This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment, they may still be less competent than they were when they signed the Ulysses Contract. As such, even if competent at time 1 (...) and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people’s most meaningful concerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis, this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)

According to standard philosophical and clinical understandings, pain is an essentially mental phenomenon. In a challenge to this standard conception, a recent burst of empirical work in experimental philosophy, such as that by Justin Sytsma and Kevin Reuter, purports to show that people ordinarily conceive of pain as an essentially bodily phenomenon—specifically, a quality of bodily disturbance. In response to this bodily view, other recent experimental studies have provided evidence that the ordinary concept of pain is more complex than previously (...) assumed: rather than tracking only bodily or only mental aspects of pain, the ordinary concept of pain can actually track either of these aspects. The polyeidic analysis of the folk concept of pain, as proposed by Emma Borg et al., captures this complexity. Whereas previous empirical support for the polyeidic view has focused on the context-sensitivity of the folk concept of pain, here we discuss individual differences in people’s ‘pain priors’—namely, their standing tendencies to think of pain in relatively mind-centric or body-centric ways. We describe a preliminary empirical study and present a small number of findings, which will be explored further in future work. The results we discuss are part of a larger programme of work which seeks to integrate philosophical pain research into clinical practice. For example, we hypothesise that variations in how patients with chronic pain are thinking about pain could help predict their responses to treatment. (shrink)

According to standard philosophical and clinical understandings, pain is an essentially mental phenomenon (typically, a kind of conscious experience). In a challenge to this standard conception, a recent burst of empirical work in experimental philosophy, such as that by Justin Sytsma and Kevin Reuter, purports to show that people ordinarily conceive of pain as an essentially bodily phenomenon—specifically, a quality of bodily disturbance. In response to this bodily view, other recent experimental studies have provided evidence that the ordinary (‘folk’) concept (...) of pain is more complex than previously assumed: rather than tracking only bodily or only mental aspects of pain, the ordinary concept of pain can actually track either of these aspects. The polyeidic (or ‘many ideas’) analysis of the folk concept of pain, as proposed by Emma Borg et al., captures this complexity. Whereas previous empirical support for the polyeidic view has focused on the context-sensitivity of the folk concept of pain, here we discuss individual differences in people’s ‘pain priors’—namely, their standing tendencies to think of pain in relatively mind-centric or body-centric ways. We describe a preliminary empirical study and present a small number of findings, which will be explored further in future work. The results we discuss are part of a larger programme of work which seeks to integrate philosophical pain research into clinical practice. For example, we hypothesise that variations in how patients with chronic pain are thinking about pain could help predict their responses to treatment. (shrink)

According to the Argument for Autonomous Mental Disorder, mental disorder can occur in the absence of brain disorder, just as software problems can occur in the absence of hardware problems in a computer. This article argues that the AAMD is unsound. I begin by introducing the “natural dysfunction analysis” of disorder, before outlining the AAMD. I then analyze the necessary conditions for realizer autonomous dysfunction. Building on this, I show that software functions disassociate from hardware functions in a way that (...) mental functions do not disassociate from brain functions. It follows that mental disorders are brain disorders necessarily. (shrink)

Sabellianism, the doctrine that the Persons of the Trinity are roles that a single divine being plays either simultaneously or successively, is commonly thought to entail that the Father is the Son. I argue that there is at least one version of Sabellianism that does not have this result and meets the requirements for a minimally decent doctrine of the Trinity insofar as it affirms that each Person of the Trinity is God and that the Trinity of Persons is God (...) while maintaining monotheism without undermining the distinctness of Persons. (shrink)

Justin Garson has recently advanced a Generalised Selected Effects Theory of biological proper function. According to Garson, his theory spells trouble for the Dysfunction Account of Disorder. This paper argues that Garson’s critique of the Dysfunction Account from the Generalised Theory fails, and that we should reject the Generalised Theory outright. I first show that the Generalised Theory does not, as Garson asserts, imply that neurally selected disorders are not dysfunctional. Rather, it implies that they are both functional and dysfunctional. (...) I argue on this basis that the Generalised Theory yields conflicting functional norms, and we that should reject it outright on these grounds. (shrink)

