When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

Nassim Noroozi proposes a juxtaposition of pedagogy with and a characterization of it as justice. The term pedagogical here is not limited to “the educational,” nor is pedagogy limited to the methods of teaching. At the same time, the term justice will not be framed in terms of liberal conceptual grounds. Noroozi defines pedagogy as an arrangement of meaning so that it becomes impossible not to see injustice. Noroozi argues that “pedagogy-as-justice” concerns itself with exposing injustice in transformative ways, and (...) as such it is an ethical undertaking. She explores how philosophizing for struggle is inherently pedagogical and, because of our perception of “the pedagogical,” how it is inherently transformative. Furthermore, she argues that seeing pedagogy as justice will consequentially deem “the arrangements of meanings to engage others in the issues pertaining to injustice” as equally important to writing or thinking about those struggles. To illustrate the above points, Noroozi analyzes a case of public philosophical engagement against war. By expanding on this case, she proposes some central attributes of pedagogy-as-justice, namely its preoccupation with grounding abstract and anonymous concepts in their contested historical realities; its commitment to wrestling with an “opacity of concepts” or with “dishonest reasonings” that end up promoting suffering and injustice; and its recognition of the precarities inherent in undertaking pedagogy-as-justice. Noroozi traces a genealogy of the concept of pedagogy-as-justice going back to Socratic public philosophical engagements. (shrink)

An innovative examination of the ways in which dance and philosophy inform each other, Dance and Philosophy brings together authorities from a variety of disciplines to expand our understanding of dance and dance scholarship. Featuring an eclectic mix of materials from exposes to dance therapy sessions to demonstrations, Dance and Philosophy addresses centuries of scholarship, dance practice, the impacts of technological and social change, politics, cultural diversity and performance. Structured thematically to draw out the connection between different perspectives, this books (...) covers: - Philosophy practice and how it corresponds to dance - Movement, embodiment and temporality - Philosophy and dance traditions in everyday life - The intersection between dance and technology - Critical reflections on dance Offering important contributions to our understanding of dance as well as expanding the study of philosophy, this book is key to sparking new conversations concerning the philosophy of dance. (shrink)

Nursing policy and healthcare reform are focusing on two, interconnected areas: person‐centred care and fundamental care. Each initiative emphasises a positive nurse–patient relationship. For these initiatives to work, nurses require guidance for how they can best develop and maintain relationships with their patients in practice. Although empirical evidence on the nurse–patient relationship is increasing, findings derived from this research are not readily or easily transferable to the complexities and diversities of nursing practice. This study describes a novel methodological approach, called (...) holistic interpretive synthesis (HIS), for interpreting empirical research findings to create practice‐relevant recommendations for nurses. Using HIS, umbrella review findings on the nurse–patient relationship are interpreted through the lens of the Fundamentals of Care Framework. The recommendations for the nurse–patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients to deliver person‐centred fundamental care. Future research should evaluate the validity and impact of these recommendations and test the feasibility of using HIS for other areas of nursing practice and further refine the approach. (shrink)

The term “therapeutic misconception” was coined in 1982 by Paul Appelbaum, Loren Roth, and Charles Lidz. Appelbaum and his colleagues interviewed participants in several psychiatric studies, including a drug trial with a placebo control arm. Appelbaum's group found that many people were unaware of the differences between participating in a study and receiving treatment in the clinical setting. Rather than understanding these differences, study participants tended to believe that therapy and research were governed by the same primary goal: to advance (...) the individual patient's best interests. Appelbaum's group labeled this mistaken belief the therapeutic misconception. (shrink)

Many people are worried about developing dementia, fearing the losses and burdens that accompany the condition. Dementia‐specific advance directives are intended to address dementia's progressive effects, allowing individuals to express their treatment preferences for different stages of the condition. But enthusiasm for dementia‐specific advance directives should be tempered by recognition of the legal, ethical, and practical issues they raise. Dementia‐specific advance directives are a simplistic response to a complicated situation. Although they enable people to register their future care preferences, in (...) many cases, those preferences will not, and should not, determine their later care. (shrink)

Most patients suffering from progressive dementia have thoughts, emotions, perspectives, and perceptions of a world of experience. Decisions about life‐sustaining treatment should incorporate a principled approach to evaluating what life is like for these patients.

