In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at (...) once practically relevant and philosophically significant. (shrink)

This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have occurred since the (...) model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social. (shrink)

This study adapts the theory of reasoned action (Ajzen and Fishbein, 1980) to the behavior of fraudulent reporting on financial statements so as to examine the effects of moral reasoning and self-monitoring on intention to report fraudulently, using structural equation modeling. The paper seeks to investigate two of the red flags for financial statement fraud identified in Loebbecke et al.'s (1989) paper: client management displays a significant lack of moral fiber and client personnel exhibit strong personality anomalies. As expected, high (...) moral reasoners are more influenced than low moral reasoners by their own attitude towards the behavior. Contrary to prior research, low self-monitors are found to be more influenced than high self-monitors by subjective norms. Future research is recommended to investigate the counter-intuitive results for self-monitors, to consider the implications of group decision making as regards the promulgation of fraudulent financial statements, and to examine additional red flags for financial statement fraud. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 29.2 (2005) 269-285 [Access article in PDF] Oedipus The King: Temperament, Character, and Virtue Grant Gillett Robin Hankey University of Otago I Recent discussions of ethics and literature suggest that there is a relationship between reading (or, better, immersing oneself in) literature (in particular, fiction) and the virtues. Nussbaum goes so far as to claim not only that good literature is conducive to moral sense (...) and sensibility but also that "the well-lived life is a work of literary art."1 The character development in most substantial fictional work that aims to engage us through its realism and truth to the human condition suggests that there is such a thing as a quasi-stable character and that an agent's character plays a significant role in the way not only that the person acts but also in the kinds of thing that happen to him or her. For a certain kind of virtue theorist, the internal harmony of character required for a person to do the right thing in a diverse range of situations involves cultivating exactly those skills required to live well. This thesis amounts to a claim that there is a close, indeed conceptual, relationship between right living and good living and that the type of character which results from cultivating the virtues is a character conducive to getting the best out of the situations that life throws in our way, whereas the vicious character reveals itself by causing strife, harm, and even tragedy.Gilbert Harman, criticizing virtue ethics on the basis of some key experiments in social psychology which have led to the idea of a "fundamental attribution error," argues that people do not have enduring character traits of the type required to sustain such a position.2 His critique has itself been attacked on the basis that what the experiments show is not the absence of character traits but their ability [End Page 269] to be influenced by the demands of a situation.3 Our objection is against the conception of virtues being attacked and also his sweeping conclusion about human nature and it has two strands. First we argue that phronesis, as the hallmark of a virtuous character, is a mix of skills, abilities, and attitudes honed in such a way as to allow the person to act fittingly in different life situations. Second, character runs true to type in an individual and even runs in families.We find support for both claims in Sophocles' Oedipus the King. This is, of course, a myth but one that has spoken to human beings across the ages and it recognizes both that different individuals show certain regularities in their modes of relationship and their conduct and that these tendencies are often familial, contributing significantly to the events marking family stories and traditions. Phronesis or practical wisdom is the skill to negotiate the challenges that life produces when fate deals one a hand of this (genetic and genealogical) kind. In the process of making the case we will support the claim that fiction "can significantly contribute to moral understanding by revealing what certain situations amount to" and therefore that it "can bring home to us the force of, for example, moral dilemmas" and indeed moral concepts, and we will use the Oedipus story to reflect on the lessons emerging from one version of virtue ethics.4We approach the Oedipus myth through Sophocles' tragedy in which an oracle about patricide and incest plays itself out in the lives of certain characters. The relevance for virtue ethics arises from the ways in which characters in the play react to their predicament and try to cope with the situations they must face. In moral life, individuals need to find strategies to deal with challenges they face both as individuals and as persons-in-relationships-with-others. The reactions portrayed in Oedipus make vivid not only the idea of character traits but also the role of virtue in moderating what we might do in situations that interact with our characters in potentially disastrous ways. II Harman's challenge begins... (shrink)