The archive can take many forms but all are marked by a connective sequence: archive, memory, the past, narrative. The author explores this sequence through an account of her engagement with four different types of archive, constructing a phenomenology of the archive which highlights the promises and seductions offered to the researcher. Postmodern questioning may throw in doubt older conceptions, whereby the archive is used to legitimate knowledge claims about the past of a nomological nature. However, in a context where (...) intellectuals become interpreters rather than legislators, the role of the archive as repository of inert meanings is strengthened rather than weakened; using the archive helps us to understand the dialectical nature of the relationship between past and present and our own positioning within this. (shrink)

The prior issue of Krisis (42:1) published Critical Naturalism: A Manifesto, with the aim to instigate a debate of the issues raised in this manifesto – the necessary re-thinking of the role (and the concept) of nature in critical theory in relation to questions of ecology, health, and inequality. Since Krisis considers itself a place for philosophical debates that take contemporary struggles as starting point, it issued an open call and solicited responses to the manifesto. This is one of the (...) sixteen selected responses, which augment, specify, or question the assumptions and arguments of the manifesto. (shrink)

This paper asks when a natural disease kind is truly 'reactive' and when it is merely associated with a corresponding social kind. I begin with a permissive account of real kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive kinds as varieties of real kind characterised by super-explanatory properties. I then situate disease kinds within this framework, arguing that many disease kinds prima facie are both natural and reactive. I proceed to distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential (...) dependence’ between a natural kind and its classification, and argue that a natural kind is only really reactive, in an important sense, under conditions of essential dependence. On this basis, I offer a principled hypothesis for why psychiatric kinds tend to be more metaphysically unstable than paradigm somatic disease kinds. (shrink)

Can a materialist look for the resurrection of the dead and the life of the world to come? Dean Zimmerman’s Falling Elevator Model is a speculative account of how persons, understood as material beings, might survive in a post-mortem resurrected state—a just-so story. It assumes endurantism, the doctrine that persons and other ordinary objects are three-dimensional beings which are wholly present at every time they exist. I argue that neither endurantism, nor purdurantism, according to which persons are four-dimensional ‘worms’ who (...) have proper temporal parts at every time that they exist, provides a plausible account of personal survival. If you want to be a Christian materialist you should embrace exdurantism, the ‘stage theory’, according which persons are instantaneous stages and are not identical to their temporal successors either in this world or in any world to come. Exdurantism provides a plausible account of survival in ordinary cases and extraordinary cases of this-worldly fission, and of post-mortem survival. (shrink)

Background Generally, there is unanimity about the value of community engagement in health-related research. There is also a growing tendency to view genetics and genomics research (GGR) as a special category of research, the conduct of which including community engagement (CE) as needing additional caution. One of the motivations of this study was to establish how differently if at all, we should think about CE in GGR. Aim To assess the perspectives of genetics and genomics researchers in Uganda on CE (...) in GGR. Method A cross-sectional qualitative study was conducted at Makerere University and Uganda Virus Research Institute. Twenty-five individuals participated, the majority being male (sixteen). Participants included nineteen genetics and genomics researchers (researchers and research coordinators), two CE officers, three nurses and one nursing counsellor. Data were collected using in-depth interviews and analyzed in a thematic manner using NVivo version 12 Plus. Study findings Thirteen of the respondents had conducted CE in their GGR in either a geographical and disease-specific community. Some respondents said CE principles are the same and there is no need for special consideration for CE in GGR. Others gave ethical issues in GGR that require special consideration for CE in such research and these were categorized into six themes: GGR is new to communities, Difficulty in communicating GGR by the researchers, Genes are shared in communities, Cultural sensitivities against GGR, Community attitude toward GGR, Some GGR studies take long to end, and Negotiation of research benefits. Special considerations for CE when conducting GGR were suggested and categorized into seven themes: creating awareness of GGR in communities, obtaining both community acceptance and individual consent, CE team composition, involve communities in solving GGR challenges, prolong CE in some GGR, develop guidelines for CE in GGR, and legal considerations on GGR. Conclusion GGR was characterized by special issues that require special CE considerations for such research. (shrink)

