BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

The basic disagreement between Richard Shiff and me is one of approach and ultimately of intellectual taste. What I tried to do in “Painting memories” was read Charles Baudelaire’s Salon of 1846 with a view to construing its central argument as rigorously as possible, which for me meant without appealing, except in one crucial, authorized instance, to other writings by Baudelaire or indeed anyone else. This seemed to me desirable, first, because on the strength of a long familiarity with the (...) Salon of 1846 I had become convinced that it was not the fragmented, somewhat incoherent, less than fully mature performance that many previous commentators had taken it to be but rather that it possessed a problematic consistency, even systematicness, which I wanted to explore; and second, because I had come to feel that one of the principal sources of the dreariness and predictability of much exegesis not only of that Salon but of Baudelaire’s art criticism generally was the tendency of many commentators to treat his art writing as a single, barely differentiated mass, to be supplemented when desired by selected passages from the lyric poems. Let me be as clear as I can. I am not claiming that the only fruitful approach to Baudelaire’s art criticism is to consider each of his writings in isolation from the rest. I am saying that the widespread tendency to read a particular Salon or article on the visual arts in the light of others has meant that insufficient attention has been paid to the workings of individual texts, with dismaying consequences both for our understanding of those texts and for our sense of the shape of Baudelaire’s intellectual career. Michael Fried, professor of humanities and the history of art and director of the Humanities Center at the Johns Hopkins University, is the author of Morris Louis and Absorption and Theatricality: Painting and Beholder in the Age of Diderot. He is currently at work on books on Gustave Courbet and on Thomas Eakins and Stephen Crane. His most recent contributions to Critical Inquiry are “The Structure of Beholding in Courbet’s Burial at Ornans” and “Paitnig Memories: On the Containment of the Past in Baudelaire and Manet”. (shrink)

Time was when you could bite a tomato and not ingest fish genes. Time was when you could eat french fries and just worry about the fat and salt, not the bacterial genes that produce insecticides in the potato. Those times are over, thanks to corporate control over both genetic engineering and the lack of food-labeling. Unless you are a “hard core” consumer of organic foods, you eat genetically engineered foods everyday. While 80-90% of US consumers believe genetically engineered (...) foods should be labeled, only 3% know they already on the market.[1] Today 60-70% of the food in a grocery store contains components from genetically modified crops. Moreover, this technology was unleashed on over 45 million acres of US farmland last year alone, after having been commercially introduced only four years ago.[2] Here we will provide a brief background on the types of genetically engineered crops that are being surreptitiously forced upon consumers, then argue against their current widespread use. (shrink)

Nel Medioevo tante volte presentato dalla letteratura come un grande romanzo di avventure, un posto decisamente particolare spetta alla vicenda di Tommaso Becket, prima cancelliere di re Enrico II e poi arcivescovo di Canterbury, assassinato nella sua cattedrale nel 1170. Si tratta di una vicenda che presenta i motivi fondamentali di ogni racconto epico e tragico. Ispirandosi a questa convinzione l’articolo ripercorre alcune delle maggiori opere letterarie che hanno raccontato da diversi punti di vista lo scontro tra Becket e il (...) suo re: alcune delle agiografie medievali, Alfred Tennyson, Conrad Ferdinand Meyer nel XIX secolo, e – nel XX – Thomas Stearns Eliot, Christopher Fry e Jean Anouilh. Del _vero_ Tommaso Becket è assai difficile riuscire a farsi un’idea precisa, mentre sembra realizzarsi la grande metafora, proposta da Giovanni di Salisbury, suo stretto collaboratore, della vita e della storia come rappresentazione teatrale in cui hanno importanza decisiva solo i ruoli che gli uomini sono chiamati a interpretare. _In the Middle Ages, so often depicted in literature as a great adventure novel, a very special place belongs to the story of Thomas Becket, firstly chancellor of King Henry II and later Bishop of Canterbury, murdered in his cathedral in 1170. _ _This episode presents the fundamental motifs of every epic and tragic tale. Inspired by this conviction, this article examines some of the most significant literary works that have described the conflict between Becket and his king from different points of view: some of the medieval hagiographies, Alfred Tennyson, Conrad Ferdinand Meyer in the 19th century, and – in the 20th – Thomas Stearns Eliot, Christopher Fry and Jean Anouilh._ _It is very difficult to get a precise idea of the _real_ Thomas Becket, while the great metaphor proposed by John of Salisbury, his close collaborator, of life and history as a theatrical representation in which only the roles that men are called to play are of decisive importance, seems to have been realized._. (shrink)