Off-label prescribing is an integral part of contemporary medicine. Many patients benefit when they receive drugs or devices under circumstances not specified on the label approved by the Food and Drug Administration. An off-label use may provide the best available intervention for a patient, as well as the standard of care for a particular health problem. In oncology, pediatrics, geriatrics, obstetrics, and other practice areas, patient care could not proceed without off-label prescribing. When scientific and medical evidence justify off-label uses, (...) physicians promote patients’ interests by prescribing products off label.Off-label prescribing can also harm patients, however. The potential for harm is greatest when an offlabel use lacks a solid evidentiary basis. A 2006 study examining prescribing practices for 169 commonly prescribed drugs found high rates of off-label use with little or no scientific support. Researchers examining off-label use in U.S. children’s hospitals concluded, “[W]e still have incomplete knowledge about the safety and efficacy of many medications commonly used to treat children across a range of drug classes and clinical diagnoses.”. (shrink)

In Christian books today readers can find dozens of spiritual practices. One resource of the Protestant tradition, however, that has largely been forgotten is the Puritan practice of conference. This article describes how for the English Puritans conference exemplified the importance of communal spiritual life, then considers applications for the contemporary church. Conference refers to intentional conversation among believers about spiritual matters. Conference particularly expresses the value of Christian community and the need for the body of Christ to function together (...) on the journey of faith. Understanding this practice not only illuminates the past but also offers valuable insights for the church today. (shrink)

A person of good character treats other sentient beings with care and compassion. Yet virtue ethics apparently has trouble accounting for the moral status of nonhuman animals because of its focus on excellent character traits, rather than the moral “patient,” and because of its non-codifiability, at least in some forms. The task of this article is to answer the question: How can virtue ethics account for the moral value of nonhuman animals in the context of biomedical research? I argue that (...) it can do so through attention to animal good lives, human-animal bonds, and the virtues themselves. The virtue ethics resources I draw on to support nonhuman animal value are not the same as those typically brought to bear in moral status discussions, but I suggest that moral status as usually conceived has its own problems as a tool for use in practical contexts like animal research. (shrink)

Chater & Loewenstein make a persuasive case for focusing behavioural research and policy making on s- rather than i-interventions. This commentary highlights some conceptual and ethical issues that need to be addressed before such reform can be embraced. These include the need to adjudicate between different conceptions of “effectiveness,” and accounting for reasonable differences between how people weight different values.

BackgroundClinical trials should be as inclusive as possible to facilitate equitable access to research and better reflect the population towards which any intervention is aimed. Informed by the UK’s National Institute for Health and Care Research (NIHR) Innovations in Clinical Trial Design and Delivery for the Under-served (INCLUDE) guidance, we audited oncology trials conducted by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London (ICR-CTSU) to identify whether essential documents were overtly excluding any groups and whether (...) sufficient data were collected to assess diversity of trial participants from groups suggested by INCLUDE as under-served by research in the UK.MethodsThirty cancer clinical trials managed by ICR-CTSU and approved between 2011–2021 were audited. The first ethics approved version of each trial’s protocol, patient information sheet, and patient completed questionnaire, together with the first case report forms (CRFs) version were reviewed. A range of items aligned with the INCLUDE under-served groups were assessed, including age, sex and gender, socio-economic and health factors. The scope did not cover trial processes in participating hospitals.ResultsData relating to participants’ age, ethnic group and health status were well collected and no upper age limit was specified in any trials’ eligibility criteria. 23/30 (77%) information sheets used at least one gendered term to address patients. Most CRFs did not specify whether they were collecting sex or gender and only included male or female categories. The median reading age for information sheets was 15–16 years (IQR: 14–15 – 16–17). Socio-economic factors were not routinely collected and not commonly mentioned in trial protocols.ConclusionsNo systemic issues were identified in protocols which would explicitly prevent any under-served group from participating. Areas for improvement include reducing use of gendered words and improving readability of patient information. The challenge of fully assessing adequate inclusion of under-served populations remains, as socio-economic factors are not routinely collected because they fall beyond the data generally required for protocol-specified trial endpoint assessments. This audit has highlighted the need to agree and standardise demographic data collection to permit adequate monitoring of the under-served groups identified by the NIHR. (shrink)