Modal counterpart theory identifies a thing’s possibly being F with its having a counterpart that is F at another possible world; temporal counterpart theory, the stage view, according to which people and other ordinary objects are instantaneous stages, identifies a thing’s having been F or going to be F, with its having a counterpart that is F at another time. Both counterpart theories invite what has been called ‘the argument from concern’ (Rosen, G. 1990. “Modal Fictionalism.” Mind 99 (395): 327–54). (...) Why should I be concerned about my counterparts at other possible worlds or other times? I care about how things might have gone for me—not how they go for other people at other possible worlds; I care about my prospects—not the way go for other people at other times. Jiri Benovsky has argued that while modal counterpart theory can be defended against this style of argument, temporal counterpart theory cannot (Benovsky, J. 2015. “Alethic Modalities, Temporal Modalities, and Representation.” Kriterion: Journal of Philosophy 29: 18–34). I argue that temporal counterpart theory, like modal counterpart theory, resists the argument from concern. (shrink)

Modal counterpart theory identifies a thing’s possibly being F with its having a counterpart that is F at another possible world; temporal counterpart theory identifies a thing’s having been F or going to be F, with its having a counterpart that is F at another time. Benovsky, J. 2015. “Alethic Modalities, Temporal Modalities, and Representation.” Kriterion: Journal of Philosophy 29: 18–34 in this journal endorses modal counterpart theory but holds that temporal counterpart theory is untenable because it does not license (...) the ascription of the intuitively correct temporal properties to ordinary objects, and hence that we should understand ordinary objects, including persons, as transtemporal ‘worms’. I argue that the worm theory is problematic when it comes to accounting for what matters in survival and that temporal counterpart theory provides a plausible account of personal persistence. (shrink)

Defining Mental Disorder: Jerome Wakefield and His Critics, edited by Denis Forest and Luc Faucher, is essential reading for students and researchers in philosophy of medicine whose work is informed by that of Jerome Wakefield, or the disease debate in general. If you are anything like me, this book will open the door to a new depth of understanding of the harmful dysfunction analysis (HDA) and its methodical underpinnings, and an enriched appreciation of what is at stake in defining medical (...) disorder. To those confident that they understand Wakefield’s view and the surrounding debate, thinking perhaps that they do not need a refresher, I would say: perhaps you do not understand it as well as you think. Defining Mental Disorder provides much more than an overview of previously well-trodden ground. The chapters themselves, and Wakefield’s own detailed responses, help to elucidate a number of methodological nuances and peculiarities that have rarely been covered in such depth before. I was startled to learn how philosophically complex Wakefield’s position actually is, and how shallow my own understanding of it has been. It emerges as a far more nuanced and sophisticated account than I had given it credit for, and one that deserves serious reevaluation. (shrink)

At first blush, the notion a “feminist epistemology” appears, at best, peculiar—not, as Sandra Harding suggests, because “‘woman the knower’ appears to be a contradiction in terms” but because it is hard to see how an epistemology, a philosophical theory of knowledge, can be either feminist or anti-feminist since it is not clear how such a theory might benefit or harm women.

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries to those (...) with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

During the past four decades the governance of environmental problems – the definition of issues and their political and practical resolution – has evolved to include a wider range of stakeholders in more extensive open discussions. In the introduction to this issue of Environmental Values on ‘Environment, Policy and Participation’, we outline some features of these recent developments in participatory environmental governance, indicate some key questions that arise, and give an overview of the collection of papers in this special issue.

