This chapter contains sections titled: Knowing the Difference Between One's Ass and First Base Self‐Important Dork Personal Ethics and Professional Ethics The Philosophical Foundations of Bioethics Clinical Bioethics and Some Major Players Risk Versus Benefit Autonomy Inside the Outside Influences of Your Ink Memory Remodeling.

Dinh, Hoa Trung At the forefront of the current debate on 'assisted death' is the autonomy argument. Advocates of assisted death often appeal to respect for autonomy as a trump card that can override all other considerations: the value of human life, the prohibition of killing in the medical tradition, and other social responsibilities. For Kant, who invented the concept of autonomy and regarded it as the manifestation of human dignity, the concept of killing oneself is rationally indefensible (...) and totally at odds with the exercise of autonomy. This article discusses the origin of respect for autonomy in health ethics, and provides a Kantian critique of physician-assisted death. (shrink)

The failure of the attempt by Michael Polanyi to capture the social organization of science by comparing it to the operation of a market bears salutary lessons for modern philosophers of science in their rush to appropriate market models and metaphors. In this case, an initially plausible invisible hand argument ended up as crude propaganda for the uniquely privileged social support of science.

Over the last fifty years, medical practice has shifted to an autonomy-based model that promotes patient self-determination as the basis for decision making. Physicians and other health care professionals are often expected to acquiesce to patients’ wishes, even when these wishes are for inappropriate medical care. Three cases are used to illustrate specific conflicts between a professional’s understanding of the science of human biology and a patient’s autonomy. Medical professionals must carefully evaluate issues of patient autonomy in their practices if (...) they are to provide care that displays deep respect for the full human dignity of their patients combined with respect for their own professional role and expertise. National Catholic Bioethics Quarterly 12.4 : 653–673. (shrink)

Today’s debates about academic freedom in the US and the UK often echo arguments and counterarguments made by Immanuel Kant and the sovereign who censored him around the time when the modern Humboldtian university would be founded on the twin principles of critique and institutional autonomy. This article considers the limits of the criticist account by reading Jacques Derrida’s deconstructive engagement with Kant’s Conflict of the Faculties in the context of recent legislative developments and political interference which imperil these foundations. (...) To do so, it makes a turn to the ear and to the multiple senses of ‘hearing’ as auditory perception, responsiveness and judgement to explore an alternative basis for defending academic freedom that radicalizes Kant’s position and liberates scholarly inquiry from its closures. (shrink)

A rational justification for therapeutic decisions can be developed using probability and decision theory. The set of treatments and their outcomes or consequences, which are states of health, have to be defined; and estimates made of the probabilities of outcomes, their utilities, and the costs of treatments. Most difficult is the estimation of utilities of states of health but this may be possible using a wagering technique. Until it is possible to establish some equivalence between utility and money, costs may (...) be introduced by measuring the efficiency of treatment by comparing expected utilities per unit cost. The whole method is examined practically in a plausible clinical setting. Emphasis is laid on the value of testing the completed model using a computer to get an intimate feel of the problem using different assumptions and different values for all the parameters. (shrink)