Thomas Reid , the Scottish natural and moral philosopher, was one of the founding members of the Aberdeen Philosophical Society and a significant figure in the Scottish Enlightenment. Reid believed that common sense should form the foundation of all philosophical inquiry. He criticised the sceptical philosophy propagated by his fellow Scot David Hume and the Anglo-Irish bishop George Berkeley, who asserted that the external world did not exist outside the human mind. Reid was also critical of the theory of (...) ideas propagated by Locke and Descartes, arguing that it was incompatible with physical and experiential facts. For Reid, our senses demonstrate that the external world must exist, and this work is organised in chapters examining each of the senses in turn. The book, based on his lectures, was first published in 1764 when Reid was a regent professor at King's College, Aberdeen, and was reissued in 1818. (shrink)

There is sometimes a sense in which one theory posits ‘less structure’ than another. Philosophers of science have recently appealed to this idea both in the debate about equivalence of theories and in discussions about structural parsimony. But there are a number of different proposals currently on the table for how to compare the ‘amount of structure’ that different theories posit. The aim of this paper is to compare these proposals against one another and evaluate them on their own merits.

The rhetoric of Principia Ethica, as of not a few philosophy books, is that of the clean break. Moore claims that the vast majority of previous writing on ethics has been misguided and that an entirely new start is needed. In its time, however, the book’s claims to novelty were widely disputed. Reviews in Mind, Ethics, and The Journal of Philosophy applauded the clarity of Moore’s criticisms of Mill, Spencer, and others, but said they were “not altogether original,” had for (...) the most part “already been brought out by other critics,” and were even “the standard criticisms.”1 To the Mind reviewer, “The book indicates throughout how strongly the author has been affected by Sidgwick’s views.”2 Hastings Rashdall rejected as historically inaccurate Moore’s claim that only Sidgwick before him had recognized that “good” is indefinable: “To say nothing of writers who (like Mr. Moore and myself) learned the doctrine largely from Sidgwick, I should contend that it was taught with sufficient distinctness by Plato ..., Aristotle, and a host of other writers who have studied in their school.”3 Rashdall also described Moore’s principle of organic unities as just “a new and striking way of stating a very old truth.”4 Some recent commentators have taken a similar line. Bernard Williams has said that much of Principia Ethica comes from Sidgwick,5 while Thomas Baldwin, discussing the book’s substantive values, has said the principle of organic unities “was expressly stated by Bradley,” while “McTaggart had for some years extolled the value of love, and the value of art is a central theme of romanticism.”. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

Thomas Murray's graceful and humane book illuminates one of the most morally complex areas of everyday life: the relationship between parents and children. What do children mean to their parents, and how far do parental obligations go? What, from the beginning of life to its end, is the worth of a child? Ethicist Murray leaves the rarefied air of abstract moral philosophy in order to reflect on the moral perplexities of ordinary life and ordinary people. Observing that abstract moral (...) terms such as altruism and selfishness can be buried in the everyday doings of families, he maintains that ethical theory needs a richer description than it now has of the moral life of parents and children. How far should adults go in their quest for children? What options are available to women who do not want to bear a child now? Should couples be allowed to reject a child because of genetic disability or "wrong" gender? How can we weigh the competing claims of the genetic and the rearing parents to a particular child? _The Worth of a Child_ couples impressive learning with a conversational style. Only by getting down to cases, Murray insists, can we reach moral conclusions that are unsentimental, farsighted, and just. In an era of intense public and private acrimony about the place and meaning of "family values," his practical wisdom about extraordinary difficult moral issues offers compelling reading for both experienced and prospective parents, as well as for ethicists, social and behavioral scientists, and legal theorists. (shrink)