During the past four decades the governance of environmental problems – the definition of issues and their political and practical resolution – has evolved to include a wider range of stakeholders in more extensive open discussions. In the introduction to this issue of Environmental Values on 'Environment, Policy and Participation' , we outline some features of these recent developments in participatory environmental governance, indicate some key questions that arise, and give an overview of the collection of papers in this special (...) issue. (shrink)

Utilising empirical ethics analysis, we evaluate the merits of systems proposed to increase deceased organ donation in South Africa. We conclude that SA should maintain its soft opt-in policy, and enhance it with ‘required transplant referral’ in order to maximise donor numbers within an ethically and legally acceptable framework. In SA, as is the case worldwide, the demand for donor organs far exceeds the supply thereof. Currently utilising a soft opt-in system, SA faces the challenge of how to increase donor (...) numbers in a context which is imbued with inequalities in access to healthcare, multiplicitous personal beliefs and practices, distrust of organ transplant and varying levels of education and health literacy. We argue that a hard opt-in, opt-out or mandated consent system would be problematic, and we present empirical data from Gauteng Province illustrating barriers to ethically sound practice in soft consent systems. Ultimately, we argue that in spite of some limitations, a soft opt-in system is most realistic for SA because its implementation does not require extensive public education campaigns at national level, and it does not threaten to further erode trust at a clinical level. However, to circumvent some of the clinical-level barriers identified in our empirical study, we propose a contextually sensitive option for “enabling” soft opt-in through “required transplant referral”. We argue that this system is legally defensible, enhances ethical practice and could also increase donor numbers as it has in many other countries. (shrink)

This reflection item provides an edited account of human rights lawyer Harriet Wistrich’s conversation with Manvir Grewal, Visiting Lecturer and Ph.D. student, and Harriet Samuels, Reader in Law at the University of Westminster. It summarises the exchange which focused on Harriet Wistrich’s career trajectory and the many public interest law cases that she has brought on behalf her clients, mainly women, in both domestic and international forums. It also includes a condensed version of the question and answer (...) session with the audience. Questions included the broader issues around domestic violence, rape, coercive control, sex work and the nature of feminism. (shrink)

Climate science denial is serious. It facilitates political procrastination and brings us ever closer to a world beset by growing food insecurity, heatwaves, floods, storms, fires and extensive los...

The ArgumentWritten as one book, Science, Technology and Society in Seventeenth-Century England has become two. One book, treating Puritanism and science, has since become “The Merton Thesis.” The other, treating shifts of interest among the sciences and problem choice within the sciences, has been less consequential. This paper proposes that neglect of one part of the monograph has skewed readers' understanding of the whole. Society and culture contributed to institutionalization of science and the directions it took, neither one exclusively. Four (...) aspects of the neglected chapters are examined: their theoretical underpinnings, the conceptions providing foundations for this part specifically and for the monograph as a whole; their comparative neglect, attributed partly to the absence of a cognitive constituency for their claims; the problem of problem choice in science in Merton's work; and the Merton monograph and later social constructionism:their differences and affinities. (shrink)

All authors in this symposium use a food regime perspective to ask questions about the present which—as these articles demonstrate—have several possible answers. History suggests a time perspective of 25–40 year cycles so far—a food regime 1870–1914, an experimental and chaotic era 1914–1947, and a food regime 1947–1973. It has been less than 40 years since 1973, when food regime analysts agree that a contested and experimental period began. There is no consensus on whether it has already ended or how (...) it might issue into a new food regime. The conversation is more fruitful than the conclusions. I intend these comments as an invitation to join in. (shrink)

There appear to be at least two important disanalogies between the situation of women and that of racial and ethnic minorities whose members are generally regarded as paradigmatic victims of oppression. First, in the case of oppressed racial and ethnic minorities it is relatively easy to identify the oppressors and the policies which serve to keep the oppressed in their place; it is not so easy to determine who the oppressors of women are--surely men are not universally blameworthy--nor even to (...) ascertain which policies are oppressive. Secondly, unlike most members of disadvantaged racial and ethnic minorities, many women seem actively to support the very policies and institutions which contribute to their oppression. (shrink)