continent. 1.2 (2011): 136-140. In early 2011, Cow Heavy Books published The Official Catalog of the Library of Potential Literature , a compendium of catalog 'blurbs' for non-existent desired or ideal texts. Along with Erinrose Mager, I edited the project, in a process that was more like curation as it mainly entailed asking a range of contemporary writers, theorists, and text-makers to send us an entry. What resulted was a creative/critical hybrid anthology, a small book in which each page opens (...) to a new iteration of textual desire. These texts explore the material possibilities of the book. Somewhat parallel to the call of N. Katherine Hayles who, in her book Writing Machines , urges literary theorists to take up the practice of Medium Specific Analysis (to account for the way the medium in which it is presented conditions or at least bears on a literary text). I see in the imagined works of The Official Catalog a call for the innovative writers of today to become Medium-Responsive. This would mean thinking through the specific (materially constrained) possibilities offered by the media in which texts are presented, and in thinking of the literary text as a kind of art in the greater context of other arts and the book as a medium situated within the context of many other media. In doing so, the contemporary writer refutes the chorus of critics who lament the death of the book by consistently reinvigorating literary innovation. The following are selections from The Official Catalog of the Library of Potential Literature that show possible paths for (thinking about) new writing that engages with its medium. —Ben Segal, Editor THE CUBE Even the most radical non-linear texts have tended to exploit or subvert only the sequential possibilities of print—from the continuous loop of Joyce's Finnegans Wake to the shuffled cards of Marc Saporta's Composition No. 1 —but The Cube takes such multiplicities to an entirely new level. Set in a grid, the book's words can be read conventionally, across the page, as well as down each column—with either route making complete grammatical sense. But they can also be read as stacked strata and mined like lexical core samples through the layered pages of the book. Each path tells the same story from a different perspective (the narrative, naturally, hinges on the potential outcomes of a throw of cubed dice). By opening up the z-axis to reading in this way, The Cube recognizes the book as a three-dimensional sculptural space. Taking its lead from Armand Schwerner's (If Personal) and Raymond Queneau's Cent mille milliards de poèmes , The Cube reads like a experiment by Christian Bök precision printed by Emily McVarish. Craig Dworkin is the editor, most recently, of The Consequence of Innovation: 21st Century Poetics (Roof Books, 2008), The Sound of Poetry/The Poetry of Sound , with Marjorie Perloff (U. Chicago Press, 2009), and Against Expression: An Anthology of Conceptual Writing , with Kenneth Goldsmith (Northwestern UP, 2010). He teaches at the University of Utah. HE GOES In He Goes , we read notes, letters and e-mails from a scholar father to his novelist daughter. We read of the father's musings on Beckett, on Pinter, on Anne Frank; his description of a woman hanging laundry from a line. We read about his journey toward dying, followed by a brief, third person account of his death, and his obituary. Then a long series of blank pages that demand to be read in real time, non-sentence by non-sentence, blank page by blank page. Finally—and it is here that this peculiar little book begins to soar—the dead father writes to his as-of-yet-still-living daughter. He does not write from death. He does not write from life. The words unprint, unstamp, unkindle. Still, they require no translation. The father "writes" (for lack of a better word) about the serendipitous, the commonplace; he recommends another book. He jokes. He asks his daughter how her stomach is. He says forget about presence in absence, darling; screw words as memorial and the guys in garbage cans and loss as redemption and I can't go on I must go on. He goes, "Love, Fodder." He goes, "incidentally." He goes, "I thought you might like to know." Elizabeth Graver is the author of a story collection, Have You Seen Me? , and three novels: Unravelling ; The Honey Thief ; and Awake . Her work has been anthologized in Best American Short Stories , Best American Essays , and Prize Stories: the O. Henry Awards . She teaches at Boston College. THE PAPER ARCHIVIST A stunning package and a triumph of imagination, The Paper Archivist at times looks to be less a book than an abstract expressionist painting. Softly bound, its contents unfold to a single sheet of uneven thickness and texture—a canvas splattered with colored lines, stickers, broken sentences, and nonsense pictographs. But by following the directions to fold, dip, smell, rub, scratch, and tear the sheet according to the contingencies of the weather and using only the objects at hand, the reader slowly brings the forces hidden in the noise into a glorious sculptural convergence, processing a different story and shape each time. This is the rare book that continues to stir, whirl, and pop on every new reading. Sean Higgins blogs at BOMBlog where he is responsible for the column Volumes and Territories, as well as Ghost Island , a fledgling collaborative intellectual collective. THE SLOW BOOK The Slow Book , written by an anonymous author at the dawn of literacy, on a minor planet (otherwise notable only as the source of that exceptionally hardy, not very tasty grain called “shef” sowed on hostile planets as an early step to colonization), and encoded into a series of punctures on a strip of copper coiled inside a clever device, something between a player piano and an old-fashioned film projector, is being released into print, as was the author’s intention, at a rate of one word per century (local time). Each word is, across the Forty Galaxies, agreed to be uncannily apt for the century in which it appears—even “of,” in a century during which the highest value was attached to fidelity, whether to ideals, worlds, or romantic love; even “the,” which governed two centuries, one extraordinarily materialistic, during which advances in propulsion and navigation accelerated the exchange of exceptional objects between the remotest planets of the Forty, and one in which the central concern, both of philosophers and the common man, was whether, in an age of rapidly proliferating hypothetical worlds, anyone or anything concretely existed at all. Even those words published long before interstellar contact can be seen in retrospect to have transgalactic pertinence. As a result, attempts to abstract the machine from its publishers, Hobson & Hui, in order to “predict the future” for insight or gain by “fast- forwarding” the copper strip have been many and ingenious. While, in centuries of skepticism (“maybe”), or of unrest (“go”) the book has been nearly forgotten, in others it seems to haunt every thought, every deed, despite the fact that the subject of The Slow Book is still unclear. So far only a few sentences exist in print; everyone knows them, can quote them, offer the standard exegeses and assorted heresies; yet certainties are the stuff of adolescence; mature readers are forced to acknowledge that these sentences are probably only a preamble to the main argument. They contain no proper nouns, nor can we identify any definite theme. There is even disagreement about their tone, whether coolly ironic, as some insist, or ardent. The appearance of an unusual grammatical case, sometimes called the future pluperfect continuous, used to describe events that at some future point will have always been true (but are not yet)—hitherto known to appear only in the synthetic dogmas of the Thanatographical Society, and in certain highly circumscribed religious contexts—has suggested to some scholars that the Slow Book was originally intended for ritual use, but the proximity of the usage to a term designating a small hand plow that, as Pott and Mielcke have convincingly shown, would have borne a distinctly obscene double meaning in its culture of origin in the author’s time, argues otherwise. It is likewise unclear whether the situation that seems to be—with teasing incompleteness—sketched out in these few lines is intended as an illustration of general principles, a case study, a dramatic scene, or an extended metaphor. In short, we have no idea what The Slow Book is about. In our own time, we believe that it is almost certainly a work of fiction, but that may be because we live in the century of “if”. In each age, perhaps, we see the book we most need to read. Some have dared to suggest that the metal strip is blank until, with millennial fanfare, it advances into its new position, that no ur-text exists, that the book itself is brought into being—written—by our need. But that is exactly the sort of thing we would believe, in 7645. Shelley Jackson is the author of the story collection The Melancholy of Anatomy , the novel Half Life , and hypertexts including Patchwork Girl . The recipient of a Howard Foundation grant, a Pushcart Prize, and the 2006 James Tiptree Jr Award, she has also written and illustrated several children's books, including The Old Woman and the Wave ; Sophia, the Alchemist's Dog ; and Mimi's Dada Catifesto . Her stories and essays have appeared in Conjunctions , McSweeney's , The Paris Review , and Cabinet Magazine . In 2004 she launched her project SKIN , a story published in tattoos on 2095 volunteers. THE BOOK OF SOUNDS The Book of Sounds is just that: a book of sounds made when letters are construed in new ways to bring forth out of the alphabet new forms of speech. A book meant to be read out loud, The Book of Sounds is not unlike Laurie Anderson's O Superman or Brian Eno's Music for Airports in its attempt to make music out of the most primary and simplest of methods. It breaks language down to its barest bones and makes out of the page a drum that has never before been beaten upon. Peter Markus is the author of a novel, Bob, or Man on Boat (Dzanc Books) as well as two books of short fiction, Good, Brother and The Singing Fish , both of which were published by Calamari Press. A new collection of stories, We Make Mud , is now available from Dzanc Books. PARADISE OF THE BLIND by Celan Solen Although the reclusive Celan Solen published his first and only book in 1963—paying out-of-pocket for a limited edition of the slim collection No One May Have the Same Knowledge Again —he remained in American obscurity for almost three decades. In 1992 a micro-press in Istanbul brought out No One in Turkish. A German translation followed in 1995. Soon it became clear in literary circles Solen was a world-class (if highly unclassifiable) artist—lyrical, dense, enigmatic—who could undo the conventional short story in 397 words by inventing impossible worlds housed in impossible whirls (in “Small Sadnesses,” a single chartreuse tree frog in Borneo unknowingly holds time together by its very presence in the universe, while each letter of its tale refers, not to itself, but to the one preceding it in the alphabet). By his disappearance last year, Solen was considered master by a generation of writers and critics (except, alas, for those gentlemen in the Swedish Academy). Imagine, then, that generation’s delight at the discovery, locked away in the author’s safe-deposit box, of his second and final composition. Had Lynch’s Lost Highway been book instead of film, and had it been penned by Beckett at his least certain, revised by Barthelme at his most formally deranged, and typeset by Derrida at his most semiotically catastrophic, the result might have been something like Paradise of the Blind : interlacing narratives of a man composed of borrowed organs (whose most cheerless and difficult to locate, god, could only have been invented by an empty heart), a nonexistent medieval painting blamed for the ruin of future hope, and the spread of a philosophy that holds earth a mistake constantly recurring in the dream of a fish lying on the floor of the Atlantic (if the fish wakes, our world winks off)—all contained in a text packed with typed-over passages, torn postcards, poems that can be deciphered only when held up to a mirror, pages ornamented with trompe-l'œil paperclips and coffee stains and buzzing houseflies, some busy with illegible runes that dissolve when exposed to light, three that smell like roses or lemons (depending on whether a man or woman is reading), two that stain with the bloody fingerprints of the those who handle them, one that ignites when brushed with breath, thirteen sewn from baby skin, one that moans when touched, and one that screams—yet all without mass, unimaginable, and invisible. Lance Olsen is author of more than 20 books of and about innovative fiction, including, most recently, the novels Calendar of Regrets (2010) and Head in Flames (2009). He teaches experimental narrative theory and practice at the University of Utah. SUPERSTRUCTURE! by Barbara D'Albi As soon as I opened the third drawer of Barbara D'Albi's wooden novel, everything became hopeless. Now in Ithaca, there was no going back. And it wasn't just the intricate series of shelves, hinged doors and locked drawers which D'Albi layered into the book, no, lo, I was constructed anew by the story. Who else but D'Albi to imagine a God who becomes a carpenter and gets killed?! And makes it good! You want stories? D'Albi is a skyscraper, built with planes and levers. Momentarily I wondered where I could shelve this book, and then I thought: no matter; I couldn't put it down. Adam Robinson lives in Baltimore, where he runs Publishing Genius. He is the author of Adam Robison and Other Poems and Say, Poem. 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in this article, we explore how responsible research and innovation (RRI) interacts with the current political context. We examine the (1) possible consequences for RRI and related agendas if values associated with ‘populist’ movements become more pervasive, (2) the role that a lack of RRI has potentially played in the development of this political context, and (3) how RRI as a concept, practice, and research agenda should respond. We argue that whilst RRI is threatened, it is now more important than (...) ever. We propose that RRI needs to go beyond being a method for facilitating societal input into research and innovation and for highlighting desired impacts. RRI needs to evolve to provide an effective conduit for criticisms and the input of critical thinking and reflexivity into science and innovation, including in terms of economic policy and politics. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.Methods:Ethnographic field study.Ethical considerations:The boards (...) representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Personalised learning systems—systems that predict learning needs to tailor education to the unique learning needs of individual students—are gaining rapid popularity. Praise for educational technology is often focused on how technology will benefit school systems, but there is a lack of understanding of how it will affect the student and the learning process. By uncovering what the meaning of ‘personal’ is in educational philosophy and as embodied in the technology, we illustrate that these two understandings are different regarding the autonomy (...) of the student. Personalised learning technology, therefore, bears the risk of failing to achieve its educational ideal of what personalisation should be. We also illustrate how personalised learning technology effects student autonomy by requiring the intensive tracking of the learning process, exposing them to privacy and data protection risks. We do not claim that education does not need technology, but we want to illustrate the importance of values as drivers of innovation. (shrink)

