The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

:The question as to whether people with an addiction have control over their addiction, and voluntarily decide to use substances is an ongoing source of controversy in the context of research on addiction, health policy and clinical practice. We describe and discuss a set of five challenges for further research into voluntariness based on our own research experiences and those of others.

The legalization of cannabis in Canada instantiates principles of harm-reduction and safe supply. However, in-depth understanding of values at stake and attitudes toward legalization were not part of extensive democratic deliberation. Through a qualitative exploratory study, we undertook 48 semi-structured interviews with three Canadian stakeholder groups to explore opinions and values with respect to the legalization of cannabis: (1) members of the general public, (2) people with lived experience of addiction and (3) clinicians with experience treating patients with addiction. Across (...) all groups, participants tended to be in favor of legalization, but particular opinions rested on their viewpoint as stakeholders. Clinicians considered the way legalization would affect an individual’s health and its potential for increasing rates of addiction on a larger scale. People with lived experience of addiction cited personal autonomy more than other groups and stressed the need to have access to quality information to make truly informed decisions. Alternatively, members of the public considered legalization positive or negative in light of whether one’s addiction affected others. We elaborate on and discuss how scientific evidence about drug use impact values relates and how can different arguments play in democratic debates about legalization. (shrink)

Addiction is a common condition affecting millions of people worldwide of which only a small proportion receives treatment. The development and use of healthcare services is influenced by how addiction is understood (e.g., a condition to treat, a shameful condition to stigmatize), notably with respect to how volition is impacted (e.g., addiction as a choice or a disease beyond one’s control). Through semi-structured qualitative interviews, we explore the implicit views and understandings of addiction and volition across three stakeholder groups: people (...) with lived experience of addiction, clinicians with experience treating addiction, and members of the public without lived experience of addiction. We notably examine whether three paradigms, i.e., three philosophical sets of understandings about the nature of reality and knowledge (realism, relativism, pragmatism) reflect how stakeholders envision addiction and volition in the context of addiction. The use of these paradigms allows for the characterization of different stances on addiction and volition and an assessment of the coherence of beliefs about these matters. Our findings demonstrate that few participants relied on a single epistemic paradigm when describing their views. Furthermore, there were notable differences in understandings of volition between the clinician group, who were more oriented toward pragmatism, and people with lived experience of addiction, who were less oriented toward realism. Despite its limitations, our study suggests that a greater appreciation for the complexity of views held by different stakeholders about addiction and volition could help critically assess the search for coherence expressed in academic and policy debates. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

This anthology looks at the early sages of Western philosophy and science who paved the way for Plato and Aristotle and their successors. Democritus's atomic theory of matter, Zeno's dazzling "proofs" that motion is impossible, Pythagorean insights into mathematics, Heraclitus's haunting and enigmatic epigrams-all form part of a revolution in human thought that relied on reasoning, forged the first scientific vocabulary, and laid the foundations of Western philosophy. Jonathan Barnes has painstakingly brought together the surviving Presocratic fragments in their original (...) contexts, utilizing the latest research and a major new papyrus of Empedocles. Translated and edited by Jonathan Barnes. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

The Oxford Translation of Aristotle was originally published in 12 volumes between 1912 and 1954. It is universally recognized as the standard English version of Aristotle. This revised edition contains the substance of the original Translation, slightly emended in light of recent scholarship three of the original versions have been replaced by new translations and a new and enlarged selection of Fragments has been added. The aim of the translation remains the same: to make the surviving works of Aristotle readily (...) accessible to English speaking readers. (shrink)

What distinguishes evils from ordinary wrongs? Is hatred a necessarily evil? Are some evils unforgivable? Are there evils we should tolerate? What can make evils hard to recognize? Are evils inevitable? How can we best respond to and live with evils? Claudia Card offers a secular theory of evil that responds to these questions and more. Evils, according to her theory, have two fundamental components. One component is reasonably foreseeable intolerable harm -- harm that makes a life indecent and (...) impossible or that makes a death indecent. The other component is culpable wrongdoing. Atrocities, such as genocides, slavery, war rape, torture, and severe child abuse, are Card's paradigms because in them these key elements are writ large. Atrocities deserve more attention than secular philosophers have so far paid them. They are distinguished from ordinary wrongs not by the psychological states of evildoers but by the seriousness of the harm that is done. Evildoers need not be sadistic:they may simply be negligent or unscrupulous in pursuing their goals. Card's theory represents a compromise between classic utilitarian and stoic alternatives (including Kant's theory of radical evil). Utilitarians tend to reduce evils to their harms; Stoics tend to reduce evils to the wickedness of perpetrators: Card accepts neither reduction. She also responds to Nietzsche's challenges about the worth of the concept of evil, and she uses her theory to argue that evils are more important than merely unjust inequalities. She applies the theory in explorations of war rape and violence against intimates. She also takes up what Primo Levi called "the gray zone", where victims become complicit in perpetrating on others evils that threaten to engulf themselves. While most past accounts of evil have focused on perpetrators, Card begins instead from the position of the victims, but then considers more generally how to respond to -- and live with -- evils, as victims, as perpetrators, and as those who have become both. (shrink)

