Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

When emotions are mentioned in the literature on mental competence, it is generally because they are thought to influence competence negatively; that is, they are thought to impede or compromise the cognitive capacities that are taken to underlie competence. The purpose of the present discussion is to explore the possibility that emotions might play a more positive role in the determination of competence. Using the MacArthur Treatment Competence Study as an example, it is argued that appreciation, a central theoretical concept (...) in many contemporary approaches to competence, has important emotive components that are seldom sufficiently recognized or acknowledged. If true, this means that some leading contemporary accounts of competence need to be revised in order to make more adequate provision for the positive contribution of emotion. (shrink)

This article gives a brief introduction to the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and critically examines its theoretical presuppositions. On the basis of empirical, methodological and ethical critique it is emphasised that the cognitive bias that underlies the MacCAT-T assessment needs to be modified. On the one hand it has to be admitted that the operationalisation of competence in terms of value-free categories, e.g. rational decision abilities, guarantees objectivity to a great extent; but on the other hand it bears severe (...) problems. Firstly, the cognitive focus is in itself a normative convention in the process of anthropological value-attribution. Secondly, it misses the complexity of the decision process in real life. It is therefore suggested that values, emotions and other biographic and context specific aspects should be considered when interpreting the cognitive standards according to the MacArthur model. To fill the gap between cognitive and non-cognitive approaches the phenomenological theory of personal constructs is briefly introduced. In conclusion some main demands for further research to develop a multi-step model of competence assessment are outlined. (shrink)

Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation of the personal relevance of this information, and logical reasoning, may be insufficient to address this question. This is so because major depression may not impair these (...) four abilities while it may disrupt coherence of personal preferences by changing them. Such change may be evaluated by comparing the treatment preferences of the individual during the depression to his or her treatment preferences during normal periods. If these preferences are consistent, they should be respected. If they are not consistent, or past treatment preferences that were arrived at competently cannot be established, treatment refusal may have to be overridden or ignored so as to alleviate the depression and then determine the competent treatment decision of the individual. Further study of the relation between depression and competence to refuse or consent to psychiatric treatment is required. (shrink)

Challenging and rewarding in equal measure, _Phenomenology of Perception_ is Merleau-Ponty's most famous work. Impressive in both scope and imagination, it uses the example of perception to return the body to the forefront of philosophy for the first time since Plato. Drawing on case studies such as brain-damaged patients from the First World War, Merleau-Ponty brilliantly shows how the body plays a crucial role not only in perception but in speech, sexuality and our relation to others.

Challenging and rewarding in equal measure, _Phenomenology of Perception_ is Merleau-Ponty's most famous work. Impressive in both scope and imagination, it uses the example of perception to return the _body_ to the forefront of philosophy for the first time since Plato. Drawing on case studies such as brain-damaged patients from the First World War, Merleau-Ponty brilliantly shows how the body plays a crucial role not only in perception but in speech, sexuality and our relation to others. Perhaps above all, Merleau-Ponty's (...) insights about the embodied mind are a bold and refreshing challenge to the new era of virtual reality and artificial intelligence, as scientists and psychologists discover the centrality of the body to mind and intelligence. (shrink)

What makes this work so important is that it returned the body to the forefront of philosophy for the first time since Plato.

This paper investigates the question of what an organ is from a phenomenological perspective. Proceeding from the phenomenology of being-in-the-world developed by Heidegger in Being and Time and subsequent works, it compares the being of the organ with the being of the tool. It attempts to display similarities and differences between the embodied nature of the organs and the way tools of the world are handled. It explicates the way tools belong to the totalities of things of the world that (...) are ready to use and the way organs belong to the totality of a bodily being able to be in this very world. In so doing, the paper argues that while the organ is in some respects similar to a bodily tool, this tool is nonetheless different from the tools of the world in being tied to the organism as a whole, which offers the founding ground of the being of the person. However, from a phenomenological point of view, the line between organs and tools cannot simply be drawn by determining what is inside and outside the physiological borders of the organism. We have, from the beginning of history, integrated technological devices (tools) in our being-in-the-world in ways that make them parts of ourselves rather than parts of the world (more organ- than tool-like), and also, more recently, have started to make our organs more tool-like by visualising, moving, manipulating, and controlling them through medical technology. In this paper, Heidegger’s analysis of organ, tool, and world-making is confronted with this development brought about by contemporary medical technology. It is argued that this development has, to a large extent, changed the phenomenology of the organ in making our bodies more similar to machines with parts that have certain functions and that can be exchanged. This development harbours the threat of instrumentalising our bodily being but also the possibility of curing or alleviating suffering brought about by diseases which disturb and destroy the normal functioning of our organs. (shrink)

In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders — the diagnoses for which treatment with antidepressants is most commonly indicated — is also explored (...) by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society. (shrink)

I outline the early Heidegger's views on mood and emotion, and then relate his central claims to some recent finding in neuropsychology. These findings complement Heidegger in a number of important ways. More specifically, I suggest that, in order to make sense of certain neurological conditions that traditional assumptions concerning the mind are constitutionally incapable of accommodating, something very like Heidegger's account of mood and emotion needs to be adopted as an interpretive framework. I conclude by supporting Heidegger's insistence that (...) the sciences constitute a derivative means of disclosing the world and our place within it, as opposed to an ontologically and epistemologically privileged domain of inquiry. (shrink)

This first volume contains discussions of the brain, methods for analyzing behavior, thought, consciousness, attention, association, time, and memory.