Pregnancy is a frequently applied exclusion criteria for many forms of research. Common justifications for this exclusion include the potential for teratogenicity, as well as the potential for physiologic changes in pregnancy to impact the research itself. The systematic exclusion of pregnant persons from clinical studies has created a significant gap in knowledge regarding medication safety and efficacy in pregnancy, which continues to cause significant harm to pregnant persons in need of medical therapy. To produce meaningful data and facilitate effective (...) knowledge translation to the clinical setting, special consideration to the pharmacology of pregnancy, as well as to outcomes of concern for this population is essential. The exclusion of pregnant participants from research is not ethically justifiable, as it violates the principles of autonomy, justice and nonmaleficence. While the inclusion of pregnant patients in research presents it’s own challenges, with appropriate methodological, ethical, and clinical considerations, we may be able to narrow the knowledge gap and improve drug availability and safety for pregnant patients and their children. (shrink)

In this chapter, I consider how an analysis of responsibility for habitual behaviour can help us to make judgements about people’s responsibility for their health. Much of our behaviour is habitual, featuring high levels of automaticity and low levels of reflection. Further, habitual behaviour is particularly commonplace in many “everyday” health-affecting actions like diet and physical activity. It is unclear what role conscious awareness plays in habitual behaviour, but it is generally assumed that conscious control over habitual behaviour is limited, (...) if not completely lacking, at least at the time that behaviour is performed. There has been relatively little written about responsibility for habitual behaviour. At least, few philosophical accounts of responsibility have explicitly discussed habitual behaviour or habits. A notable exception is Fischer and Ravizza’s influential Responsibility and Control, which makes reference to behaviour that is performed “instinctively” or out of “unreflective habit”. There is also a significant literature on responsibility for character, which could be considered of direct relevance to attempts to illuminate responsibility for habitual behaviour. This chapter will outline what work remains to be done in order to properly align discussions of responsibility with a psychologically informed analysis of habitual behaviour, and will indicate how this could support discussions of people’s responsibility for their health. (shrink)

I welcome the efforts described by Neal Dickert and his colleagues in “Partnering with Patients to Bridge Gaps in Consent for Acute Care Research” (Dickert et al. 2020). I am a long-time supporter...

The empirical evidence for exploration underlying the appeal of imaginary worlds is mostly absent or contradictory. Openness, and the cognitive exploration it represents, provides a better account than the overall drive to explore predicted by evolutionary theory. Furthermore, exploration cannot explain why imaginary worlds foster frequent re-engagement.

This paper will examine intertextual references between the Dialogus of Tacitus and the letters of Pliny, in particular those regarding boar hunting. It will argue that there are clues in the letters of Pliny which can help us to understand the relationship between these two writers as well as the tone and purpose of the Dialogus. By studying Pliny's letters to Tacitus on hunting , one can see the specific reference to boars as an allusion to Marcus Aper, the chief (...) spokesperson for contemporary eloquence in the dialogue, indicating a degree of humor and irony in the Dialogus that is further displayed by the similarity of Pliny's opening exhortation in Epistle 1.6, ridebis et licet rideas, to the final words of the Dialogus, cum adrisissent, discessimus. Moreover, the dialogue between Pliny and Tacitus in Pliny's letters can be seen as an indication that the Dialogus itself may have been revised throughout the years, thus problematizing the debate about the “publication date” of the Dialogus. (shrink)