Part I -- Scientific Composition and the New Mechanism. - 1. Laura Franklin-Hall: New Mechanistic Explanation and the Need for Explanatory Constraints. - 2. Kenneth Aizawa: Compositional Explanation: Dimensioned Realization, New Mechanism, and Ground. - 3. Jens Harbecke: Is Mechanistic Constitution a Version of Material Constitution?. - 4. Derk Pereboom: Anti-Reductionism, Anti-Rationalism, and the Material Constitution of the Mental. Part II -- Grounding, Science, and Verticality in Nature. - 5. Jonathan Schaffer: Ground Rules: Lessons from Wilson. - 6. Jessica Wilson: (...) The Unity and Priority Arguments for Grounding. - 7. Carl Gillett: The Metaphysics of Nature, Science, and the Rules of Engagement. - 8. Andrew Melnyk: Grounding and the Formulation of Physicalism. - 9. Alyssa Ney: Grounding in the Philosophy of Mind: A Defense. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 23-24 [Access article in PDF] Schechtman's Narrative Account of Identity Grant Gillett Keywords personal identity, narrative self, memory I have long been an admirer of Schechtman's sensitive and psychologically realistic account of personal identity. In the present piece, she addresses the issues surrounding personal identity through Locke's view and problems attending that view and the psychological continuity theories descended from it.She examines (...) the claim that the person is more extensive than the conscious mind and includes aspects of nonconscious mental activity. Schechtman argues that one must have a self-conception that includes a trajectory where present experience unfolds meaningfully out of one's past replete with implications for what one does and how one does it. She locates, in current writing on the self, the idea of a perceiver or narrator self who tries to make sense out of herself as a human being with certain thoughts and feelings and is sometimes at a loss to do so. To this potentially very rich starting point we need only add the fact that a person draws on discursive and narrative skills that have been inscribed in her being to do this narrative, editorial, and judicial task and that many of these skills have been imbibed with mother's milk (and father's voice). From this discursively inscribed set of resources and orientations arise guilt, shame, pride, aspiration, vulnerability, and that crucial sense of who one is as a person among others.It follows that here we might also find the source of the discontents that induce a person to apply to a psychiatrist or counselor for help with the narrative work required to fashion a liveable self. If Schechtman is right, the cognitive capacities contributing to memory and "keeping track of oneself"(in a deep and satisfying way) are to be found in part in the nonconscious domain rather than the thin layer of consciousness and propositional attitude psychology that enters the mind of an analytic philosopher or a psychiatrist uninterested in depth.I think she is right and that this paper and her more extensive work on the constitution of self represent a fertile point at which psychiatrists and psychotherapists can begin the task of understanding the nature of identity and the challenges involved in finding one that will serve the unfolding project of understanding and forming the self. I believe that the resources that individuals need for this task are derived from one's rootedness in culture and human relationships where the levels of self that support consciousness can be nurtured according to what Michel Foucault calls the techniques proper to the care of the self. Schechtman has done us a favor in taking the debates surrounding neo-Lockean [End Page 23] views of personal identity and outlining a perspective on identity and memory that can lead us to develop our understanding of the complexity of the human psyche as it roams through the jungle/jumble of discursive life and tries to nourish itself on what it finds there.Grant Gillett is a Professor of Medical Ethics at the University of Otago in Dunedin, New Zealand. He is also a practicing neurosurgeon. His philosophical work is in philosophy of mind and psychiatry, continental philosophy, and bioethics. His most recent books are The Mind and Its Discontents (Oxford University Press) and Bioethics in the Clinic (Johns Hopkins University Press). He works on postmodern and traditional analytic approaches to mind, language, and psychiatry. He can be reached at Dunedin Hospital and Otago Bioethics Centre, University of Otago Medical School, PO Box 913, Dunedin, New Zealand, or via e-mail at grant.gillett@stonebow.otago.ac.nz.... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.2 (2002) 123-125 [Access article in PDF] The Self as Relatum in Life and Language Grant Gillett THE STUDY REPORTED by van Staden is extremely interesting to any psychological theorist influenced by Jacques Lacan because of Lacan's insistence that the unconscious is not only structured like a language but actually reflects and is produced by linguistic interactions between the subject and others.The distinction he (...) draws, on the basis of Frege's analysis of logical and grammatical structure, is not straightforwardly evident on a superficial inspection of the sentences concerned. It is also less clear than the agent-patient or subject-object distinction that one might look for on the basis of considering the action being performed. van Staden makes both of these points in the course of illustrating the relevant deep grammatical property on which the study turns. In doing so he engages with the subtle work on subject and object by Strawson (1959) who was one of the first, in the "descriptive metaphysics" of Individuals, to explore the resonance between what we might call (after Frege) "logical grammar" and the deep metaphysical structure of our thought. Strawson noted that the position of grammatical subject in a sentence was typically occupied by a particular or individual substance rather than the accident or property of a substance so that the subject predicate structure of language reflects a basic feature of our world picture whereby the world is seen to be populated by particular objects that instance universal features.Chomsky is the other player whose thought is important in this area in that he argues that we have an innate sense of deep structure, which allows us to disambiguate any sentence so as to reveal the state of affairs that is being represented. Thus we discern that what is denoted by "John loves Mary" is the same thought as that conveyed by "Mary is loved by John." van Staden focuses on something more general—the deep structure that expresses semantic relations or positions. This is not the same as the agent or the simply grammatical subject and van Staden calls it the owner of the relation involved as distinct from the accident of that relation. The terms are well chosen because ownership is a term a la mode in postmodern thought to express the relationship of a human being to the events and attributes associated with him or her. When we look at this subtle grammatological or semantic feature of language we see that the linguistic feature in question is the kind of thing that could easily be overlooked were it not for a post-Fregean analysis of the type van Staden offers.The content that van Staden identifies in relation to what is signified or represented by an utterance is difficult to characterize. It is not what Frege would call logical content in that it does not contribute to the truth value of any of the propositions concerned. It is also problematic to call it psychological content because it is not part of the conscious message conveyed by the utterance. Nevertheless, the study concerned raises [End Page 123] the possibility that it is psychic in a very significant way, which is best approached by considering the relationships between language and the unconscious.Chomsky is regarded as having defined a number of linguistic operations that take propositional or meaningful content and transform it into the form in which it is uttered. The relevant cognitive operations are usually regarded as being performed by the cognitive unconscious, which in some sense applies the rules of grammar to yield well-formed utterances on the basis of speaker intentions. In any event, nobody would seriously question the idea that there are unconscious operations that underpin the production of grammatically structured utterances.If we add to this the possibility that a more dynamic aspect to the unconscious has a role to play in the semantic content of our utterances, then a fruitful line of thought begins to emerge. The dynamic unconscious has to do with self-image and those influences that form the psyche... (shrink)

