This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Studying Penguins to Understand BirdsJacinta O. A. Tan (bio), Anne Stewart (bio), Ray Fitzpatrick (bio), and Tony Hope (bio)Keywordsanorexia nervosa, treatment decision-making, competence, valuesWe are grateful to Grisso, Appelbaum, Charland, and Vollmann for their thoughtful commentaries on our paper. We would like to respond by picking up on some of the points they make, although we do not address all the issues raised.Our general aims in the paper (...) are less immediately pragmatic than are the central concerns of Grisso and Appelbaum. Our interest is primarily in a number of ethical, and related conceptual, issues that arise from empirical data. In the long run, of course, we believe that these ethical and conceptual issues are important to the care of people with mental disorders, but our focus is philosophical.Our central interest is what justifies overriding treatment refusal. We are unhappy with a "status" approach according to which, for example, the mere fact that a person suffers a mental disorder provides grounds for overriding her wishes. Such an approach, it seems to us, fails to identify reasons, and discriminates against those with mental disorder, a view shared by the Law Commission (The Law Commission 1995). We are, on the other hand, attracted by the approach that grounds any overriding of treatment refusal on lack of capacity (or competence) to make treatment decisions. The concept of capacity has been well developed through legal cases and conceptual analysis, not least by Grisso and Appelbaum themselves. We were struck, however, first through clinical experience, and subsequently from the pilot study reported in our paper, that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity, using the current criteria, and yet show features or give reasons that raise serious doubts as to whether it is right to respect their refusal of treatment.To avoid reliance on a "status" approach, the issue with which we are grappling is whether the concept of capacity (and therefore lack of capacity) can be developed to encompass some of our findings, and whether it is ethically right to do so. Charland makes the important point that the concept of competence, or capacity, has both a descriptive and a prescriptive component. It is for this reason that the question of whether, for example, we should extend the criteria for capacity is part of the question of when it is morally right to override treatment refusal.Grisso and Appelbaum suggest that our work advances "our thinking about appreciation, rather than requiring that we add new elements" (2006, 297). From our perspective, and at this stage, it is a secondary issue whether we are suggesting a development of appreciation, or a new element (e.g., "pathological values"). The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in [End Page 299] such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests.We chose to study anorexia nervosa for various reasons, but we expect that the issues raised have a more general relevance (such as to substance abuse and impulse control disorders as Grisso and Appelbaum and Charland suggest). We do not expect the results to be relevant to all, or even most, mental disorders. Our main interest is not the specific management of people with anorexia, but how the data challenge, and help to develop, the concept of capacity, and the ethical analysis of overriding patient refusal of treatment. Our paper aims to address what we understand Charland to be referring to by the "pretheoretical desiderata" (2006, 283) of the concept of capacity. One reason why we chose anorexia as the focus of this work is because it is different from many mental disorders in the issues that it raises. In this it is, perhaps, rather like studying penguins to better understand the concept of bird just because penguins, although clearly birds, have unusual features.We agree, therefore, with Grisso and Appelbaum's caution that it would be unwise to jump in and change the MacCAT-T on the basis of the results... (shrink)

A family of instruments has been developed over the last twenty five years in order to measure the individual's subjective view of his health. The instruments vary in how broadly they define health. A wide range of critiques have challenged both the validity of these measures and their uses. This paper argues that disproportionate attention has been given to one form of health status measure—the so-called utility-based measures. The ensuing controversies have distracted from the substantial progress achieved in the application (...) of health status measures. This paper identifies the major areas of progress and argues that any serious critique needs to engage with this now sizeable body of applied knowledge. (shrink)

A remarkable surge in efforts to assess the quality of life of patients has occurred in recent years in medical research. Philosophical discussions of these developments have focused, on the one hand, on epistemological reservations about the plausibility of measuring quality of life and, on the other hand, on moral and ethical qualms about the meaning of life conveyed in such assessments. Whilst providing an important note of caution, such critiques fail to recognise two basic principles of quality of life (...) in medical research. Firstly it is intended to provide understanding about groups and categories of patients rather than individuals. Secondly the purpose of such research is to produce generalisations about the relative costs and benefits of specific health care interventions rather than absolute judgements regarding the quality of life of patients per se. Selecting a good quality of life measure for a clinical trial requires balancing criteria such as validity with practical feasibility. Such measures will play an increasingly central role in providing research evidence to improve health care. (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

