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:Decision-Making as a Broader ConceptJacinta O. A. Tan (bio), Anne Stewart (bio), and Tony Hope (bio)KeywordsCompetence, decision-making, capacity, anorexia nervosa, autonomy, values, identityWe thank Demian Whiting for the thoughtful critique of aspects of our paper (Tan et al. 2006a). A primary aim of our research was to provide empirical grounds on which to stimulate discussion about the nature of decision-making capacity (DMC). Whiting criticizes in particular the concept of (...) 'pathological values' that we suggested might be relevant in the assessment of DMC and in the related issue of deciding when a patient's refusal of beneficial treatment should be overridden.Whiting's central concern is with DMC. Whiting argues that the absence of pathological values should not be a criterion for DMC. We are unclear whether he is also arguing that pathological values do not provide a reason of any kind for overriding treatment refusal. At the end of the paper he writes: "we cannot justify compulsory treatment of patients who have pathological values... on the grounds that these patients lack DMC" (2009, XX). This seems to leave open the possibility that we may be able to justify compulsory treatment of patients who have pathological values on grounds other than that they lack DMC. As we wrote in our response to the discussants of our original paper, "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 such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests" (Tan et al. 2006b, 300).In deciding on whether to use compulsory treatment, there are other relevant factors that may need to be considered, such as the seriousness of the decision, which determines the threshold for competence. However, in this response we consider three issues. First, we argue that the current concept of DMC is by no means so clear cut or generally agreed upon as Whiting implies, and that some of the lack of clarity relates to pathological values. Second, that the concept of DMC is itself dependent on accounts of autonomy, and that it is plausible that pathological values can affect autonomy. Third, we directly consider the question of whether a coherent account of pathological values might be given based on a concept of authenticity.The Current Criteria for DMCWhiting argues that the current criteria for DMC are correct and that an additional criterion along the lines of absence of pathological values should not be added. This argument assumes that there is a clear and agreed understanding of the current criteria. We believe this is not the case for three reasons.(i) Whiting begins his account of DMC by saying that it is normally taken to include: "(1) [End Page 345] understanding (and appreciation)" (2009, 341). Already there is an area of dispute, and the use of parentheses reflects this. The concept of 'appreciation' was developed by Grisso and Applebaum (Grisso, Appelbaum, and Hill-Fotouhi 1997). It is not included in either English common law development, for example (ReC), nor in the criteria specified in the Mental Capacity Act 2005. More important, Grisso and Appelbaum in their comment on our original paper (2006) argue that our work advances thinking about 'appreciation' rather than requiring that we add new elements. The implication is that they believe that what we have called pathological values are relevant to the assessment of capacity and are already included in an account of capacity that incorporates the criterion of 'appreciation.' In our response, we argued that pathological values are not entirely captured within the account of appreciation that Grisso and Appelbaum had previously given. We do not want to revisit that issue here, but the point of relevance is that on one view (that of Grisso and Appelbaum) pathological values are already included in the current criteria for DMC as part of the concept of appreciation, whereas on Whiting's view they are not.(ii) Even if there were agreement over the wording and concepts relevant to DMC there is a further important issue: how are those concepts... (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)

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)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks (...) relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. (shrink)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...) nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)

We are grateful for these two insightful commentaries, which both see novelty and value in the manner in which we invoke the hypothesis that anorexia nervosa is a passion, to help explain data from the Anorexia Experiences Study, which provides the basis of our inquiry. In this response, we wish to clarify and elaborate on our hypothesis; in particular, the difference between passions and moods, the manner in which our hypothesis touches on issues of authenticity and identity, and the compelling (...) parallel with addiction. We also wish to emphasize that, in proposing the hypothesis that anorexia nervosa is a passion, our primary aim is not so much to exclude or replace alternative theoretical approaches. Our focus, really, is to argue that the hypothesis that anorexia nervosa is a passion adds something rich and unique to our current understanding of that condition, which is not fully or adequately captured by alternative accounts... (shrink)

This second volume in the Come Along: We Are Truth-Bound series is a cross-examination of the concepts derived in Volume One, conducted by means of a dialogue with a representative thinker from each of the related bodies of knowledge. The study reveals reality to be an intricate, harmoniously-integrated whole.

Indigenous knowledge is often dismissed as ‘traditional and outdated’, and hence irrelevant to modern ecological assessment. This theoretical paper critically examines the arguments advanced to elevate modern western ecological knowledge over indigenous ecological knowledge, as well as the sources and uses of indigenous ecological knowledge. The central argument of the paper is that although the two systems are conceptually different, it would be fallacious to regard one as superior to the other merely because they are premised on different worldviews.