With growing awareness of a crisis in pollinator health, the practice of urban hobbyist beekeeping has grown in Canada with practitioners arguing that this activity can help to foster healthier honey bees and more mindful beekeeping practices. However, urban hobbyist beekeepers have been critiqued for encouraging improper beekeeping practices and over-saturation of honey bees in cities. Drawing on a multispecies ethnography based in London, Ontario and Toronto, including participant observation with the Toronto Beekeeping Collective and the London Urban Beekeeping Collective (...) and interviews with 26 urban beekeepers, I argue that urban hobbyist beekeepers develop a sensuous and embodied relationship with honey bees that typifies playful work. By integrating participant perspectives with social reproduction theory, I demonstrate that the playful work of urban hobbyist beekeeping allows practitioners to engage with non-human nature outside of the constraints of capitalist labour regimes, enabling the expression of delight, enchantment, and curiosity. This relationship between beekeepers and honey bees encourages the development of bee-centred practices in which the preferences and physiological needs of the bees are consciously put ahead of the needs of the beekeeper. The possibility for honey bee flourishing is increased significantly when bee-centred beekeeping is coupled with integrated pest management. (shrink)

The Fundamentals of Care Framework is an evidence‐based, theory‐informed framework that conceptualises high‐quality fundamental care. The Framework places the nurse–patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse–patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse–patient relationship instruments (...) by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty‐seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring ‘focus’, ‘anticipate’ and ‘evaluate’. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse–patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework. (shrink)

It's not unusual to hear someone say, ‘I'd rather be dead than have Alzheimer's’. In ‘Alzheimer Disease and Preemptive Suicide’,1 Dena Davis explains why this is a reasonable position. People taking this position will welcome the discovery of biomarkers permitting very early AD diagnosis, Davis suggests, for this will enable more of them to end their lives while they remain motivated and able to do so. At the same time, Davis observes, people would have less reason to resort to the (...) drastic remedy of pre-emptive suicide if they had absolute authority over the medical treatment they received as patients with dementia; but the threat of pre-emptive suicide is not, in my view, a sufficient reason to grant competent individuals that authority.If preclinical diagnosis of AD becomes possible, some pre-emptive suicides will probably occur. There would be no ethical or practical way to ban such suicides, and it would be silly to try. Clinicians will undoubtedly try to discourage people seeking biomarker information in furtherance of a suicide plan, but savvy individuals will simply conceal their true motivation for having the tests. The real problem for people intent on self-destruction is that biomarkers are unlikely to deliver a clear suicide signal.First, as Davis notes, work on biomarkers remains in the research stage. No one yet knows whether biomarker tests will prove accurate enough to warrant clinical use. Second, even clinically accepted biomarker tests will generate imperfect information about future disease. Biomarkers may produce more accurate estimates of a person's risk of developing AD, but like all predictive tests, they will also yield false positive and negative results. The …. (shrink)

Several personality dispositions with common features capturing sensitivities to negative social cues have recently been introduced into psychological research. To date, however, little is known about their interrelations, their conjoint effects on behavior, or their interplay with other risk factors. We asked N = 349 adults from Germany to rate their justice, rejection, moral disgust, and provocation sensitivity, hostile attribution bias, trait anger, and forms and functions of aggression. The sensitivity measures were mostly positively correlated; particularly those with an egoistic (...) focus, such as victim justice, rejection, and provocation sensitivity, hostile attributions and trait anger as well as those with an altruistic focus, such as observer justice, perpetrator justice, and moral disgust sensitivity. The sensitivity measures had independent and differential effects on forms and functions of aggression when considered simultaneously and when controlling for hostile attributions and anger. They could not be integrated into a single factor of interpersonal sensitivity or reduced to other well-known risk factors for aggression. The sensitivity measures, therefore, require consideration in predicting and preventing aggression. (shrink)