Currently a number of feminists in philosophy and religious studies as well as other academic disciplines have argued that policies, practices and doctrines assumed to be sexneutral are in fact male-biased. Thus, Rosemary Reuther, reflecting on the development of theology in the Judeo-Christian tradition suggests that the long-term exclusion of women from leadership and theological education has rendered the “official theological culture” repressive to women and dismissive of women’s experience: “To begin to take women seriously,” she notes, “will involve a (...) profound and radical transformation of our religions.”3 Such a project exists in tension with what is generally regarded as Christian orthodoxy and so, as Reuther suggests, challenges the assumptions and categories of traditional theology. (shrink)

I was an altar girl at St. Mary the Virgin, New York City–one of the first, in fact. In the mid‑70s, one of my friends approached the Rector and negotiated a deal: we women, who were interested in acolyting, would be allowed to serve at mass during the week, in street clothes, on the condition that we form and staff an altar guild.

Introduction: is multiculturism good for anyone? -- Do people like their cultures? -- A philosophical prelude: what is multiculturalism? -- The costs of multiculturalism -- The diversity trap: why everybody wants to be an X -- White privilege and the asymmetry of choice -- Communities: respecting the establishment of religion -- Multiculturalism and the good life -- The cult of cultural self-affirmation -- Identity-making -- Identity politics: the making of a mystique -- Policy.

A 365 million year‐old trilobite moult‐carcass assemblage was described by Błażejowski et al. (2015) as the oldest direct evidence of moulting in the arthropod fossil record. Unfortunately, their suppositions are insufficiently supported by the data provided. Instead, the morphology, configuration and preservational context of the highly fossiliferous locality (Kowala Quarry, Poland) suggest that the specimen consists of two overlapping, queued carcasses. The wider fossil record of moulting actually extends back 520 million years, providing an unparalleled opportunity to study behaviour, ecology (...) and development in early animals. Taking cues from modern analogues, it is possible to quantify precise details about moulting behaviour to determine broad‐scale evolutionary trends, ontogenetic sequences and morphological selection pressures. In this review, we argue that this rich source of data has been underused in evolutionary studies, though has great potential for investigating the life history and evolution of arthropods in deep time. (shrink)

The triumph was the most prestigious accolade a politician and general could receive in republican Rome. After a brief review of the role played by the triumph in republican political culture, this article analyzes the severe limits Augustus placed on triumphal parades after 19 BC, which then became very rare celebrations. It is argued that Augustus aimed at and almost succeeded in eliminating traditional triumphal celebrations completely during his lifetime, by using a combination of refusing them for himself and his (...) relatives and of rewarding his legates who fought under his auspices with ornamenta triumphalia and an honorific statue in the Forum of Augustus. Subsequently, the elimination of the triumph would have been one natural result of the limit placed on further imperial expansion recommended by Augustus in his will, a policy his successors chose not to follow. Tiberius, however, was unwilling to conform to this new order and retired from public life to Rhodes the year after celebrating a triumph in 7 BC, the first such celebration since 19 BC. Tiberius' two triumphs and the senate's repeated offers of further triumphs to Augustus himself represented a different vision of the role triumphal celebration should take in a restored res publica and an ongoing challenge to the princeps. (shrink)

To mark International Women’s Day the Research Group for Law, Gender and Sexuality at Westminster Law School held an evening conversation on 10 March 2016 on Women and Asylum. Speakers working in different areas of the asylum system shared their insights and experiences with an audience of staff, students, activists and other visitors. Harriet Samuels chaired the conversation and the speakers were Princess Chine Onyeukwu, Debora Singer, Priya Solanki and Zoe Harper. This article is an edited extract from the (...) transcript of the presentations and wide-ranging discussion, including the question and answer session. The discussion focused on the different steps in the refugee determination process and considered, in particular, the gendering of credibility and how women’s perceived lack of credibility has a significant impact on determinations and processes. (shrink)

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies (...) regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)