Este artículo presenta una lectura crítica de un trabajo central de Axel Honneth desde la teoría de la sujeción de Judith Butler. Intenta mostrar que, por la ausencia en su escrito de una consideración sobre el poder, el pensador alemán no logra cumplir satisfactoriamente su objetivo propuesto de enfrentar las posturas que cuestionan el potencial crítico del reconocimiento. La hipótesis que aquí se maneja es que esa ausencia está ligada a su definición del reconocimiento como lo contrario de las prácticas (...) de dominio o sometimiento. Ahora bien, Honneth afirma que el escepticismo de esas posturas respecto del reconocimiento se basa en la idea de que toda praxis recognoscente reproduce de alguna manera el orden social dominante. El presente trabajo se propone entonces, cuestionar esta aseveración del autor advirtiendo que un análisis sobre el modo en que el poder actúa en las prácticas cotidianas de reconocimiento no necesariamente conlleva una renuncia de la función crítica del concepto para la teoría social. Más bien, como sugiere la noción butleriana (y foucaultiana) de crítica, sólo enmarcando al reconocimiento en el horizonte normativo que lo delimita puede convertirse en la base de la indagación social. (shrink)

In this text we explore and present some elements that allow us to consider the elaboration of a feminist theory of the State. In principle, it is about starting from a materialistic philosophical perspective that provides us with a broad and rigorous framework for inquiry, which includes a consideration of the complex social topic in which our practices are inscribed and a special attention to the dynamics of affects that guide us in them. Based on this perspective, we propose the (...) concept of State of care. The logic of care to which we refer here is not limited to the problem of social reproduction but crosses the set of instances and practices, and simultaneously involves a way of knowing, a way of being and a way of constituting oneself. (shrink)

This paper is a critical examination of Odera Oruka’s theory of punishment in his Punishment and Terrorism in Africa. It argues that although Oruka clearly highlights the weaknesses of the Retributionist and Utilitarian accounts of punishment and therefore calls for the Reformist view of ‘treating both the criminal and society’, he is mistaken in calling for the abolition of punishment simply because it cannot reform the criminal. The paper contends that the reform of the criminal is only one major function (...) of punishment and not the only one, and so we cannot call for its abolition on the basis of this single consideration. The paper further urges that Oruka’s theory of punishment is rather deterministic: according to him, the criminal commits the crime because of the criminal forces which he or she has very little control over, so that he or she cannot be held morally responsible for his or her actions. (shrink)

The main argument of this theoretical paper is that the pursuit of honest profits in a voluntary market exchange is not only moral but also ingrained in human nature, in that human beings pursue activities that benefit them and avoid those that cause them loss. Through an examination of the Kenyan business venture called Iko Toilet (which is a mix of the Kiswahili word ‘iko’ meaning ‘there is’ and the English word ‘toilet’ to literally mean ‘there is a Toilet’), the (...) paper contends that there is no inherent contradiction between doing well (engaging in honest voluntary business transactions) in order to do good (maximize legitimate profits). (shrink)

The aim of this study was to ascertain nurses' and doctors' perspectives on the practice of slow codes, which are cardiopulmonary resuscitative efforts that are intentionally performed too slowly for resuscitation to occur. A Heideggerian phenomenological study was conducted in 2005, during which data were gathered in the Republic of Ireland from three nurses and two doctors (via unstructured interviews) and analysed using Colaizzi's reductive procedure. Slow codes do occur in Ireland and are intended as beneficent acts. However, slow codes (...) were identified as pointless and undignified when intrusive measures were employed. There is a need for discussion on the topic of slow codes in Ireland, and for aids to cardiopulmonary resuscitation decision making to be developed, such as advance directives, communication training, clinical guidelines and an explanatory leaflet for patients and families. (shrink)

This chapter contains section titled: Decent Peoples The Idea of Toleration The Cosmopolitan Critique Intervention and Cosmopolitanism Acknowledgments Notes.

The concept of civilization is intrinsic to the English School’s understanding of international society. At the same time, engagement with discourses of civilization has been an important site of c...

是東漢哲學家、思想家桓譚的主要論着，但早己亡佚。今存之輯本有《指海》內佚名氏輯本、清孫馮翼輯本、清嚴可均輯本、黃以周輯本，及近人朱謙之輯本，但均有不足。有鑒於此，吳則虞先生於1962年着有新輯本，收錄 二百餘條，以類相從，分為八卷，並添加附編，匯涵桓譚佚文、存疑、訂訛之文；記載桓譚事跡、著述、評論之文。 桓譚，后漢時人，官至給事中。博學多識，破讖緯迷妄，去虛妄偽飾，先於王充、張衡，具有唯物啟蒙學者之學識，是漢時哲學思想家。《新諭》是桓譚主要論着，但早已亡佚。據歷史記載，明有二卷本，清有孫之騌輯本，皆不 傳。另有《指海》內佚名氏輯本、清孫馮翼輯本、清嚴可均輯本、黃以周輯本及近人朱謙之輯本。從今日的學術、校勘、編排諸方面來看，諸本均有不足：或短椾零篇，漫無倫紀；或望文歸屬，強系篇名；或條目重復，內容雜陳 迭見；或引用刻本，多有遺漏；或雖沿用十七卷篇目之名稱，但其條目已不能再顯現原書各篇的思想內容。有鑒於此，吳則虞先生於一九六二年着有新輯本，收錄二百余條，以類相從，分為八卷，並添加附編，匯涵桓譚佚文、存 疑、訂訛之文；記載桓譚事跡、著述、評論之文；最后殿以輯校引用書目及版本之詳目，以便於讀者查閱與研究。此書成為目前桓譚《新論》集大成之著作。.