In psychiatry, caregivers try to get free and informed consent of patients, but often feel required to restrict freedom and to use coercion. The present article develops ethical advice given by an Ethics Committee for Mental Health Care. The advice recommends an ethical ideal of shared deliberation, consisting of information, motivation, consensus and evaluation. For the exceptional use of coercion, the advice develops three criteria, namely incapacity to deliberate, threat of serious harm and proportionality between harm and coercion.The article also (...) discusses the viewpoints of the ethical advice and of the European Convention on Human Rights and Biomedicine: is the advice in agreement with the Convention and can the advice refine the guidelines of the Convention for the particular context of psychiatry? Although the Convention emphasises the autonomy of the individual patient, whereas the advice focuses on the relationships between the partners involved, the advice enjoys a complementary and supportive function in the application of the Convention. (shrink)

This chapter contains sections titled: Questions of Identity1 Personal Identity Across Time Somatic and Psychological Accounts Tattoos and the Somatic Account Narrative Identity Tattoos of Anchors … and Anything Else as Anchors When You Get a Tattoo, You Tattoo You.

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 3. © 2018 by Feminist Studies, Inc. 699 Jennifer C. Nash The Political Life of Black Motherhood In 1976, Adrienne Rich wrote, “We know more about the air we breathe, the seas we travel, than about the nature and meaning of motherhood.”1 In the four decades since the publication of Rich’s now-canonical Of Woman Born, Andrea O’Reilly has argued for the advent of “maternal theory” (...) as an academic discipline, the maternal memoir has become a highly popular (and profitable) literary genre, and there has been sustained attention to maternal activism with scholarly analyses of such organizations as Mothers Against Drunk Driving and Mothers of the Movement.2 If Mamie Till Bradley boldly “let the world see” her son’s mutilated body in a 1955 public plea to make visible black suffering and antiblack violence, Valerie Castile’s statement after a jury found a police officer not guilty in the death of her son continued in the tradition of 1. Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (New York: W. W. Norton, 1995), 11. 2. See Andrea O’Reilly, ed., Maternal Theory: A Reader (New York: Demeter Press, 2007); Ann Hulbert, “The Real Myth of Motherhood,” Slate, March 8, 2005; Jennifer C. Nash and Samantha Pinto, “Strange Intimacies: Reading Black Mothering Memoirs,” Public Culture (forthcoming); Danielle Poe, Maternal Activism: Mothers Confronting Injustice (Albany: SUNY Press, 2016); and Ruth Feldstein, Motherhood in Black and White: Race and Sex in American Liberalism, 1930–1965 (Ithaca, NY: Cornell University Press, 2000). 700 Jennifer C. Nash Books Discussed in This Essay Revolutionary Mothering: Love on the Front Lines. Edited by Alexis Pauline Gumbs, China Martens, and Mai’a Williams. Oakland, CA: PM Press, 2016. Laboring Positions: Black Women, Mothering and the Academy. Edited by Sekile Nzinga-Johnson. Bradford, ON: Demeter Press, 2013. How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to Trump. By Laura Briggs. Oakland: University of California Press, 2017. Birthing Justice: Black Women, Pregnancy, and Childbirth. Edited by Julia Oparah and Alicia Bonaparte. New York: Routledge, 2016. making black (male) pain visible through grief-stricken black motherhood. Castile said, My son loved this state. He had one tattoo on his body and it was of the twin cities, the state of Minnesota with “TC” on it. My son loved this city, and this city killed my son and the murderer gets away.... We’re not evolving as a civilization, we’re devolving, we have taken steps forward, people have died for us to have these rights and now we’re devolving, we’re going back to 1969.3 Her emotional plea reveals the political currency of black maternal suffering, one of the few spaces in which black pain is readily culturally visible. Indeed, there has been intensified scholarly and popular interest in representing black motherhood as both a site constituted by grief and expected loss and as a political position made visible (only) because of its proximity to death. It is certainly the case that a cultural inattention to motherhood has been replaced by an intense investment in representing at least some aspects of “the nature and meaning of motherhood” and 3. “Philando Castile’s Mother Reacts to Verdict,” Washington Post video on YouTube, posted on June 16, 2017, https://www.youtube.com/watch?v=RJsD4cCpUA. Jennifer C. Nash 701 in representing certain mothers—particularly black mothers—as symbols of trauma and injury, of pain that can be mobilized for “legitimate” political ends and social change. If, as O’Reilly suggests, maternal theory is now a distinct field, it has been fundamentally shaped by the intellectual and political labor of black feminists—Dorothy Roberts, bell hooks, Alice Walker, Patricia Hill Collins, Hortense Spillers, and Audre Lorde—who have captured the myriad ways that black maternity is cast as pathological, excessive, and marked by aberrant performances of gender and heterosexuality that threaten both the nuclear family and the heterosexual state. Drawing on a varied archive from the Moynihan Report to cultural panics about “kids having kids,” from ongoing representations of black women’s “failure” to breastfeed as a public health crisis to the racialized underpinnings of birth control, black feminist theory... (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

Bioethics has entered a new era: as many commentators have noted, the familiar mantra of autonomy, beneficence, nonmaleficence, and justice has proven to be an overly simplistic framework for understanding problems that arise in modern medicine, particularly at the intersection of public policy and individual preferences. A tradition of liberal pluralism grounds respect for individual preferences and affirmation of competing conceptions of the good. But we struggle to maintain (or at times explicitly reject) this tradition in the face of individual (...) preferences that we find distasteful, suspect, or even repugnant, especially where the broader social good or respect for equality is at stake. Directed donation presents us with such a dilemma: can we uphold the right of self-determination through respect of individual preferences regarding disposition of transplantable organs while at the same time maintaining an allocation system that reflects values of equity and justice claimed to underlie the socially negotiated practice of transplantation? Or are some preferences simply to be deemed unethical and not respected, even if that leads to a reduction in the number of transplantable organs available and to an apparent disregard for the autonomous decisions of the recently deceased? (shrink)