This paper considers John Doris, Stephen Stich, Alexandra Plakias, and colleagues’ recent attempts to utilize empirical studies of cross-cultural variation in moral judgment to support a version of the argument from disagreement against moral realism. Crucially, Doris et al. claim that the moral disagreements highlighted by these studies are not susceptible to the standard ‘diffusing’ explanations realists have developed in response to earlier versions of the argument. I argue that plausible hypotheses about the cognitive processes underlying ordinary moral judgment and (...) the acquisition of moral norms, when combined with a popular philosophical account of moral inquiry—the method of reflective equilibrium—undercut the anti-realist force of the moral disagreements that Doris et al. describe. I also show that Stich's recent attempt to provide further theoretical support for Doris et al.'s case is unsuccessful. (shrink)

Ludwig Wittgenstein is perhaps the greatest philosopher of the twentieth century, and certainly one of the most original in the entire Western tradition. Given the inaccessibility of his work, it is remarkable that he has inspired poems, paintings, films, musical compositions, titles of books -- and even novels. In his splendid biography, Ray Monk has made this very compelling human being come alive in a way that perfectly explains the fascination he has evoked. Wittgenstein's life was one of great moral (...) and spiritual depth. Although his work addresses problems of logic, language, mind, and knowledge, he often described it as having an ethical point, and once said that he "could not help seeing every problem from a religious point of view." In successfully bridging the gap assumed by many to exist between Wittgenstein's life and his work, Monk's biography helps to explain the interest in Wittgenstein's later philosophy on the part of Buddhist scholars. (shrink)

Advanced directives and living wills have improved our ability to dictate end-of-life care, but even these cannot guarantee that we will be allowed the dignity of a natural death. Designed by two sisters-one a doctor, one a lawyer-and drawing on their decades of experience, the five-step Compassion Protocol outlined in A Better Way of Dying offers a simple and effective framework for leaving caretakers concrete, unambiguous, and legally binding instructions about your wishes for your last days. Meant for people in (...) every walk of life-from the elderly, to those in the early stages of mentally degenerative diseases like Alzheimer's, to healthy young people planning for an unpredictable future-this book creates space for a discussion we all must have if we wish to ensure comfort and control at the end of our lives.." -- from publisher's website. (shrink)

Propositions are the things we believe, intend, desire, and so on, but discussions are often less precise than they could be and an important driver of this deficiency has been a focus on the objects but a neglect of the attitudinal relations we bear to them. In what follows, we will offer some thoughts on what it means for a proposition to be the object of an attitude and we will argue that an important part of the story lies with (...) the attitude relations rather than the propositions. As we will see there are infinitely many relations we might bear to a proposition, but the propositional attitude relations are special amongst them. Accounting for what makes them special will be an important component in the discussion that follows. We will argue that once one appreciates certain facts about propositional attitude relations, various claims that metaphysicians often make regarding propositions themselves begin to look undermotivated. In fact, many views on the metaphysical nature of propositions come to look like plausible candidates for being that to which our propositional attitudes relate us. As will emerge, we will see that the principle role of propositions in the theory of mind is simply to keep track of how our attitudinal states represent things as being. But, we argue, in order to do this work, very few constraints must be placed on the nature of propositions themselves. In particular, contra much of the recent work on the metaphysics of propositions, they need not represent nor must they be structured. In light of these observations, we conclude by sketching our own favored minimalist view of propositions. (shrink)

Using the example of Black people’s inequitable COVID-19 outcomes and their health outcomes prior to the pandemic, I argue that the pandemic has forever changed how we should think about the conceptual and practical nature of health equity. From here on, we can no longer think of health equity without the concept of intersectionality. In particular, we must acknowledge that discrimination (e.g. sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed for health from people who (...) themselves have intersecting identities that make them vulnerable to the effects of discrimination. To ignore intersectionality in our work on health equity would mean ignoring a great injustice imposed on some of the most overlooked people in our communities, which would also be a great disserve to bioethics’ professional longevity. (shrink)

"In Applied Ethics and Social Problems Tony Fitzpatrick presents introductions to the three most influential moral philosophies: consequentialism, Kantianism ...

In this book, Fitzpatrick and May make the case for a reimagined approach to critical ethnography in education. Exploring how critical ethnography works within contemporary inquiries, the authors argue that many researchers already do the kind of critical ethnography that readers imagine, whether they call their studies critical or not. Such studies employ the tenets of ethnography and are grounded in work that attends to, reimagines, troubles, and questions notions of power, in/justice, in/equity, and marginalization. Understanding the tensions and (...) complexities that come with the posts-including poststructuralism, postcolonialism, and posthumanism-Fitzpatrick and May argue that social, theoretical, and political issues in education can be more profoundly viewed through a lens that is personal, embodied, and lived: critical ethnography. Offering a wide-ranging and insightful commentary on approaches and influences on critical ethnography over time, Fitzpatrick and May interrogate how it has moved and engaged with ongoing theoretical developments to now include a wide range of possible analytical approaches. With extensive examples, excerpts, and personal discussions, they demonstrate how critical ethnography is an expansive, eclectic, and inclusive methodology. Linking work across a range of topics, this book highlights the ongoing importance of this methodology in education. It is essential reading for students, scholars, and researchers in qualitative inquiry, ethnography, educational anthropology, educational research methods, sociology of education, and philosophy of education. (shrink)