Many states recognize a legal right to bodily integrity, understood as a right against significant, nonconsensual interference with one’s body. Recently, some have called for the recognition of an analogous legal right to mental integrity: a right against significant, nonconsensual interference with one’s mind. In this chapter, we describe and distinguish three different rationales for recognizing such a right. The first appeals to case-based intuitions to establish a distinctive duty not to interfere with others’ minds; the second holds that, if (...) we accept a legal right to bodily integrity, then we must, on pain of philosophical inconsistency, accept a case for an analogous right over the mind; and the third holds that recent technological developments create a need for a legal right to mental integrity. (shrink)

As the contract cheating market has become more sophisticated and competition has intensified, the contract cheating industry has had to redevelop its approach to gain custom. The industry has developed new models of internal operation and providers are using more sophisticated techniques to reach potential customers. This paper discusses contract cheating industry workflows and introduces terminology to allow complexities of the industry to be more consistently discussed. Examples are provided throughout to indicate the scale and challenge of the contract cheating (...) industry operations.An analysis of contract cheating operations on the micro-outsourcing website Fiverr.com is presented, using comparative data collected in June 2016 and October 2018. The analysis of the data demonstrates how the contract cheating industry is seeing continual change. Specifically, on Fiverr.com, this includes an increase in the number of providers offering essay writing services, particularly those from Kenya and Pakistan. The increase in service availability is accompanied by an associated reduction in essay pricing. The advertised pricing per 1000 words has dropped substantially, from $31.73 USD to $5.73 USD. The accounts used by contract cheating providers are also being replaced at an increased rate.Based on the data, contract cheating providers on Fiverr.com are currently estimated to be taking a minimum of $92,001 USD per year in revenue. This is an example calculated from only one search term on which contract cheating providers advertise on only one micro-outsourcing site used for contract cheating. The actual industry income from micro-outsourcing web sites is likely to be substantially higher. (shrink)

Thomas Hobbes's Leviathan is the greatest work of political philosophy in English and the first great work of philosophy in English. In addition, it presents the fundamentals of his beliefs about language, epistemology, and an extensive treatment of revealed religion and its relation to politics. Beginning with premises that were sometimes controversial, such as that every human action is caused by the agent's desire for his own good, Hobbes derived shocking conclusions, such as that the civil government enjoys absolute (...) control over its citizens and that the sovereign has the right to determine which religion is to be practiced in a commonwealth. Hobbes's contemporaries recognized the power of the arguments in Leviathan and many of them wrote responses to it. Selections from books by John Bramhall, Robert Filmer, Edward Hyde, George Lawson, William Lucy, Samuel Pufendorf and Thomas Tenison are included in this edition. Leviathan is divided into four parts: In the first part, Of Man, Hobbes presents a view of human beings and of the natural world in general that is materialistic and mechanistic. In the second part, Of Commonwealth, he defends the theory of absolute sovereignty, the view that the government has all the political power and has the right to control any aspect of life. In the third part, Of a Christian Commonwealth, he critiques concepts like revelation, prophets, and miracles in such a way that it becomes doubtful whether they can be rationally justified. In the fourth part, Of the Kingdom of Darkness, he explains various ways in which priestly religion has corrupted religion and transgressed the rights of the sovereign. In this revised edition of Hobbes's classic work, A.P. Martinich improves Hobbes's punctuation for the sake of clarity. He has also added new notes for readers, extensive cross references, and substantial part of Hobbes's reply to Bramhall's The Catching of Leviathan. (shrink)