This article frames Trump's politics through a genealogy of propaganda, going back to P.T. Barnum in the 19th century and moving through the crowd psychologist Gustave Le Bon and the public relations counsel Edward Bernays in the 20th. This genealogy shows how propaganda was developed as a tool by eager professionals who would hire themselves to the elite to control the masses. Trump’s propaganda presents a break in that he has not only removed professionals from control over his (...) propaganda, he has mobilized it as a force against them. His lower and middle class supporters may not materially gain from Trump’s politics, but they get to vent their ressentiment on the professional class and see them too become the targets of propagandistic control. Ultimately, the conflict between working class whites, those without college degrees, and professionals earns little for its participants and occludes the role that elites play in class dynamics in the United States. This article adds substance and context to the claims that Trump’s appeal is anti-professional while showing that the claims that his supporters are ‘voting against their interests’ does not reflect the real psychological benefits many Trumpists get from supporting him. (shrink)

In a modern democratic society appearance has great importance. This is especially true of the dress code in health care sphere. More recently, changing your appearance by getting tattoos and body modifications has been decried by different generations in the medical community. However, what is significance of appearance of a medical officer during epidemiological instability around the world? The response to this question was given in our study. The objectives of the study are: to interrogate the attitude of medical (...) university students to medical officers with tattoos as well as to identify medical students who are "exposed" to the fashionable trend of tattoos and body modifications. To implement these objectives, the study involved 106 medical students of various levels of degree and faculties of Rostov state medical University. The results of the study showed that the majority of medical students has not resorted to changes in their appearance, although tattoos and body modifications did not avoid the community of medical students. (shrink)

Objective: To survey members of the American Society for Bioethics and Humanities and of the Society for Medical Decision Making to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas.Cases: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure.Method: Four questions, with structured multiple alternatives, (...) were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be.Observations and results: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference . In case 2, both groups agreed that the question of discontinuing treatment should be discussed with the family and that the family alone should not be the decision maker.Conclusion: Despite distinctively different methods of case analysis and little communication between the two professional communities, many similarities were observed in the actual decisions they reached on the two clinical dilemmas. (shrink)

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons giving (...) birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)

Alice encounters at least three distinct problems in her struggles to understand and navigate Wonderland. The first arises when she attempts to predict what will happen in Wonderland based on what she has experienced outside of Wonderland. In many cases, this proves difficult -- she fails to predict that babies might turn into pigs, that a grin could survive without a cat or that playing cards could hold criminal trials. Alice's second problem involves her efforts to figure out the basic (...) nature of Wonderland. So, for example, there is nothing Alice could observe that would allow her to prove whether Wonderland is simply a dream. The final problem is manifested by Alice's attempts to understand what the various residents of Wonderland mean when they speak to her. In Wonderland, "mock turtles" are real creatures and people go places with a "porpoise" (and not a purpose). All three of these problems concern Alice's attempts to infer information about unobserved events or objects from those she has observed. In philosophical terms, they all involve *induction*. -/- In this essay, I will show how Alice's experiences can be used to clarify the relation between three more general problems related to induction. The first problem, which concerns our justification for beliefs about the future, is an instance of David Hume's classic *problem of induction*. Most of us believe that rabbits will not start talking tomorrow -- the problem of induction challenges us to justify this belief. Even if we manage to solve Hume's puzzle, however, we are left with what W.V.O. Quine calls the problems of *underdetermination *and *indeterminacy.* The former problem asks us to explain how we can determine *what the world is really like *based on *everything that could be observed about the world. *So, for example, it seems plausible that nothing that Alice could observe would allow her to determine whether eating mushrooms causes her to grow or the rest of the world to shrink. The latter problem, which might remain even if resolve the first two, casts doubt on our capacity to determine *what a certain person means *based on *which words that person uses.* This problem is epitomized in the Queen's interpretation of the Knave's letter. The obstacles that Alice faces in getting around Wonderland are thus, in an important sense, the same types of obstacles we face in our own attempts to understand the world. Her successes and failures should therefore be of real interest. (shrink)

This book uses the example of informed consent guidelines for international research on human subjects to demonstrate how a philosophical analysis can assist in understanding how underlying concepts affect public policy; how and why such policies are exclusionary; and what methodology can be used to remedy injustices in public policy and practice. Epidemics, such as AIDS, have resulted in an increase in medical research in less developed countries. In an attempt to be more globally applicable, current international guidelines for research (...) on human subjects have attempted to acknowledge the importance of community. This book explains how these attempts fail to adequately acknowledge the importance community has for many people in less developed countries, and how these guidelines fail to attend to constraints to autonomy that oftentimes get magnified once community is involved in the informed consent process. The book further explains how these problems can be traced to a mistaken underlying notion of autonomy and what policymakers can do to remedy these problems . (shrink)

Inspired by the recent trends in education towards learner autonomy with their emphasis on the interests and desires of the students, and borrowing ideas from philosophy (particularly ethics), the present study is an attempt to investigate the discrepancy in the findings of the studies addressing error correction in L2 writing instruction, and suggest the (oft-neglected) students’ beliefs, interests and wants as what can point the way out of confusion. To this end, a questionnaire was developed and 56 advanced adult EFL (...) learners were asked to complete the questionnaire. The opinions of 20 EFL teachers were also collected using another questionnaire. Twenty-three of the students and 13 of the teachers were then interviewed in an attempt to collect explanations for their answers in the questionnaires. The results indicated that all the learners wanted the errors in their writings to be corrected. About 90 percent of them believed that all the errors in their writings should be corrected and only less than 10 percent of them agreed that there is no need to correct all the errors and that only “important” errors should be rectified. On the contrary, of the teachers who participated in the study, only 20 percent believed that all the errors in the students’ writings should be corrected. While most of the interviewed students attributed their preference of choice to feeling more confident and efficient in learning when they can recognize all the errors in their written assignments, most of the teachers believed that by correcting important errors (and not all errors), learners can get the most of their writings. Given the incongruity between teachers’ and (advanced) students’ beliefs over writing error correction, and considering advanced students as legitimate decision makers for their own learning, some suggestions are offered for EFL writing teachers. -/- . (shrink)

This chapter contains sections titled: Of Ouija Boards and Bar Owners1 Bad Reasons for Condemning Tattoos Some Moral Compliments My Complaint Traditional Virtue Ethics Virtue Ethics and Tattoos Tough Tattoos … What Lies Beneath.