Narratives have allowed us to show the limits of positivism in humanistic disciplines and to challenge dominant presuppositions. A recent development in feminist philosophy, epistemic injustice describes the ways in which marginalized peoples are unfairly deprived of the ability to participate in society's knowledge‐ and meaning‐making practices. Marginalized groups can respond with their own ways of thinking, speaking, acting, and organizing, thus resisting an oppressive status quo. Much like an economic monopoly, a “hermeneutical monopoly” exists where people are forced, both (...) by coercion and by lack of alternatives, to consume and use the dominant hermeneutical resources. The chapter describes an overlooked problem in the context of mass incarceration and thus to point to the need for a solution. The problem is the hermeneutical injustice and hermeneutical marginalization of prisoners, which is not adequately addressed by scholars who simply attend to the narratives of the oppressed. (shrink)

This volume explores the relationship between individuals and institutions in scholastic thought and practice across the twelfth and fifteenth centuries, setting an agenda for future debates. Written by leading European experts from numerous fields, this theoretically sophisticated collection analyses a wide range of intellectual practices and disciplines. Avoiding narrow approaches to scholasticism, the book addresses ethics, history, heresy, law, inquisition, metaphysics, pastoral care, poetry, religious orders, saints' cults and theology. A substantial introduction establishes an accessible historiographical context for the volume's (...) agenda, and a final afterword examines implications for future research. The history of individuals and institutions in scholasticism has often been unhelpfully treated either as a simple intellectual genealogy of schools and doctrines, or a constitutional history of particular organizational forms. This volume advances our understanding by reconsidering these fields as a whole and addressing two large questions. What was the relationship between particular intellectuals and their wider networks? How did individuals alter their institutions, and how did those institutions shape their individuality? This volume is of major importance to intellectual, religious and cultural historians as well as historians of knowledge and science. It will engage those working on individuals and institutions in the middle ages as well as in other periods. (shrink)

The sources that we have conveying information about the early Greek philosophers are far removed from the original texts. Manuscripts from the era were disseminated by scribes, making copies of a text. The text that formed the basis for the scribe was more likely than not a copy of a copy of a copy. Scribes are imperfect conduits of information. In addition to the challenges faced in ascertaining accuracy of the base text, there are errors that often occur in transcription (...) of the base text. There are errors of omission: Homeoteleuton occurs when a transcription skips words because a subsequent word has the same or a similar ending. Homeoarchy occurs when the transcriber skips lines, because of the similarity of the beginning of the lines. Haplography occurs when the transcriber copies once a term that appears twice in the base text. There are errors of addition. Dittography occurs when the transcriber writes a term twice that appeared once in the base text. Contamination occurs when a transcriber inserts text that was not in the base text. There are errors of transposition. Metathesis occurs when a transcriber reverses letters, words, or phrases from the base text. Finally, but not exhaustively, there are errors of alteration. These errors occur when a transcriber attempts, deliberately or not, to make sense of the base text in the transcription. (shrink)

Migration and Islamic Ethics, Issues of Residence, Naturalization and Citizenship addresses how Islamic ethical and legal traditions can contribute to current global debates on migration and displacement; how Islamic ethics of muʼakha, ḍiyāfa, ijāra, amān, jiwār, sutra, kafāla, among others, may provide common ethical grounds for a new paradigm of social and political virtues applicable to all humanity, not only Muslims. The present volume more broadly defines the Islamic tradition to cover not only theology but also to encompass ethics, customs (...) and social norms, as well as modern political, humanitarian and rights discourses. The first section addresses theorizations and conceptualizations using contemporary Islamic examples, mainly in the treatment of asylum-seekers and refugees; the second, contains empirical analyses of contemporary case studies; the third provides historical accounts of Muslim migratory experiences. (shrink)

A collection of philosophical and aesthetic essays, influenced by Bernard Stiegler, which focuses on the techno-cultural artefact in order to critique, engage, or respond to, an aspect of digital culture.