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

There is an important gap in philosophical, clinical and bioethical conceptions of decision-making capacity. These fields recognize that when traumatic life circumstances occur, people not only feel afraid and demoralized, but may develop catastrophic thinking and other beliefs that can lead to poor judgment. Yet there has been no articulation of the ways in which such beliefs may actually derail decision-making capacity. In particular, certain emotionally grounded beliefs are systematically unresponsive to evidence, and this can block the ability to deliberate (...) about alternatives. People who meet medico-legal criteria for decision-making capacity can react to health and personal crises with such capacity-derailing reactions. One aspect of this is that a person who is otherwise cognitively intact may be unable to appreciate her own future quality of life while in this complex state of mind. This raises troubling ethical challenges. We cannot rely on the current standard assessment of cognition to determine decisional rights in medical and other settings. We need to understand better how emotionally grounded beliefs interfere with decision-making capacity, in order to identify when caregivers have an obligation to intervene. (shrink)

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

We review the use of introspective and phenomenological methods in experimental settings. We distinguish different senses of introspection, and further distinguish phenomenological method from introspectionist approaches. Two ways of using phenomenology in experimental procedures are identified: first, the neurophenomenological method, proposed by Varela, involves the training of experimental subjects. This approach has been directly and productively incorporated into the protocol of experiments on perception. A second approach may have wider application and does not involve training experimental subjects in phenomenological method. (...) It requires front-loading phenomenological insights into experimental design. A number of experiments employing this approach are reviewed. We conclude with a discussion of the implications for both the cognitive sciences and phenomenology. (shrink)

The ethical principle of respect for autonomy has come into its own In American medicine since World War II as equal in importance to the traditional medicomoral principles of nonmaleficence and beneficence. Respect for autonomy provides the ethical underpinning for the patient's right to exercise an informed choice – whether to consent to or to refuse recommended medical treatment. However, an informed choice demands a certain level of competence. Typical criteria for patient competence to accept or to refuse medical treatments (...) Include ability to make a choice and ability to comprehend the nature of the treatment, as well as the risks and benefits of accepting or refusing the treatment. (shrink)

In _Reconstructing the Cognitive World_, Michael Wheeler argues that we should turn away from the generically Cartesian philosophical foundations of much contemporary cognitive science research and proposes instead a Heideggerian approach. Wheeler begins with an interpretation of Descartes. He defines Cartesian psychology as a conceptual framework of explanatory principles and shows how each of these principles is part of the deep assumptions of orthodox cognitive science. Wheeler then turns to Heidegger's radically non-Cartesian account of everyday cognition, which, he argues, can (...) be used to articulate the philosophical foundations of a genuinely non-Cartesian cognitive science. Finding that Heidegger's critique of Cartesian thinking falls short, even when supported by Hubert Dreyfus's influential critique of orthodox artificial intelligence, Wheeler suggests a new Heideggerian approach. He points to recent research in "embodied-embedded" cognitive science and proposes a Heideggerian framework to identify, amplify, and clarify the underlying philosophical foundations of this new work. He focuses much of his investigation on recent work in artificial intelligence-oriented robotics, discussing, among other topics, the nature and status of representational explanation, and whether cognition is computation rather than a noncomputational phenomenon best described in the language of dynamical systems theory. Wheeler's argument draws on analytic philosophy, continental philosophy, and empirical work to "reconstruct" the philosophical foundations of cognitive science in a time of a fundamental shift away from a generically Cartesian approach. His analysis demonstrates that Heideggerian continental philosophy and naturalistic cognitive science need not be mutually exclusive and shows further that a Heideggerian framework can act as the "conceptual glue" for new work in cognitive science. (shrink)

In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...) and ethics, and increasingly an independent topic of philosophical inquiry. (shrink)

The primary difference between direct and inferential theories of perception concerns the location of perceptual content, the meaning of our perceptions. In inferential theories of perception, these meanings arise inside animals, based upon their interactions with the physical environment. Light, for example, bumps into receptors causing a sensation. The animal (or its brain) performs inferences on the sensation, yielding a meaningful perception. In direct theories of perception, on the other hand, meaning is in the environment, and perception does not depend (...) upon meaning- conferring inferences. Instead the animal simply gathers information from a meaning- laden environment. But if the environment contains meanings, then it cannot be merely physical. This places a heavy theoretical burden on direct theories of perception, a burden so severe that it may outweigh all the advantages to conceiving perception as. (shrink)