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance.The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research (...) evidence which points towards patients wanting more information and a greater degree of openness.Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted (...) in a professional development course for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

This paper aims to provide autonomy-based reasons in favour of limitarianism. Limitarianism affirms it is of primary moral importance that no one gets too much. The paper challenges the standard assumption that having more material resources always increases autonomy. It expounds five mechanisms through which having too much material wealth might undermine autonomy. If these hypotheses are true, a theory of justice guided by a concern for autonomy will support a limitarian distribution of wealth. Finally, the paper discusses two issues (...) autonomy-based limitarianism would raise. First, insofar as coercion invades autonomy, do autonomy-based reasons legitimate coercive measures to secure a limitarian distribution of wealth? Second, is a limitarian ethos consistent with the incentive to produce enough wealth to secure distributive justice? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:482 HISTORY OF PHILOSOPHY with Diderot, in 1773, did not generate any excitement on either side: Diderot found the philosopher far less interesting than the patroness; Hemsterhuis, for his part, thought Diderot in person a disappointment, after reading his works. I wish I could say that I found Hemsterhuis an exciting thinker, as he is presented in Moenkemeyer 's useful and informed study. I cannot. On the other hand, (...) this quiet philosopher from Holland stood at one of the great crossroads in the history of European thought. In his struggle against the Atheism he saw emerging from the French Enlightenment, in his stress on essences, known and unknown, as opposed to the atheistic concept of matter, in his doctrine of total personality rather than faculty psychology, in his idea of perfectibilityand the Golden Age that he likened to the afterlife--in these he had found a way out of the sterile impass confronting the disciples of Diderot and d'Holbach. In short, this is a figure of undeniable consequence historically, and he has been too long ignored by American students of philosophy. We should be grateful both to the author and to the publisher for making him known to us in this monograph, the first comprehensive study of Hemsterhuis ever published in English. WALTER E. REX University of California, Berkeley The Autonomy of Reason: A Commentary on Kant's "Groundwork of the Metaphysic of Morals." By Robert Paul Wolff. (New York: Harper & Row, 1975. Pp. x + 228. $12.50) The Autonomy of Reason reflects Wolff's determination to get out of Kant's system what is good and to get out of Kant's system for good. It thus burns with the conflicting passions of a devoted student who has learned much from a reserved teacher but who now finds it imperative to break with him for precisely the reasons that attracted him initially. This explains why much of the book reads like a declaration of independence yet is based on a sympathetic, even immanent, critique of Kant addressed to Wolff himself. Although he is addressing himself, others may share and will certainly benefit from Wolff's two decades of intense study of Kant. Without question Wolff has written a provocative and important book. Contrary to its title, however, it is not really about the autonomy of reason; and contrary to its subtitle, it is only partly a commentary on Kant's Groundwork. It serves, rather, as a propaedeutic to Wolff's own moral and political views. I believe this at least accounts for some of the puzzling features of the book: its highly personal nature, its style of philosophical commentary, and its devastating introduction. Wolff does not see his task as one of either historical exegesis or philosophical criticism. In the place of both Whiff proposes a "philosophical reconstruction" of the text. This is both desirable and necessary, he says, because "of all the great philosophers, there is none so rich in insights and so plagued by inconsistency as Kant" (p. 4). The resulting reconstruction will be worthwhile provided that affirmative answers can be given to two questions: "Does the interpretation developed here illuminate the text, so that at least some of what Kant says is clearer and more plausible in the light of it; and, more important still, does the interpretation result in an argument whose independent philosophical merit justifies the effort spent grappling with Kant?" (p. 5). A third question suggests itself: would Kant recognize himself as the author of the reconstructed text? This question one must answer in the negative, for the Groundwork that emerges, although certainly Kantian, does not accurately reflect Kantianism. To the extent that this is a criticism, it is so only because the book advertises itself as a commentary. In short, Wolff's book is similar to Strawson's Bounds of Sense in that the value of both lies in salvaging something of worth from the sunken hulk of Kantianism. Wolff's Introduction is particularly revealing, for it consists of a sustained attack on several BOOK REVIEWS 483 of Kant's central metaphysical claims, an attack which, if successful, undermines much of his ethics. As an introduction to a commentary, it prejudices the... (shrink)