The fourteenth-century thinker Thomas Bradwardine is well known in both the history of science and the history of theology. The first of the Merton Calculators (mathematical physicists) and passionate defender of the Augustinian doctrine of salvation through grace alone, he was briefly archbishop of Canterbury before succumbing to the Black Death in 1349. This new edition of his Insolubilia, made from all thirteen known manuscripts, shows that he was also a logician of the first rank. The edition is accompanied (...) by a full English translation. In the treatise, Bradwardine considers and rejects the theories of his contemporaries about the logical puzzles known as 'insolubles,' and sets out his own solution at length and in detail. In a substantial introduction, Stephen Read describes Bradwardine's analysis, compares it with other more recent theories, and places it in its historical context. The text is accompanied by three appendices, the first of which is an extra chapter found in two manuscripts (and partly in a third) that appears to contain further thoughts by Bradwardine himself. The second contains an extract from Ralph Strode's Insolubilia, composed in the 1360s, repeating and enlarging on Bradwardine's text; and the third consists of an anonymous text that applies Bradwardine's solution to a succession of different insolubles"--P. [4] of cover. (shrink)

The chapter examines fifty years of philosophers working on lying - from the 1970s to the current day – focusing on how lying is defined (descriptively and normatively), whether lying involves an intention to deceive (Deceptionists) or not (Non-Deceptionists), why lying is wrong, and whether lying is worse than other forms of deception, including misleading with the truth. Philosophers discussed include Roderick Chisholm and Thomas Feehan, Alan Donagan, Sissela Boy, Charles Fried, David Simpson, David Simpson, Bernard Williams, Paul Faulkner, (...) Thomas Carson, Roy Sorensen, Don Fallis, Jennifer Saul, Andreas Stoke, Jonathan Webber and Clea Rees. (shrink)

In this article I take on the “Transcendentalist Challenge” to naturalized phenomenology, highlighting how the ontological and methodological commitments of Merleau-Ponty’s philosophy point in the direction of an integration of the transcendental and the scientific, thus making room for a productive exchange between philosophy and psychological science when it comes to understanding consciousness and its place in nature. Discussing various conceptions of naturalized phenomenology, I argue that what I call an “Integrationist View” is required if we are to make sense (...) of the possibility of productive exchange between phenomenology and the sciences. My main argument is that if we conceive of consciousness as a structure of behavior ontologically prior to the distinctions between objectivity and subjectivity and third- and first-person perspectives, we arrive at a view of the transcendental as not essentially separate from the domain of science, but rather as contingent organizational norms of empirical nature that are best illuminated through a dialectical exchange between phenomenological and scientific approaches. I end by showing how Merleau-Ponty’s engagement with the “Schneider case” in an example of such an integration. (shrink)

to appear in Larry May, ed., War and Political Philosophy (Cambridge: Cambridge University Press).

The proliferation of new accounts of infused and acquired virtue in Thomas has brought much welcome attention to his understanding of the relationship between nature and grace. But the very originality of these interpretations has raised a multitude of unanswered questions and difficulties. For any of these accounts to be plausible, they must be accompanied by an account of the way in which Thomas thinks that the specifically one virtue of prudence considers the matter of all virtues, and (...) his statement that such prudence depends on a correct order to the ultimate end. The current disagreement over acquired moral virtue cannot be resolved until these related disagreements are adequately addressed. (shrink)

