Abstract Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical–ethical discussions in the opinion sections of medical and nursing journals. Some argue that CSD is morally equivalent to physician-assisted death (PAD), that it is a form of “slow euthanasia.” A qualitative thematic content analysis of opinion pieces was conducted to describe and classify arguments that support or reject a moral difference between CSD and PAD. Arguments pro (...) and contra a moral difference refer basically to the same ambiguous themes, namely intention, proportionality, withholding artificial nutrition and hydration, and removing consciousness. This demonstrates that the debate is first and foremost a semantic rather than a factual dispute, focusing on the normative framework of CSD. Given the prevalent ambiguity, the debate on CSD appears to be a classical symbolic struggle for moral authority. Content Type Journal Article Category Original Research Pages 1-13 DOI 10.1007/s11673-012-9369-8 Authors Sam Rys, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Reginald Deschepper, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Freddy Mortier, End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium Luc Deliens, End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium Douglas Atkinson, Interfacultair Departement voor Taalonderwijs (ITO), Vrije Universiteit Brussel, Brussels, Belgium Johan Bilsen, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529. (shrink)
The influence of culture and sociohistorical change on all aspects of the psyche and on psychoanalytic theory is the missing dimension in psychoanalysis. This dimension is especially relevant to clinicians in the mental health field--whether psychoanalyst, psychologist, psychiatrist, social worker or marriage counselor--to enable them to understand what is at stake in working with those from various Asian cultures in North America and European societies. It is even more relevant than most clinicians realize to working with those from one's own (...) culture. Cultural Pluralism and Psychoanalysis explores the creative dialogue that the major psychoanalysts since Freud have had with the modern Northern European/North American culture of individualism; and tries to resolve major problems that occur when psychoanalysis, with its cultural legacy of individualism, is applied to those from various Asian cultures. Alan Roland first examines the theoretical issues involved in developing a multicultural psychoanalysis. He then looks at the interface between Asian-Americans and other Americans, discussing the frequent dissonances, miscommunications, and misunderstandings that result from each coming from vastly different cultural and psychological realms. Finally, Roland examines the various ways in which culture enters the space of psychoanalytic work with Asians in America, illustrating his clinical theory with case vignettes of immigrants and second and third generation patients in the United States. (shrink)
In this paper, I consider an argument for the claim that any satisfactory epistemology of mathematics will violate core tenets of naturalism, i.e. that mathematics cannot be naturalized. I find little reason for optimism that the argument can be effectively answered.
That believing truly as a matter of luck does not generally constitute knowing has become epistemic commonplace. Accounts of knowledge incorporating this anti-luck idea frequently rely on one or another of a safety or sensitivity condition. Sensitivity-based accounts of knowledge have a well-known problem with necessary truths, to wit, that any believed necessary truth trivially counts as knowledge on such accounts. In this paper, we argue that safety-based accounts similarly trivialize knowledge of necessary truths and that two ways of responding (...) to this problem for safety, issuing from work by Williamson and Pritchard, are of dubious success. (shrink)
This paper argues that Philip Kitcher's epistemology of mathematics, codified in his Naturalistic Constructivism, is not naturalistic on Kitcher's own conception of naturalism. Kitcher's conception of naturalism is committed to (i) explaining the correctness of belief-regulating norms and (ii) a realist notion of truth. Naturalistic Constructivism is unable to simultaneously meet both of these commitments.
C. S. Jenkins has recently proposed an account of arithmetical knowledge designed to be realist, empiricist, and apriorist: realist in that what’s the case in arithmetic doesn’t rely on us being any particular way; empiricist in that arithmetic knowledge crucially depends on the senses; and apriorist in that it accommodates the time-honored judgment that there is something special about arithmetical knowledge, something we have historically labeled with ‘a priori’. I’m here concerned with the prospects for extending Jenkins’s account beyond arithmetic—in (...) particular, to set theory. After setting out the central elements of Jenkins’s account and entertaining challenges to extending it to set theory, I conclude that a satisfactory such extension is unlikely. (shrink)
Penelope Maddy advances a purportedly naturalistic account of mathematical methodology which might be taken to answer the question 'What justifies axioms of set theory?' I argue that her account fails both to adequately answer this question and to be naturalistic. Further, the way in which it fails to answer the question deprives it of an analog to one of the chief attractions of naturalism. Naturalism is attractive to naturalists and nonnaturalists alike because it explains the reliability of scientific practice. Maddy's (...) account, on the other hand, appears to be unable to similarly explain the reliability of mathematical practice without violating one of its central tenets. (shrink)
Philip Kitcher's account of scientific progress incorporates a conception of explanatory unification that invites the so-called 'obsessive unifier' worry, to wit, that in our drive to unify the phenomena we might impose artificial structure on the world and consequently produce an incorrect view of how things, in fact, are. I argue that Kitcher's attempt to address this worry is unsatisfactory because it relies on an ability to choose between rival patterns of explanation which itself rests on the relevant choice having (...) already been made. I also suggest a way of answering the worry that Kitcher is not likely to endorse. (shrink)
Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)
Philip Kitcher has advanced an epistemology of science that purports to be naturalistic. For Kitcher, this entails that his epistemology of science must explain the correctness of belief-regulating norms while endorsing a realist notion of truth. This paper concerns whether or not Kitcher's epistemology of science is naturalistic on these terms. I find that it is not but that by supplementing the account we can secure its naturalistic standing.