There is a fairly closed circle between culture, language, meaning, and truth such that the world of a given culture is a world understood in terms of the meanings produced in that culture. Medicine is, in fact, a subculture of a powerful type and has its own language and understanding of the range of illnesses that affect human beings. So how does medicine get at the truth of people and their ills in such a way as to escape its own (...) limited constructions? There is a way out of the closed circle implicit in the idea of a praxis and the engagement with reality that is central to it and the further possibility introduced by Jacques Lacan that signification is never comprehensive in relation to the subject's encounter with the real. I will explore both of these so as to develop a conception of truth that is apt for the knowledge that arises in the clinic. (shrink)

Topics in Cognitive Science, Volume 14, Issue 2, Page 363-387, April 2022.

Abstract: There has recently been controversy over the existence of 'multiple realization' in addition to some confusion between different conceptions of its nature. To resolve these problems, we focus on concrete examples from the sciences to provide precise accounts of the scientific concepts of 'realization' and 'multiple realization' that have played key roles in recent debates in the philosophy of science and philosophy of psychology. We illustrate the advantages of our view over a prominent rival account ( Shapiro, 2000 and (...) 2004 ) and use our work to rebut recent objections to the long-standing claim that psychological properties are multiply realized. For we use scientific evidence, in combination with our more precise theoretical framework, to show that we have strong reason to believe that psychological properties are indeed multiply realized both at the biochemical and neuronal levels. (shrink)

Delusions, a key feature of psychosis, are usually thought of as a type of belief, as in the definition of the American Psychiatric Association: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious (...) faith). This characterization is often criticized, but other definitions typically comprise similar elements. For some, delusions are only loosely considered as beliefs (Jaspers 1963; Moor and Tucker .. (shrink)

Biologists seems to hold two fundamental beliefs: Organisms are organized into levels and the individuals at these levels differ in their properties. Together these suggest that there will be massive multiple realization, i.e. that many human psychological properties are multiply realized at many neurobiological levels. This paper provides some documentation in support of this suggestion.