continent. 1.4 (2011): 230—233. A word about the quotation marks. People ask about them, in the beginning; in the process of giving themselves up to reading the poem, they become comfortable with them, without necessarily thinking precisely about why they’re there. But they’re there, mostly to measure the poem. The phrases they enclose are poetic feet. If I had simply left white spaces between the phrases, the phrases would be read too fast for my musical intention. The quotation marks make (...) the reader slow down and silently articulate—not slur over mentally—the phrases at the pace, and with the stresses, I intend. They also distance the narrative form myself. I am not Alette. Finally they may remind the reader that each phrase is a thing said by a voice: this is not a thought, or a record of thought process, this is a story, told.(1) We read (reread) the poems that keep the discourse with ourselves going. —Wallace Stevens We have to break open words or sentences, too, and find what’s uttered in them. —Gilles Deleuze “The Descent of Alette” “is an allegorical poem” “in four books” “first published” “in 1992” “by Alice Notley.” “In the Descent of Alette,” “the double quotation mark” “is wrapped around” “words, phrases, sometimes whole sentences, and utilized as bones for structure and tonality.” “The winged” “dbl quotation” “like angels or devils” “descending from elsewhere” “function as” “poetic feet.” “Distance” “in the text through the use of dbl quotes,” “according to Notley,” “was a way to distance” “her self” “from the narrative.” I know someone who tattooed double quotes on her shoulder blades. In other words, the body is quotable. To be able to say that one is quotable. A body filled with other’s sayings. I never asked her what for, what is the double quote tattoo for and why on the shoulder blades? I prefer my own interpretation that keeps shifting every time I see her. First words of every poem in every book: Book One One ... On ... A ... There ... I ... We ... An ... A ... A ... I ... At ... A ... When ... When ... There ... I ... In ... At ... I ... Once ... A ... A ... In ... A ... A ... Two ... I ... I ... Eyeball ... In ... I... A ... I ... I ... On ... I ... There ... What ... As ... As Book Two I ... When ... I ... I ... As ... I ... I ... There ... I ... There ... I ... A ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I ... I Book Three The ... Presently ... I ... I’m ... I ... We ... What ... My ... I ... Who ... But ... Lay ... My ... I ... The ... Your ... The ... I ... It’s ... As ... The ... Talon’s ... When ... We ... I ... Slowly ... I ... I ... The ... How ... The Book Four I ... I ... You ... The ... Now ... She ... The ... There ... As ... Then ... The ... All ... Let’s I ... You ... The ... Thus ... The ... I ... The ... I ... There ... Have ... The ... As ... The Defamiliar Object “Poetry is a defamiliarized language, whose formations, so far from being simply formations of meaning, are aesthetic structures...”(2) “The same can be” “irresponsibly associated” “with the use of punctuation.” “The dbl quotation as a measure” “of poetic feet” “is treated as such” “because the author” “injects artfulness into it.” “The dbl quote is an object—” “a joystick” “to control breadth” “(of breath.)” “To de-familiarize” “said sign” “is also to” “impart the sensation of [it] as [it is] perceived and not as they are known.”(3) “The dbl quote” “nests previous words, phrasings and sayings.” “How many have come and gone” “through the doorway of this punctuation sign.” “There are also air quotes and virtual quotes.” “There is emphasis and there’s irony.” “It would be aggravating” “or interesting” “to watch a reading of” “The Descent of Alette” “with someone” “raising and curling” “fingers” “bent out of shape” “in what could be used as” “peace signs.” “I am trying to avoid” “scare quotes.” “I looked up” “what they are” “and supposedly they arose” “in the early 20th century.” “The scare quote” “is a mark around a word or phrase to indicate that it doesn’t signify conventional or literal meaning.” “This isn’t how Notley” “intended to use them” “in The Descent of Alette.” “The characters, places, and things” “signify nothing” “beyond” “their literal meaning” “ within the allegory .” “I’d like to stress” “within the allegory;” “that’s why its” “italicized.” “It is told through” “the main character/voice of” “Alette.” “The author reminds us she is not Alette.” “The author marvelously found a way” “to distance” “her self” “from the narrative.” “This was attempted” “by tonal and intimate” “affect of the dbl quote” “used as poetic feet.” “Its as though” “punctuation in this regard” “becomes a magical toy.” “Arguably, punctuation” “(as perceived)” “undergoes a kind of” “ defamiliar ” “make-over.” “The text” gently forces the reader” “to slow down,” “read slowly.” “At some point” “one begins to sense” “lines of text” “moving on its own.” “Broken words, phrases, and sentences” “shuttling left to right” “like a subway” “that stops” “from station to station;” “open quote to end quote.” Double Quote Occupied “There are two worlds; one above ground” “and one underground.” “The world above ground is where,” “the tyrant” “with a capital t” “lives.” “(The “T” gets tangled in the claws of the dbl quote.)” “Alette becomes an owl and kills him.” “In the last book the tyrant dies.” “ “...the tyrant” “a man in charge of” “the fact” “that we were” “below the ground” “endlessly riding” “our trains, never surfacing” “A man who” “would make you pay” “so much” “to leave the subway” “that you don’t” “ever ask” “how much it is” “It is, in effect,” “all of you & more” “Most of which you already” “pay to live below” “But he would literally” “take your soul” “Which is what you are” “below the ground” “Your soul” “your soul rides” “this subway” “I saw” “on the subway a” “world of souls” ”(4) “New York;” “the city of cities” “and its subways—” “worlds underground,” “above ground,” “& above the above ground.” “Skyscrapers,” “Wall Street,” “old money,” “new money,” “and falling further down a cleavage;” “the middle class” “slipping away.” “Contemporary artist ” “Ligorano Reece” “recently made” “a sculpture of ice ” “a block of ice” “carved to read” “middle class” “(in all upper case letters)” “and let it melt” “naturally” “for however long—” “hours,” “days.” “It didn’t take very long to melt.” A global uprise of mass demonstrations; a cacophony of bodies on the street, in parks and universities, on City Hall lawns, coastal ports, neighborhoods, etc., and for what? The reasons are endless and finite. Not a single body is unaffected by the movement even when not “occupying.” “Occupiers” “stormed into a Sotheby’s auction” “protesting” “via human microphone” “that the CEO takes home” “about” “six thousand dollars” “a day.” “(The a/Art market” “is not a reflection” “of a desire” “for a/Art” “but a reflection” “of a desire” “for money” “confused with a/Art.)” What could it mean to occupy that which has been written or said? Someone with double quotes tattooed on both shoulders attempts to reclaim the sign; re-invent it privately-publicly since the body is always split between both spheres. A genre of hide-and-seek; the speaking and silent body which can never mean what it says even while it so desires to mean something. To nest (and hold hostage) someone in double quotes is an act of violence; a gesture of displacement where one is arrested, dislocated, and scrutinized under a distant gaze. “The air quote” “also known as” “finger quote or ersatz quote” “supposedly” “harks back to” “1927.” “The brevity of this gesture” “ as something invisible” “like virtual money or credit” “doesn’t really exist” “though it take up space;” “its the ghostliest of all punctuation signs” “and one that requires the presence and appearance of a body.” “ “she made a form” “in her mind” “an imaginary” “form” “to settle” “in her arms where” “the baby” “had been” “We saw her fiery arms” “cradle air” “She cradled air...” ”(5) “The air” “gets occupied” “by one or two hands” “with thumb, forefinger, and middle finger” “which alternately could be used” “to shoot rubber bullets,” “pepper spray,” “tear gas.” “How three fingers” “could be responsible for so much:” “satire, sarcasm, irony” “and ultimately” “bruises, blood, death.” (“The violence of the dbl quote is to eagerly to place oneself inside a tornado.)” “The violence of this” “embodied punctuation mark” “stems from a discordance with others.” “Is the name, word, or phrase” “placed in dbl quotes” “heroic” “ or brave?” “An act of displacement;” “must there always be” “bright or negative lights—” “a leaderless act” “to inhabit, to occupy” “space removed” “from normative use.” “Of course” “I’m also wondering” “what it means to re-occupy” “public/private space—the street, neighborhood or page” “policed” “by laws, limits, and” “to some extent” “punctuation.” Echo, Mirror “There are first, second, and third voices interwoven.” “ “Braid of voices,”(6) ” “Some lines read as internal thoughts,” “dialogues,” “and scene descriptions,” “all of which make up the allegory.” “It seems appropriate” “for the word” “allegory” “to nest in dbl quotes” “for perhaps it might be” “a gesture to echo on and on” “eternally referencing” “whatever came before.” I notice the first tooth of the double quote, when paying too close attention, gets caught in the hook of the “f”. I space bar to untangle them; the f does not resist the closed bite of “deaf” and I resist to know what it could mean, because it could doubly mean nothing. “ “He looked” “so familiar” “to me...”(7) ” “The second-person” “echoes in one of two directions:” “further into” “or farther from” “me.” “Its as though” “the second-person amplifies” “or else the opposite” “in which he,” “who looks so familiar,” “retreats further” “like stars in a telescope.” “The dbl quote” “has this kind of affect” “concerning distance and dimension” “as also illusory” “as something twice removed” “and unreal” “in a similar way” “movie stars are unreal and far away.” “ “I entered” “a car” “in which I seemed” “to see double” “Each person I” “looked at seemed” “spread out” “as if doubled” “Gradually” “I perceived that” “each person” “was surrounded by a ghostly” “second image” “was encased in it” “& each” / “of those images,” “those encasings,” “was exactly the same” “each was in fact” “the tyrant...” ”(8) A daydream of a mirror-less world while staring through window blinds; a palm tree behind. It was dark with nothing there. A world with no mirrors “in my mind,” though my mind could only reflect what it knew: a palm tree. Naturally then, palm trees multiplied; a world of palm trees reflected the daydream with no mirror in sight. “The mirror” “(prior to obsidian manufacturing ca. 6000 B.C)” “was wherever water” “could be found.” “Its interesting” “mirrors have been around” “before humans—its funny” “animals and humans” “get born into” “a world of mirrors,” “therefore, simulation” “is always already” “a given—” “a sparkly consequence to be born with a dbl.” NOTES 1. Notley, Alice. “Author’s Note” in The Descent of Alette (New York, 1996) 2. Bruns, Gerald L. “ From Intransitive Speech to the Universe of Discourse” in Modern Poetry And The Idea of Language (New Haven & London, 1974), p.75 3. Ibid. p.77 4. Notley, Alice. The Descent of Alette (New York, 1996). p.3 5. Ibid. p.10 6. Ibid i. p.9 7. Ibid ii. p.16 8. Ibid iii. p.12. (shrink)

It has recently been suggested that personalized advertising is often _more _an affront to a person's autonomy and thus more morally worrisome than its generic counterpart precisely because it involves or takes advantage of such personalization. This paper argues that central reasons that have been forwarded to support this claim are unpersuasive and that generic and personalized advertising should therefore be treated as morally on par in terms of their potential to undermine consumer autonomy. The paper then suggests that, if (...) this is true, it presses scholars who wish to maintain there to be a moral asymmetry between personalized and generic advertising in terms of their effect on consumer autonomy to choose between three argumentative avenues, but that none of these is likely to be particularly attractive for a defender of the asymmetry. (shrink)