The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? Our goal (...) is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)
Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives (...) and patients.We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases. (shrink)
Although neglected by psychology, self-respect has been an integral part of philosophical discussion since Aristotle and continues to be a central issue in contemporary moral philosophy. Within this tradition, self-respect is considered to be based on one's capacity for rationality and leads to behaviors that promote autonomy, such as independence, self-control and tenacity. Self-respect elicits behaviors that one should be treated with respect and requires the development and pursuit of personal standards and life plans that are guided by respect for (...) self and others. In contrast, the psychological concept of self-esteem is grounded in the theories of self-concept. As such, self-esteem is a self-evaluation of competency ratios and opinions of significant others that results in either a positive or negative evaluation of one's worthiness and inclusionary status. The major distinction between the two is that while competency ratios and others' opinions are central to self-esteem, autonomy is central to self-respect. We submit that not only is self-respect important in understanding self-esteem, but that it also uniquely contributes to individual functioning. Research is needed to establish the central properties of self-respect and their effects on individual functioning, developmental factors, and therapeutic approaches. (shrink)
Standard accounts of semantics for counterfactuals confront the true–true problem: when the antecedent and consequent of a counterfactual are both actually true, the counterfactual is automatically true. This problem presents a challenge to safety-based accounts of knowledge. In this paper, drawing on work by Angelika Kratzer, Alan Penczek, and Duncan Pritchard, we propose a revised understanding of semantics for counterfactuals utilizing machinery from generalized quantifier theory which enables safety theorists to meet the challenge of the true–true problem.
Abstract The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajj?laggam, an anthology of Pr?krit stanzas (subh?sita literature) dealing with a variety of topics. Focusing on the ?ethical? sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described in detail. (...) In Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self?regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well?being and virtuousness as described in the VL. (shrink)
The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajj laggam, an anthology of Pr krit stanzas (subh sita literature) dealing with a variety of topics. Focusing on the 'ethical' sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described (...) in detail. In Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self-regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well-being and virtuousness as described in the VL. (shrink)
Abstract The structure of value education in Flanders is deeply shaped by segregation, i.e. a pattern of separate social organisation based on world view. Several religious authorities are officially recognized which control their own course in the community and official schools. A course of non?denominational ethics is offered to students who do not identify with a recognized religion. Representatives of the catholic and of the humanist groups base the legitimacy of separate value education on the claim that students of respectively (...) the Roman Catholic and the ethics course reflect the sociomoral diversity in the wider population. A newly devised Dutch adaptation of the DIT and a questionnaire were administered to 631 secondary school students from the highest two grades. It was found that either (1) values education in the Flemish schools has no or very little effect on the students as far as moral reasoning is concerned, or (2) that values education in the Flemish schools does have an effect on the moral reasoning skills of the students, but that the respective populations of the courses are not influenced in an appreciably different way. (shrink)
This paper aims to increase the reader’s understanding of how the notion of the ‘bobby on the beat’ has been elevated to iconic, if not mythical, status within British policing. In doing so, the article utilises the semiotic idea of myth, as conceptualized by Roland Barthes, to explore how through representations of the ‘bobby on the beat’ police officers have been projected in a more avuncular re-assuring role to a public fearful of crime, which fails to do service to (...) the signifying practices that accompany and embody the visible police patrol. Indeed, police patrol work secures social space for the State and although it does re-assure anxious members of society that their social world is safe and secure, for others, it further illustrates how their social space is fragile and troubled. On another level, the ‘bobby’ narrative has also been harnessed as part of a broader mythologizing of ‘Englishness’ and quintessential British characteristics. (shrink)