived character states (hypotheses of the polarity of evolutionary transformations) and a complete reliance on only derived character state distributions as bona fide evidence of holophyletic assemblages of taxa. The cladistic premise that only derived character state distributions provide evidence of holophyly is reconsidered and shown to be both unjustified and inconsistent with the desire or methodological prescription of using all the available evidence. Cladistic techniques are here viewed primarily as (...) methods for the ordering of character states so that they may be differentially weighted. The problem of assigning realistic differential weight to primitive and derived character state distributions is briefly discussed. One possible use of primitive character state distributions as evidence of holophyly that is largely free of the problem of weight is proposed. This application is illustrated with an example from the caecilian amphibians (Amphibia: Gymnophiona). (shrink)

An oft misattributed piece of folk-wisdom goes: “Insanity is doing the same thing, over and over again, but expecting different results.” In many cases, we don’t just do things repeatedly but think over the same topics repeatedly. People who ruminate are not often diagnosed as insane—most of us ruminate at some point in our lives—but it is a common behaviour underlying both depression and anxiety :504, 2000). If rumination is something we all do at some time, what is it about (...) ruminative thought that makes it ‘sticky’ and difficult to stop for the worst sufferers? In order to answer this question, I will present a plausible account of how ruminative behaviour becomes entrenched to the point where sufferers of anxiety and depression simply cannot make meaning from the world except in terms of the kinds of behaviours, actions and thoughts they have become reliant on. I develop my account from Barrett’s theory of constructed emotion using the work of Merleau-Ponty, ProQuest Ebook Central, 2012. https://ebookcentral.proquest.com/lib/ed/detail.action?docID=1433878. Accessed 29 Dec 2020) in order to bridge the gap between the explicit thought we experience—an important part of the lived experience of rumination. To conclude, I will apply my account to Wu and Dunning’s :25–35, 2018; Hypocognitive mind: How lack of conceptual knowledge confines what people see and remember, 2019. https://doi.org/10.31234/osf.io/29ryz) theory of hypocognition to further illuminate the particular cognitive qualities that can be experienced by ruminators, i.e. a prohibited access to particular emotion concepts. (shrink)

Health literacy is a contemporary term used in health services, often used to describe individuals requiring additional support to access, understand and implement health service information. It is used as a measure of self‐efficacy in chronic disease models of care such as the nurse navigator service. The aim of the research was to investigate the concept of health literacy in the nurse navigator service, particularly in relation to the defined role objective of person‐centred care. Fairclough's critical discourse analysis was used (...) to analyse the experiential, relational and expressive elements of texts, investigating the hidden truths which are represented in discourse. Texts from a variety of health service micro‐, meso‐ and macro‐hierarchical sources were selected for analysis using the nurse navigator evaluation data set and other associated texts. Health literacy in the nurse navigator service is a technology of government used to increase participation of individuals in their own health and well‐being. The discourse suggests that health literacy responsibilises both individuals and nurses and is discursively formed within a matrix of rational choice. In this context, health literacy contributes to structural vulnerability. (shrink)