Thomas Reid’s epistemological ambitions are decisively at the center of his work. However, if we take such ambitions to be the whole story, we are apt to overlook the theory of mind that Reid develops and deploys against the theory of ideas. Reid’s philosophy of mind is sophisticated and strikingly contemporary, and has, until recently, been lost in the shadow of his other philosophical accomplishments. Here I survey some aspects of Reid’s theory of mind that I find most interesting. I (...) examine whether Reid is a mysterian about the mind, whether Reid has a direct realist theory of perception, and whether Reid has a higher-order, or “inner-sense,” view of consciousness. Along the way I will mention portions of the secondary literature that examine these aspects and point out whether and to what degree I part ways with the interpretations present in the literature. (shrink)

A reconciliation of different approaches to anger in the Christian moral tradition, with cautions and recommendations for virtuous anger formation.

In 1997, when Oregon became the first U.S. jurisdiction authorizing medical aid in dying (MAID), its law included a requirement that patients be legal residents of the state. Other U.S. jurisdictions legalizing MAID followed Oregon in adopting residency requirements. Recent litigation challenges the legality, as well as the justification, for such requirements. Facing such challenges, Oregon and Vermont eliminated their MAID residency requirements. More states could follow this move, for, in certain circumstances, the U.S. Constitution's privileges and immunities clause protects (...) citizens’ right to travel to secure medical care. Policy considerations could also motivate states to reexamine whether such requirements are justified in light of existing evidence of how MAID laws have been applied. (shrink)

It is especially from the 1970s onwards, and certainly linked to the “linguistic turn”, that the specialized research in Nietzsche begins to show a growing interest in his thesis of an intimate relationship between word and thought, sometimes emphasizing the role of rhetoric in Nietzschean reflections on science, truth and language. The present work aims, in the context of the first two chapters of Nietzsche's Beyond Good and Evil, to investigate Nietzsche's particular treatment of the problem of truth and what (...) such treatment, imbricated to the stylistic strategy of his rhetoric in the mentioned chapters, undertakes in terms of reinstating the question not only about truth, but also about the margins of philosophical discursiveness itself. (shrink)

The postmodern criticism of music analysis remains unwittingly preoccupied with a false image of ‘the Whole’, or with the construction of unity precisely through privileging its opposite. At the centre of this discourse there often emerges a split between two things—analysis/aesthetics, part/whole, subject/object—where the question then becomes one of reconciliation: how can the analytical methods be subsumed into aesthetic discussions of subjectivity to better represent the ‘thing itself’? This problem is now a cross-disciplinary one, with criticism favouring the application of (...) ‘external’ disciplines to complement the ‘internal’ act of music analysis. This article takes Žizek’s comments on the difference between modernism and postmodernism as alienation and separation as its starting point in order to reconsider the effects of the supposedly postmodern concept of interdisciplinarity for music analysis. Through a critique of existing musico-psychoanalytic literature, it demonstrates the ways in which the interdisciplinary relation currently seems to occupy the space of an objet petit a in scholarship that is therefore marked by a failure restricted to the principles of alienation. If read alongside Žižek’s phenomenology of the subject however, rather than become a fetishized unity, this relation could be seen to construct the space for a self-reflexive musical subject, able to avoid false reconciliation through critical self- awareness, and could also therefore hold greater significance for an interdisciplinary musicology. (shrink)

ABSTRACTThis article investigates Habermas's communicative ethic in relation to changes in the roles of institutions and the state. I reference Alexy, Weber and Taylor, arguing that an artificial delimitation of the public sphere as disparate from the private or religious cramps the capacity of those identified as outsiders to communicate within it. I question the ability of public reason as Habermas has outlined it to meet the challenges it faces regarding interreligious dialogue and integration in democratic societies, and I suggest, (...) instead, an approach more open to dialogue with religions in terms that are more comprehensible to them. (shrink)