In August 2017, a group of activists erected in Ottawa's downtown a tent as a first overdose prevention site as a response to what the public and the activists perceived as an epidemic—a devastating wave of opioid and fentanyl overdoses in Canada. The Ontario premier was urged to declare an emergency that would provide increased funding for harm reduction and also send a message to survivors and families that the lives of their loved ones mattered. Thus, the discourses around the (...) so‐called opioid crisis used a language of moral sentiments to legitimate political action. This “new humanitarianism” is considered a priori as good, but in this article, I ask what is politically at stake if we base our actions on the logic of humanitarian reason. The new universalism of humanitarian organizations is based on the individualism of human rights and thus on a moral imperative that replaces the political. Initiatives like the OPS movement often fill the gaps in social services in the absence of the state and address social problems as emergencies and public health issues, thereby transforming them into medical problems—performing the medicalization of sociopolitical problems. This is what I call the NGOization of the opioid crisis. This form of humanitarianism is a universalism of the temporal present without any universal promise for a better future or the amelioration of human conditions—it is a humanitarianism of emergency. What characterizes new humanitarianism is that it responds to situations of suffering that are the result of increasing inequality and injustices without addressing the root causes of this suffering. Not addressing these causes means to be complicit in perpetuating the inequalities and to restrict visions of possible alternatives. (shrink)

Throughout his philosophical development, Wittgenstein was more concerned with language than with any other topic. No other philosopher has been as influential on our understanding of the deep problems surrounding language, and yet the true significance of his writing on the subject is difficult to assess, since most of the current debates regarding language tend to overlook his work. In this book, Thomas McNally shows that philosophers of language still have much to learn from Wittgenstein's later writings. The book (...) examines the finer details of his arguments while also clarifying their importance for debates outside the field of Wittgenstein studies. Presenting the issues thematically, the book explores how the arguments in the Philosophical Investigations remain relevant, compelling us to reflect in novel and challenging ways on the nature of language. (shrink)

Dans la vie d'un lecteur, certains auteurs occupent une place à part : lectures inaugurales, compagnons de tous les jours, sources auxquelles on revient. La collection "Les auteurs de ma vie" invite de grands écrivains contemporains à partager leur admiration pour un classique, dont la lecture a particulièrement compté pour eux. Dans sa jeunesse, Thomas Mann a lu et médité Schopenhauer, philosophe de la volonté et du pessimisme, qui a largement influencé l'oeuvre de celui qui deviendra l'un des plus (...) grands écrivains modernes de la décadence. Cet hommage à son maître nous offre une clé précieuse de son parcours intellectuel. (shrink)

Double-effect reasoning (DER) is attributed to Aquinas "tout court". Aquinas's account, however, differs from contemporary DER insofar as Thomas considers the ethical status of "risking" an assailant's life while contemporary accounts focus on actions causing harm inevitably. Since one cannot claim to risk the inevitable, and since there is a significant difference between risking harm and causing harm inevitably. Thomas's account does not extend to cases of inevitable harm. Thus, the received understanding of Aquinas's account is flawed and (...) leads to untenable attributions of the direction of intention to Aquinas and to misunderstandings of contemporary DER. (shrink)

Wilhelm Bousset, a leading member of the religionsgeschichtliche school and author of a seminal work on early Christology, Kyrios Christos, is typically regarded by reviewers of his work as a classic nineteenth-century liberal who sought a secure foundation for faith in the historical Jesus. However, this view of Bousset fails to appreciate the significant development of his theological perspective on the relationship between faith and history, a perspective that underwent a profound shift due to the influence of the English historian (...) Thomas Carlyle and the Kantian philosopher Jakob Friedrich Fries. It is the influence of these two figures that enables Bousset to justify a full-scale flight from history and to seek faith's foundation elsewhere, in the poetic symbol of Jesus Christ. The resulting solution to the problem of faith and history represents a unique and compelling alternative to the solutions of the leading theologians and New Testament scholars of the early twentieth century. (shrink)

The cluster account of art is a purportedly non-definitional account of art, inspired by Wittgenstein's notion of family resemblance, and recently defended by Berys Gaut. Gaut does not provide good reasons to think that art is not definable, and his approach to possible counterexamples to the cluster account would, applied consistently, preclude this. The cluster account's theory of error, its resources for accounting for borderline cases, and its heuristic usefulness are not impressive. Reasons strong enough to warrant accepting the cluster (...) account, it is concluded, have not been given. (shrink)

This volume comprises essays presented to Alvin Plantinga on the occasion of his 70th birthday.