Abortion is permitted in many jurisdictions after the age at which an infant is viable on the basis of intensive neonatal care techniques. Does this cause special concerns for those involved in perinatal care and termination of pregnancy services or is the overlap mainly an abstract issue fretted over by ethicists and academics? In order to explore this question, a group of clinicians involved in this area of care were interviewed and their interviews analysed using qualitative measures. The clinicians concerned (...) were exercised by the ethical issues and had various ways of resolving them which tended to reflect a gradualist, multifaceted and, to some extent, particularist approach to ethical decision-making in relation to the edges of human life. The ways in which those strands of ethical thought are instanced in the interview material are reported and discussed. (shrink)

This collection examines prevalent assumptions in moral reasoning which are often accepted uncritically in medical ethics. It introduces a range of perspectives from philosophy and medicine on the nature of moral reasoning and relates these to illustrative problems, such as New Reproductive Technologies, the treatment of sick children, the assessment of quality of life, genetics, involuntary psychiatric treatment and abortion. In each case, the contributors address the nature and worth of the moral theories involved in discussions of the relevant issues, (...) and focus on the types of reasoning which are employed. 'Medical ethics is in danger of becoming a subject kept afloat by a series of platitudes about respect for persons or the importance of autonomy. This book is a bold and imaginative attempt to break away from such rhetoric into genuine informative dialogue between philosophers and doctors, with no search after consensus.' Mary Warnock. (shrink)

The Cognitive Integration (henceforth CI) framework posits the existence of integrated cognitive systems (henceforth ICS). In this chapter we outline the nature of ICS and their phylogenetic history. We shall argue that phylogenetically earlier forms of cognition are built upon by more recent cultural innovations. Many of the phylogenetically earlier components are forms of sensorimotor interactions with the environment (Menary 2007a, 2010a, 2016). These sensorimotor interactions are redeployed (or retrained) to service more recent cultural innovations (Dehaene & Cohen 2007). The (...) main aim of this chapter is to give an overview of the CI framework in terms of phylogenetically ancient embodied interactions with the environment and the more recent culturally evolved practices that redeploy our primitive capacities for sensorimotor interactions and manipulations of tools, objects and, in a very recent innovation, public systems of representation. In doing so, we provide a case for the enculturation of our bodies and brains. (shrink)

In the New Mechanist literature, most attention has focused on the compositional explanation of processes/activities of wholes by processes/activities of their parts. These are sometimes called “constitutive mechanistic explanations.” In this paper, we defend moving beyond this focus to a Pluralism about compositional explanation by highlighting two additional species of such explanations. We illuminate both Analytic compositional explanations that explain a whole using a compositional relation to its parts, and also Standing compositional explanations that explain a property of a whole (...) using a compositional relation to the properties of its parts. We also highlight how adopting a Pluralism about compositional explanations justifies a more Pluralist view of the ontological posits of such explanations and opens up a range of new research questions. (shrink)

A concept of diversity is an understanding of what makes a group diverse that may be applicable in a variety of contexts. We distinguish three diversity concepts, show that each can be found in discussions of diversity in science, and explain how they tend to be associated with distinct epistemic and ethical rationales. Yet philosophical literature on diversity among scientists has given little attention to distinct concepts of diversity. This is significant because the unappreciated existence of multiple diversity concepts can (...) generate unclarity about the meaning of “diversity,” lead to problematic inferences from empirical research, and obscure complex ethical-epistemic questions about how to define diversity in specific cases. We illustrate some ethical-epistemic implications of our proposal by reference to an example of deliberative mini-publics on human tissue biobanking. (shrink)

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, (...) in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation. (shrink)

Grand debates over reduction and emergence are playing out across the sciences, but these debates have reached a stalemate, with both sides declaring victory on empirical grounds. In this book, Carl Gillett provides new theoretical frameworks with which to understand these debates, illuminating both the novel positions of scientific reductionists and emergentists and the recent empirical advances that drive these new views. Gillett also highlights the flaws in existing philosophical frameworks and reorients the discussion to reflect the new (...) scientific advances and issues, including the nature of 'parts' and 'wholes', the character of aggregation, and thus the continuity of nature itself. Most importantly, Gillett shows how disputes about concrete scientific cases are empirically resolvable and hence how we can break the scientific stalemate. Including a detailed glossary of key terms, this volume will be valuable for researchers and advanced students of the philosophy of science and metaphysics, and scientific researchers working in the area. (shrink)