BL Features of the new edition: The translation has been completely rewritten, and the commentary thoroughly revised in the light of recent scholarship There is an additional glossary, and extended bibliography The Posterior Analytics contains some of Aristotle's most influential thoughts in logic, epistemology, metaphysics, and the philosophy of science. The first book expounds and develops the notions of a demonstrative argument and of a formal, axiomatized science; the second discusses a cluster of problems raised by the axioms or principles (...) of such a science, and investigates in particular the theory of definition. (shrink)

Addressing studying as a distinct educational concept and phenomenon in its own right, the essays in this volume consider study and studying from a range of perspectives. Countering dominant educational discourses, which place a heavy emphasis on learning and instruction, the contributors explore questions such as: What does it mean to study something? How is studying something different from being taught about it, or learning something about it? What does the difficulty demanded by study mean for the one who studies (...) and for the teacher? What mode of existence does study induce? The book highlights the significance of study not only, or even primarily, for its educational outcome, but as a human activity. (shrink)

William Barnes' reputation as one of the pre-eminent British "dialect" poets, the equal of Robert Burns and John Clare, is being increasingly recognized. The range of his writings is extraordinary as evidenced by the contents of this collection, which includes works on etymology, philology, topography, mathematics, ancient history and economics. This collection displays the full diversity of Barnes' considerable intellect. Included are major and lesser-known works, biographical pieces by Thomas Hardy, and the biography by his daughter, Lucy Baxter.

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Ancient philosophers -- The history of philosophy -- Philosophy within quotation marks? -- Anglophone attitudes -- Brentano's Aristotle -- Heidegger in the cave -- 'There was an old person from Tyre' -- The Presocratics in context -- Argument in ancient philosophy -- Philosophy and dialectic -- Aristotle and the methods of ethics -- Metacommentary -- An introduction to Aspasius -- Parmenides and the Eleatic One -- Reason and necessity in Leucippus -- Plato's cyclical argument -- Death and the philosopher -- (...) Aristotelian arithmetic -- The principle of plenitude -- 'Aristotle's opinion concerning destiny and what is up to us' -- 'Belief is up to us' -- The same again : the Stoics and eternal recurrence -- Bits and pieces -- Partial wholes -- 'Drei Sonnen sah ich ...' : Syrianus and astronomy -- Immaterial causes. (shrink)

The opportunities to become a good person are not the same for everyone. Modern European ethical theory, especially Kantian ethics, assumes the same virtues are accessible to all who are capable of rational choice. Character development, however, is affected by circumstances, such as those of wealth and socially constructed categories of gender, race, and sexual orientation, which introduce factors beyond the control of individuals. Implications of these influences for morality have, since the work of Williams and Nagel in the seventies, (...) raised questions in philosophy about the concept of moral luck. In The Unnatural Lottery, Claudia Card examines how luck enters into moral character and considers how some of those who are oppressed can develop responsibility. Luck is often best appreciated by those who have known relatively bad luck and have been unable to escape steady comparison of their lot with those of others. The author takes as her paradigms the luck of middle and lower classes of women who face violence and exploitation, of lesbians who face continuing pressure to hide or self-destruct, of culturally Christian whites who have ethnic privilege, and of adult survivors of child abuse. How have such people been affected by luck in who they are and can become, the good lives available to them, the evils they may be liable to embody? Other philosophers have explored the luck of those who begin from privileged positions and then suffer reversals of fortune. Claudia Card focuses on the more common cases of those who begin from socially disadvantaged positions, and she considers some who find their good luck troubling when its source is the unnatural lottery of social injustice. (shrink)

The most accessible and comprehensive guide to Aristotle currently available.

Das ethische Prinzip des Respekts vor der Autonomie des Patienten/Probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

What distinguishes evils from ordinary wrongs? Are some evils unforgivable? How should we respond to evils? Card offers a secular theory of evil--representing a compromise between classic utilitarian and stoic approaches--that responds to these and other questions.

A number of dichotomies bedevil the concept of care, among them, the question of whether healthcare is posited on care or cure. On one side the question is whether it is enough to cure without caring (to cure is to care) and on the other whether caring is sufficient without a cure. This has received attention in recent years from feminists, particularly in the nursing profession, and from renewed interest in virtue ethics. This paper describes a study that was undertaken (...) to explore what a group of experienced United Kingdom based osteopaths understand care to be. Following interviews and transcript analysis using Grounded Theory, a number of themes were identified: Care as communication; Care as understanding the patient; Care as the therapeutic relationship; Care as action; Care as most beneficial outcome. The relationships between the various themes were explored and a ‘model of osteopathic care’ was proposed. Most of the respondents put beneficial outcome of some kind at the heart of their understanding but the process of caring was not regarded as particularly important on its own. In fact the expressed intention of osteopathic care was to facilitate a beneficial outcome. However, beneficial outcome was described in very broad terms and was not confined to the resolution of patients' presenting symptoms. In placing beneficial outcome at the heart of their model of care, respondents did not appear to recognize the dichotomy between care and cure, a finding that contrasts sharply with a number of nursing studies. The paper concludes by suggesting how it may be possible to differentiate between care and good practice. (shrink)