Essays: The language of values, by W. Moore. The languages of sign theory and value theory, by E. S. Robinson. Significance, signification, and painting, by C. Morris. Evaluation and discourse, by S. C. Pepper. Empirical verifiability theory of factual meaning and axiological truth, by E. M. Adams. The third man, by I. McGreal. A non-normative definition of "good," by A. C. Garnett. The judgmental functions of moral language, by H. Fingarette. Some puzzles for attitude theories of value, by R. B. (...) Brandt. The meaning of "intrinsic value," by H. N. Lee. Value propositions, by R. S. Hartman. A second sequel on value, by R. Lepley.--Comments and responses. (shrink)

This monumental collection of new and recent essays from an international team of eminent scholars represents the best contemporary critical thinking relating to both literary and philosophical studies of literature. Helpfully groups essays into the field's main sub-categories, among them ‘Relations Between Philosophy and Literature’, ‘Emotional Engagement and the Experience of Reading’, ‘Literature and the Moral Life’, and ‘Literary Language’ Offers a combination of analytical precision and literary richness Represents an unparalleled work of reference for students and specialists alike, ideal (...) for course use. (shrink)

After giving the name “burnout” to the experience of being overworked and undervalued and the physician and patient suffering that comes from it, many clinicians have sought to elucidate further wh...

How do I handle difficult family members? What do I do if I can’t control my emotions? When do I correct others, and when do I hold my tongue? Too often we are late in realizing that we mishandled a situation, causing both resentment and frustration. But what if you could approach every situation with the mind of Christ? Distilled from his decades of experience as a clinical psychologist and a practicing Catholic, Dr. Ray Guarendi, popular radio and TV host, (...) offers here dozens of bite-sized reflections that combine sound spiritual advice with the best of modern psychology. Dr. Ray will help you address countless daily problems and create a plan of action for your most common troubles. With his trademark frankness and humor, Dr. Ray tackles all the topics that too often bring confusion and heartache, including: What to do when you’re easily offendedCommon excuses parents make for bad behavior in their children—and themselvesThe difference between speaking your mind and losing your emotions.The fine line between being a confident evangelist and being a jerk?What you should do when emotions overwhelm you?How to hold your children to high standards without causing resentmentThe difference between making an excuse and justifying an actionHow to tell people you’re angry without being nasty about it.What true humility is – and isn’t. Thinking Like Jesus is more than a self-help book. It will place you firmly into the mindset of a disciple of Christ so you can focus your attention on God and, ultimately, what it will take to spend eternity with Him in heaven. (shrink)

In this long-awaited work, Ray L. Hart offers a speculative theology that profoundly challenges traditional understandings of God. Drawing on a lifetime of reading in philosophy and religious thought, Hart unfolds a vision of God perpetually in process: an unfinished God. Breaking out of the classical doctrine of divine persons, Hart reimagines Trinity as composed of theogony, cosmogony, and anthropogony an emerging Godhead in relation to origins, temporal creation, and human existence. The book s ultimate import is that all of (...) Being and Nonbeing emerges together in interrelation and interdependence. This divine reality, Hart explains, is unfinished, imperfect, still in the course of a living-dying process that implicates all things, existent and inexistent, temporal and eternal. Doctrinal closuresomething that every orthodox theology requiresthus becomes impossible, and rightly so. Hart confronts those orthodoxies by asking: How can thinking of God reach closure when the divine is itself unfinished and its appearance to us always amounts to new creation? Hart s insights open the potencies of the nothing to the actualization of freedomthe freedom to create. That is, the nothing is not for nothingit is procreative. In the domain of radical speculative theology, then, Hart offers a fully deconstructive revisioning of the Christian God as ever an emerging and self-transfiguring actuality. It is a work with which all serious students of theology will wish to contend.". (shrink)

This chapter contains section titled: Some Personal Prefatory Remarks Introduction: Wittgenstein's Chief Contribution? The Reception of Wittgenstein's Philosophy of Mathematics in His Own Lifetime The Post 1956 Reaction.

Short inspirational selections from the great masters of Tibetan Buddhism, past and present--now part of the Shambhala Pocket Library series. Here is a portable collection of inspiring readings from the revered masters of Tibetan Buddhism.The Wisdom of Tibetan Buddhismincludes quotations from major lineage figures from the past such as Padmasambhava, Atisha, Sakya Pandita, Marpa, Milarepa, and Tsongkhapa. Also featured are the writings of masters from contemporary times including the Dalai Lama, Dudjom Rinpoche, Khyentse Rinpoche, Sakya Tridzin, Chogyam Trungpa, and others. (...) Topics include cultivating compassion, letting go of ego, learning to become more alert and present in our lives, and developing a clear perception of our own true nature. This book is part of the Shambhala Pocket Library series. The Shambhala Pocket Library is a collection of short, portable teachings from notable figures across religious traditions and classic texts.The covers in this series are rendered by Colorado artist Robert Spellman.The books in this collection distill the wisdom and heart of the work Shambhala Publications has published over 50 years into a compactformat that is collectible, reader-friendly, andapplicable to everyday life. (shrink)