Working as clinical ethicists in an academic hospital, we find that practitioners tend to take a principle‐based approach to moral dilemmas when it comes to (not) treating patients who feel like a burden, in which respect for autonomy tends to trump other principles. We argue that this approach insufficiently deals with the moral doubts of professionals with regard to feeling that you are a burden as a motive to decline or withdraw from treatment. Neither does it take into adequately (...) account the specific needs of the patient that might underlie their feeling of being a burden to others. We propose a care ethics approach as an alternative. It focuses on being attentive and responsive to the caring needs of those involved in the care process—which can be much more specific than either receiving or withdrawing from treatment. This approach considers these needs in the context of the patient's identity, biography and relationships, and regards autonomy as relational rather than as individual. We illustrate the difference between these two approaches by means of the case of Mrs K. Furthermore, we show that a care ethics approach is in line with interventions that are found to alleviate feeling a burden and maintain that facilitating moral case deliberation among practitioners can supports them in taking a care ethics approach to moral dilemmas in (not) treating patients who feel like a burden. (shrink)

In our text, we follow the traces of a (1) paradox, (2) an ambivalence and (3) a dialectic that constitute digitalized public spheres and discuss the resulting tensions in discourse-ethical and political-theoretical perspectives using the blocking of Donald J. Trump’s Twitter account as an example. Starting from this, we determine the conditions of constitution of the digital public sphere and locate the dynamics of its development in the dialectical tension between private and public: The fact that the two other (...) relations of autonomy and heteronomy, intensification and polarization come to such a head is based on an insufficient socialization of all those means of production that produce the current digital public sphere. Using the example of Donald J. Trump’s recently suspended Twitter account and with a view to Habermas’s discourse ethics, we illustrate the extent to which Trump’s partly racist and conspiracy-theoretical post violates discourse ethics standards and is also highly problematic with regard to the political; however, banishment from a part of the digital public sphere is certainly not an act that should be incumbent on a private company. From this, we conclude that the normative potentials of digital public spheres can only be vol. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lack of Autonomy: A View From the InsideSteve Weiner (bio)Keywordsagency, autonomy, deficit, determinismThe most vivid and truly overwhelming response I have to all arguments stressing agency/autonomy, that is, what lay people call free will, is this: that I’ve never had the sensation of acting autonomously since the onset of my mental illness on August 28, 1965. I have never been comfortable with saying that “I made a choice,” or (...) with other people either lecturing me or attempting to reassure me, often at the same time, by saying that I acted with autonomy/primary agency, as it were. That is my overwhelming subjective experience. I usually refrain from attempting to make a general case for determinism about myself or the universe in general, although, again, I feel far more determined than free. (I would note that Mary Midgley [2006] points out that the word determined and the concept, by extension, of determinism have two different meanings in say, social theory and geometry.)One strong criticism of this article I would put forward is that the Davidson and Shahan seemed to mention only depression among many diagnoses to make their case, although their French mentors/ co-thinkers apparently focused on schizophrenia, however unusually defined by them. In obsessive-compulsive disorder, we all have the very strong impression of the obsessive thoughts having been forced into our mind by something or someone else. My impression is that we all engage in our warding-off rituals, especially in the later, most frequent, most ritualistic repetitions, “against our will.”My most frequent diagnoses over the decades have been paranoid schizophrenia and schizoaffective disorder, and I more or less agree most of the time with those labels. I find Louis Sass’ “discovery” that our delusions are better thought of as semi-delusions with our simultaneously believing and not believing them, and our usual failure to take action on them, pretty well describes my own long-term experience. I know he is insistent on ascribing some degree of agency/whole personality involvement to us as compared with the standard National Alliance on Mental Illness/biological model, but I feel that he is getting closer to most of the “truth” when he talks about a subtle interweaving of affliction/deficit and agency.The authors’ reliance on French thinkers almost inevitably sends me back to a once-prominent French intellectual, one of my favorite writers Albert Memmi, the Tunisian-Jewish born socialist and Zionist. In a book that mentions The Story of O, (Memmi 1984) a story of extreme sexual submission or masochism, he makes the striking remark that the mentally ill are “oppressed from within.” I have spoken of this often because it seems to touch perfectly on my experience and that of fellow mentally ill people I have met. From the perspective of the outsider, it seems that the whole [End Page 237] and integrated person is involved in every behavior. What looks like agency to others, especially when it comes to undesirable behaviors, when experienced from within, is actually a situation of affliction from a seemingly autonomous place. We experience this as coming, yes, from within us, but not ultimately of us.I cannot be sure, but a belief in some degree of metaphysical choice from the beginning of one’s life seems to me the only way the authors of this article can firmly, enthusiastically come down on the side of agency as opposed to deficit/malfunction in trying to explain human problems. In contrast, I suppose I could be called a physicalist. I have noticed that physical substances (alcohol, caffeine, psychiatric drugs) have such a vivid and consistent effect on my mind that it makes sense to me to conclude that yes, mind is probably ultimately reducible to brain/body/experience of the senses. That is my private opinion based on experience as mediated through knowledge/intellect.One final point: Despite the (almost certainly) radical left politics of the authors, as an officially disabled person almost completely dependent on the welfare state, I fear that in competitive individualist America, the authors’ hoped-for far greater emphasis on autonomy will feed into popular “blame the victim” ideology. I believe... (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

The problem of the ‘mountain man’, the caricature of self-sufficiency and individualism, is not a new one for autonomy theorists. It seems plausible that there is genuine value in self-direction according to one’s deeply-held principles. If autonomy involves something like this, then anyone concerned with autonomy as a social rather than individualistic phenomenon must explain what the mountain man gets wrong when he denies that his autonomy admits of being placed under obligations to others. In particular, the mountain man challenges (...) autonomy-minded social anarchists: if his denial of legitimate non-voluntary obligations is correct, then it is not just the state we should reject, but any organising body with coercive powers. This may be consistent with individualist anarchism or right-libertarianism, but it sits ill with the social anarchist intuition that we can have genuine political obligations. My thesis addresses this problem in three stages. First, I argue for a functional analysis of authority and autonomy: the concepts are not pre-existing “immovable objects”, but rather are defined by the role that they are intended to play in our discourse. I suggest that we need a concept of political or institutional authority in order to resolve co-ordination problems and pursue collaborative social goods, and a concept of autonomy to explain when and why self-direction is valuable. Second, I defend a social-relational conception of autonomy. The autonomous agent is powerful and authoritative, where this power and authority is in large part constituted, rather than merely affected, by the social structures and relations that we stand in. We are powerful and authoritative, I argue, when we stand in relations of non-domination: we are not vulnerable to arbitrary interference in our lives, and this non-vulnerability is defended in virtue of recognition respect for us as agents. There are two important implications of this account: that autonomy comes with a built-in equality condition whereby everybody’s autonomy is threatened if anybody’s is, and that there is no principled distinction to be drawn between ‘personal’ and ‘political’ autonomy. In the last three chapters, I suggest an autonomy-justified conception of authority. I argue for autonomy as the crucial collaborative good which authoritative institutions help us to pursue, and suggest that such institutions may legitimately claim authority if they act or effect actions in ways which are likely to promote or defend autonomy-constituting relations, and act or effect actions in ways consistent with maximal equal autonomy. Finally, I return to the anarchist argument, showing that while my accounts of autonomy and authority give us a plausible picture of how autonomy is compatible with genuinely authoritative institutions, this picture still has no room for the state. (shrink)