Das ethische Prinzip des Respekts vor der Autonomie des Patienten/Probanden hat in der modernen Medizin mittlerweile weltweit Bedeutung erlangt. Die Betonung der Autonomie des Patienten und Probanden in allen in der letzten Zeit verabschiedeten internationalen Deklarationen gibt dieser Tendenz unmissverständlich Ausdruck. Doch wenngleich diese Entwicklung unstrittig positiv ist, wirft sie dennoch eine Reihe von Fragen auf, die mit der Kodifizierung, Interpretation, Reichweite und Anwendung dieses universalen Prinzips verbunden sind. Die Antworten auf diese Fragen entscheiden darüber, ob Autonomie als hilfreiches, emanzipatorisches (...) oder als überforderndes, gar hegemoniales Prinzip begriffen wird. Diese normativen Probleme werden anhand von Beispielen aus der globalen Medizinethik verdeutlicht. Was in modernen Gesellschaften als Autonomie bezeichnet und für die Praxis fruchtbar gemacht wird, ist als ein soziales Konstrukt zu verstehen, nicht im Sinne einer Schimäre, sondern im Sinne einer soziokulturellen Leistung, die auf komplexen, historisch gewachsenen und kulturell geprägten Interaktionen von Gesellschaften, Institutionen und Individuen beruht. (shrink)

This article considers the question ‘What makes hope rational?’ We take Adrienne Martin’s recent incorporation analysis of hope as representative of a tradition that views the rationality of hope as a matter of instrumental reasons. Against this tradition, we argue that an important subset of hope, ‘fundamental hope’, is not governed by instrumental rationality. Rather, people have reason to endorse or reject such hope in virtue of the contribution of the relevant attitudes to the integrity of their practical identity, which (...) makes the relevant hope not instrumentally but intrinsically valuable. This argument also allows for a new analysis of the reasons people have to abandon hope and for a better understanding of non-fundamental, ‘prosaic’ hopes. (shrink)

This essay argues that current advocacy of lesbian and gay rights to legal marriage and parenthood insufficiently criticizes both marriage and motherhood as they are currently practiced and structured by Northern legal institutions. Instead we would do better not to let the State define our intimate unions and parenting would be improved if the power presently concentrated in the hands of one or two guardians were diluted and distributed through an appropriately concerned community.

I argue for a novel answer to the question “What is hope?”. On my view, rather than aiming for a compound account, i.e. analysing hope in terms of desire and belief, we should understand hope as an irreducible concept. After criticizing influential compound accounts of hope, I discuss Segal and Textor's alternative of describing hope as a primitive mental state. While Segal and Textor argue that available developments of the standard definition do not offer sufficient conditions for hope, I question (...) the deep‐seated idea that desire and belief are even necessary conditions for hope. My suggestion is that we should take seriously the fact that we hope in a great variety of ways and should question the search for elements that are common to all cases. A promising alternative follows the Wittgensteinian idea that cases of hope are related in terms of family resemblance, i.e. are multiply realizable on the ontological level while falling under the non‐definable concept of hope. (shrink)

In this contribution to philosophical ethics, Claudia Card revisits the theory of evil developed in her earlier book The Atrocity Paradigm, and expands it to consider collectively perpetrated and collectively suffered atrocities. Redefining evil as a secular concept and focusing on the inexcusability - rather than the culpability - of atrocities, Card examines the tension between responding to evils and preserving humanitarian values. This stimulating and often provocative book contends that understanding the evils in terrorism, torture and genocide enables (...) us to recognise similar evils in everyday life: daily life under oppressive regimes and in racist environments; violence against women, including in the home; violence and executions in prisons; hate crimes; and violence against animals. Card analyses torture, terrorism and genocide in the light of recent atrocities, considering whether there can be moral justifications for terrorism and torture, and providing conceptual tools to distinguish genocide from non-genocidal mass slaughter. (shrink)

ABSTRACT Truth-conditions are systematically determined when they are the output of an algorithmic procedure that takes as input a set of semantic and contextual features. Truth-conditional sceptics have cast doubts on the thesis that truth-conditions are systematic in this sense. Against this form of scepticism, Schoubye and Stokke : 759–793) and Dobler : 451–474.) have provided systematic analyses of utterance truth-conditions. My aim is to argue that these theories are not immune to the kind of objections raised by truth-conditional sceptics. (...) In particular, I argue that the use of Questions Under Discussion and ways of being is problematic. (shrink)