Book reviewed in this article: Practical Medical Ethics. By Alastair Campbell, Grant Gillett, and Gareth Jones. If I Were a Rich Man Could I Buy a Pancreas? and Other Essays on the Ethics of Health Care. By Arthur L. Caplan. Bloomington Ethics on Call: A Medical Ethicist Shows How to Take Charge of Life and Death Choices in Today's Health Care System. By Nancy Dubler and David Nimmons.

Many senior doctors have had little in the way of formal ethics training, but express considerable interest in extending their education in this area. This paper is the report of an initiative in continuing medical education in which doctors were introduced to narrative ethics. We review the theoretical basis of narrative ethics, and the structure of and response to the two-day workshop.

In this paper we argue that the human form should be seen to exist, in a longitudinal way, throughout the continuum of human growth and development. This entails that the moral value of that form, which we link analytically to the adult, interacting, social and rational being, attaches to all phases of human life to some extent. Having established this we discuss the consequences it has for the moral status of the human embryo. We then apply this argument, and the (...) resulting moral status, to the area of reproductive technology. In doing this we show that there are certain regulations and controls which ought to apply to the use of these infertility treatments. (shrink)

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation to environmental conditions (...) which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 83-85 [Access article in PDF] Lacan, Science, and Determinism Douglas McConnell Grant Gillett Keywords Lacan, the unconscious, free will Van Staden And Hinshelwood's commen-taries raise a number of issues, but there are two particular themes common to both that we pick up in this response.The first theme concerns the reconcilability of Lacanian theory to the disciplines of analytic philosophy and "Anglo-American positivist (...) psychiatry." This is closely related to the relationship between the unconscious and the empirical sciences discussed in the editorial (McConnell and Pickering 2005). The second theme concerns the relevance of Lacanian theory to our understanding of free will and the structure of the mind. Lacan, Analytic Philosophy, and Scientific Psychiatry First, psychoanalysis or psychotherapy generally should not try to reunite with neuroscience because of the fundamental difference in their approaches to the patient, which is likely to mean that even if a theoretical rapprochement can be found, a working relationship is unlikely.Although there are many facets of Lacan's theory that were not addressed in our paper and even if many of those are totally irreconcilable to analytic philosophy, we believe that we have addressed the most ontologically fundamental issues and that these can genuinely contribute to and challenge analytic philosophy of mind.As Hinshelwood points out, psychiatry does operate with a philosophical basis, critical (or sometimes relatively uncritical) scientific realism (even though it may not be acknowledged), and it as such it can legitimately be contributed to or challenged by the philosophical aspects of Lacanian theory outlined in our paper.In fact, the theoretical basis is evinced in van Staden's commentary when he remarks on the relation between Lacanian theory and psychiatry: "... the unconscious is not only structured like a language but actually reflects and is produced by linguistic interaction between the subject and others. This is a difficult claim to verify, no doubt, but it prompts further related questions... whether the conscious mind is structured like a language" (van Staden 2005, 78). And one must ask whether this is the kind of claim that can be verified or whether it is a hermeneutic claim (in somewhat the way suggested by Jaspers), serving more as a framing belief to allow people to make sense of what has influenced them in their life histories and is currently played out in their relationships with others. We would lean toward this interpretation of the unconscious, explicitly distancing ourselves from any overreaching, quasi-scientific realism about unconscious contents and mental structures, but clinging to the thought that dealing with such contents is an essential part of the therapeutic encounter. [End Page 83]Looked at in this way, both the Lacanian unconscious and conscious mental life bear the imprint of language due to the subject's immersion and participation in the symbolic realm. This may seem a "difficult claim to verify," but because verification is linked to the scientific framework of inquiry rather than the hybrid that is clinical knowledge, we would better regard it as being difficult to establish as an axiom of therapy. The linguistic structure of the conscious and unconscious mind is, on this account, a conceptual implication of the role of the symbolic register in thought and not a thesis that requires verification (a Wittgensteinian thesis espoused by a number of contemporary philosophers, including Dummett and Davidson).As it happens, cognitive science has found linguistic structure to be important in operations of the cognitive unconscious (arguably different from the dynamic unconscious due to the former's dependence on scientific experiment and the latter's connections to life history rather than mere psychological or cognitive traits [see Gillett and McConnell 2005]). Given that language and problem solving are so closely intertwined, it would suggest that cognitive science was overlooking something important rather than damaging Lacanian theory if linguistic structure did not appear on cognitive science's "radar." So, how does language logically (in the sense defended by Husserl and Frege, that is, to do with the sense or content of thoughts not merely the processes underpinning one's contingently evolving stream... (shrink)