IntroductionThe various special concerns and commitments that individuals ordinarily have, for example towards family members, friends, and possibly compatriots, present an interesting challenge for justice. Justice, after all, is said to be blind and imposes demands on persons that ought to be impartial, at least in some respects, to personal ties and relationships. Yet individual special concerns are obviously of moral importance and are deeply valued by participants in these relationships. Thus any conception of justice to be plausible has to (...) be able to accommodate to some extent the various types of valuable and valued special concern characteristic of ordinary social life. In particular, it is important to see how the impartial demands of justice can be maintained while accommodating special concern. (shrink)

North America and New Zealand were colonized by England under an international legal principle that is known today as the Doctrine of Discovery. When Europeans set out to explore and exploit new lands in the fifteenth through the twentieth centuries, they justified their sovereign and property claims over these territories and the Indigenous people with the Discovery Doctrine. This legal principle was justified by religious and ethnocentric ideas of European and Christian superiority over the other cultures, religions, and races of (...) the world. The Doctrine provided that newly-arrived Europeans automatically acquired property rights in the lands of Native people and gained political and commercial rights over the inhabitants. England was an avid supporter of the Doctrine and used it around the world. The English colonial governments and colonists in New Zealand and America, and later the American state and federal governments and New Zealand governments, all utilized Discovery and still use it today to exercise legal rights to Native lands and to control their Indigenous people. In this article, the authors, an American Indian and a New Zealand Maori, use a comparative law methodology to trace and compare the legal and historical application of Discovery in both countries. The evidence uncovered helps to explain the current state of United States Indian law and the New Zealand law relating to Maoris. While the countries did not apply the elements of Discovery in the exact same manner, and at the same time periods, the similarities of their use of Discovery are striking and not the least bit surprising since the Doctrine was English law. Viewing American and New Zealand history in light of the international law Doctrine of Discovery helps to expand one's knowledge of both countries and their Indigenous peoples. (shrink)

Most people would not associate Confucian philosophy with contemporary education. After all, the former is an ancient Chinese tradition and the latter is a modern phenomenon. But this book shows otherwise, by explaining how millennia-old Confucian ideas and practices can inform, inspire and improve teaching and learning today. Drawing upon major Confucian texts such as the Analects and Mencius, as well as influential thinkers such as Confucius, Zhu Xi and Empress Xu, the various chapters address current educational issues and challenges (...) such as the following: How can humanity resolve the climate emergency? What (more) should schools do to promote education for girls? Is there more to lifelong learning than just skills upgrading? Is teacher-centred education really bad? What is missing in the existing frameworks on 21st century competencies? What new initiatives are needed to champion sustainable development? Confucian Philosophy for Contemporary Education answers the above questions and more by presenting a Confucian model of education. The author describes a Confucian school where Dao - a shared vision of human excellence - is realised through an inclusive, mindful, learning-centred and ultimately humanising form of education. This book is a useful resource for academic researchers, educators, students and general readers on Confucian philosophy and its continual relevance for present-day education. (shrink)

Intellectual biography -- Confucius' life, personality and influence -- Critical exposition of Confucius' educational thought -- The concept of li -- The concepts of dao and he -- The concept of ren -- The concept of junzi -- The concepts of xue, wen and si -- The relevance of Confucius' work today -- Confucius and 21st century education -- Conclusion.

In two recent papers, Mr Robert Young maintains that all attempts by philosophers to bolster the-violation-of-law concept of miracles are bound to fail and propounds what he claims to be a novel non-reductivist concept of miracles which avoids the conceptual difficulties of the violation-model. His view of miracles is of god being ‘an active agent-factor in the set of factors which actually was causally operative’ [p. 123] in an event dubbed a miracle. God is put in among ‘the plurality of (...) causes’ [p. 122, S p. 33] that could determine the event, but if he acts in a miracle, then ‘his presence…alters the outcome from what it would have been if, contrary to fact , he had not been present’ [p. 122]. Young claims that his concept ‘is neither a violation of … laws nor is it a coincidental occurrence religiously interpreted’ [p. 122, S p. 33], and so it avoids the difficulties, which he thinks are faced by the violation-model, of having an intelligible notion of an occurrence of the physically impossible, and also the reductivism inherent in taking mere coincidences as miracles. He also suggests a procedure of settling the epistemological issue regarding particular alleged miracles, an inquiry he thinks he has made possible by having first given a sense to miracles. [p. 126]. (shrink)