The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely (...) disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the model and the other group a less severe injury. At 18 month follow-up there were significant differences in outcome and healthcare requirements. This raises important ethical issues when considering life-saving but non-restorative surgical intervention. The discussion about realistic outcome cannot be dichotomised into simply life or death so that the outcome for the patient must enter the equation. As in other ‘rescue situations’, the utility of the procedure cannot be rationalised on a mere cost–benefit analysis. A compromise has to be reached to determine at what point either the likely outcome would be unacceptable to the person on whom the procedure is being performed or the social utility gained from the rule of rescue intervention fails to justify the utilitarian value and justice of equitable resource allocation. (shrink)

Lacan, despite being largely ignored and misunderstood in Anglo-American analytic philosophy, brings psychoanalytic theory into close contact with the philosophy of mind and psychiatry as illuminated by the continental tradition. He draws on Freud, phenomenology, existentialism, and structuralism to construct a subtle theoretical approach to the psyche according to which our engagement in discourse and our existence in the world combine to generate a many layered structure of meanings and influences that forms us. This allows him to focus on the (...) nature and role of language and our discursively constructed self-conceptions both in the therapeutic encounter and in the maladies of the psyche. The relevance of Lacan's thought for analytic philosophy of psychiatry can be explored by pursuing his links to Freud, his complex treatment of issues in the philosophy of language, and a subtle blend of existentialism and continentally inspired naturalism that paints the contours of the unconscious mind in operationally compelling terms. (shrink)

Almaatouq et al. propose a novel integrative approach to experiments. We provide three examples of how unaddressed measurement issues threaten the feasibility of the approach and its promise of promoting commensurability and knowledge integration.

Bioethical debates such as those surrounding the manipulation of human embryos are often based on metaphysical assumptions that lack a foundation in the natural sciences. In this paper we support a gradualist position whereby the embryo progressively takes on the form and associated ethical significance of a human being. We support this position by introducing a concept of biological structure or form to show how the gradualist position has its metaphysical foundations in modern biology. The conceptual basis for form and (...) structure are outlined and their compatibility with and basis in current empirical biology is demonstrated by some recent advances in our understanding of the processes of development from single cell to organism. We then briefly explore the ethical significance of accepting a form or structure based conception of biology for the status of the early embryo. (shrink)

Physicalism, a topic that has been central to modern philosophy of mind and metaphysics, is the philosophical view that everything in the space-time world is ultimately physical. The physicalist will claim that all facts about the mind and the mental are physical facts and deny the existence of mental events and state insofar as these are thought of as independent of physical things, events and states. This collection of essays, first published in 2001, offers a series of perspectives on this (...) important doctrine and brings depth and breadth to the philosophical debate. A group of distinguished philosophers, comprising both physicalists and their critics, consider a wide range of issues including the historical genesis and present justification of physicalism, its metaphysical presuppositions and methodological role, its implications for mental causation, and the account it provides of consciousness. (shrink)

In this paper, we analyse how GPS-based navigation systems are transforming some of our intellectual virtues and then suggest two strategies to improve our practices regarding the use of such epistemic tools. We start by outlining the two main approaches in virtue epistemology, namely virtue reliabilism and virtue responsibilism. We then discuss how navigation systems can undermine five epistemic virtues, namely memory, perception, attention, intellectual autonomy, and intellectual carefulness. We end by considering two possible interlinked ways of trying to remedy (...) this situation: [i] redesigning the epistemic tool to improve the epistemic virtues of memory, perception, and attention; and [ii] the cultivation of cognitive diligence for wayfinding tasks scaffolding intellectual autonomy and carefulness. (shrink)

In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated (...) many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)