There seems to be a deep tension between two aspects of aesthetic appreciation. On the one hand, we care about getting things right. On the other hand, we demand autonomy. We want appreciators to arrive at their aesthetic judgments through their own cognitive efforts, rather than deferring to experts. These two demands seem to be in tension; after all, if we want to get the right judgments, we should defer to the judgments of experts. The best explanation, I suggest, (...) is that aesthetic appreciation is something like a game. When we play a game, we try to win. But often, winning isn’t the point; playing is. Aesthetic appreciation involves the same flipped motivational structure: we aim at the goal of correctness, but having correct judgments isn’t the point. The point is the engaged process of interpreting, investigating, and exploring the aesthetic object. Deferring to aesthetic testimony, then, makes the same mistake as looking up the answer to a puzzle, rather than solving it for oneself. The shortcut defeats the whole point. This suggests a new account of aesthetic value: the engagement account. The primary value of the activity of aesthetic appreciation lies in the process of trying to generate correct judgments, and not in having correct judgments. -/- *There is an audio version available: look for the Soundcloud link, below.*. (shrink)

This article examines the ethical basis for government involvement in health care. It first provides the case for individual autonomy, focusing on the justifications–particularly ethical ones–for allowing individuals to make their own choices in health care, and to control more of their own resources in doing so. Next, it provides the opposite case–for abridging individual autonomy, and in particular, for redistributing resources from those who are well off to those who are not. The overriding reason for favouring the latter case, (...) which trumps the notion of individual autonomy, is to ensure that individuals who are at a disadvantage have an equal probability of attaining good health. (shrink)

A Return to Aesthetics confronts postmodernism’s rejection of aesthetics by showing that this critique rests on central concepts of classical aesthetic theory, namely autonomous form, disinterest, and symbolic discourse. The author argues for the value of these concepts by recovering them through a historical reinterpretation of their meaning prior to their distortion by twentieth-century formalism. Loesberg then applies these concepts to a discussion of two of the most significant critics of the ideology of Enlightenment, Foucault and Bourdieu. He argues that (...) understanding the role of aesthetics in the postmodern critique of Enlightenment will get us out of the intellectual impasse wherein numbingly repeated attacks upon postmodernism as self-contradictory match numbingly repeated defenses. Construing postmodern critiques as examples of aesthetic reseeing gives us a new understanding of the postmodern critique of the Enlightenment. (shrink)

Public health policy often limits people’s liberty for their own good. The very point of many types of public health measures is to restrict people’s options in order to stop them from doing unhealthy things, for example use harmful recreational drugs or drive without a seatbelt. While such restrictive public health policies enjoy widespread support, so does the traditional liberal idea that liberty (or autonomy) is a higher value, to be given priority in most, if not all, circumstances. In this (...) text, I will defend the thesis that liberty is an important value, but with no claim to priority. (shrink)

The six papers in the 2014 clinical ethics number of the Journal get us back to the basics in the work of clinical ethics and clinical ethicists: getting clear about concepts that should be used in achieving deliberative clinical ethics. The papers explore the concepts of the best interests of the patient, health and disease understood in their proper relationship to autonomy in our species, the therapeutic obligation, and the therapeutic imperative. The final paper appraises the systematic review, a (...) scholarly tool for tracking the basic concepts of clinical ethics in the literature. (shrink)

My first paper on the Is/Ought issue. The young Arthur Prior endorsed the Autonomy of Ethics, in the form of Hume’s No-Ought-From-Is (NOFI) but the later Prior developed a seemingly devastating counter-argument. I defend Prior's earlier logical thesis (albeit in a modified form) against his later self. However it is important to distinguish between three versions of the Autonomy of Ethics: Ontological, Semantic and Ontological. Ontological Autonomy is the thesis that moral judgments, to be true, must answer to a realm (...) of sui generis non-natural PROPERTIES. Semantic autonomy insists on a realm of sui generis non-natural PREDICATES which do not mean the same as any natural counterparts. Logical Autonomy maintains that moral conclusions cannot be derived from non-moral premises.-moral premises with the aid of logic alone. Logical Autonomy does not entail Semantic Autonomy and Semantic Autonomy does not entail Ontological Autonomy. But, given some plausible assumptions Ontological Autonomy entails Semantic Autonomy and given the conservativeness of logic – the idea that in a valid argument you don’t get out what you haven’t put in – Semantic Autonomy entails Logical Autonomy. So if Logical Autonomy is false – as Prior appears to prove – then Semantic and Ontological Autonomy would appear to be false too! I develop a version of Logical Autonomy (or NOFI) and vindicate it against Prior’s counterexamples, which are also counterexamples to the conservativeness of logic as traditionally conceived. The key concept here is an idea derived in part from Quine - that of INFERENCE-RELATIVE VACUITY. I prove that you cannot derive conclusions in which the moral terms appear non-vacuously from premises from which they are absent. But this is because you cannot derive conclusions in which ANY (non-logical) terms appear non-vacuously from premises from which they are absent Thus NOFI or Logical Autonomy comes out as an instance of the conservativeness of logic. This means that the reverse entailment that I have suggested turns out to be a mistake. The falsehood of Logical Autonomy would not entail either the falsehood Semantic Autonomy or the falsehood of Ontological Autonomy, since Semantic Autonomy only entails Logical Autonomy with the aid of the conservativeness of logic of which Logical Autonomy is simply an instance. Thus NOFI or Logical Autonomy is vindicated, but it turns out to be a less world-shattering thesis than some have supposed. It provides no support for either non-cognitivism or non-naturalism. (shrink)

It seems to be a humdrum fact of human agency that we act on intentions or decisions that we have made at an earlier time. At breakfast, you look at the Taco Hut menu online and decide that later today you’ll have one of their avocado burritos for lunch. You’re at your desk and you hear the church bells ring the noon hour. You get up, walk to Taco Hut, and order the burrito as planned. As mundane as this sort (...) of scenario might seem to be, philosophers have raised a problem in understanding it. If you are simply abiding by this morning’s decision, how are you acting autonomously? Your earlier self seems to be calling the shots; if you are just acting accordingly, without thinking through it or in some other way trying to ensure that the past decision conforms to your present standpoint, it is not clear how this amounts to an exercise of your present autonomous agency. It seems, rather, that your earlier self has succeeded in slaving you to her own purposes. She was the one who wanted (intended, judged it to be good, etc.) to have an avocado burrito. In simply following through, your current self seems to be just an automaton performing the commands left behind by your former self. Of course, you might not allow yourself to be shackled by your earlier self. You might refuse to follow anything but your own present judgments: you will only go to Taco Hut if this is what you judge you should do right now, and once at Taco Hut you will only eat the avocado burrito if that is what you want to eat once there. But if this is the way you generally operate, this seems to block your ability to make effective future-directed decisions. The puzzle, then, is one of explaining how the future self can do the bidding of her past self without losing her autonomy. We call this “the Problem of Diachronic Autonomy.” Philosophers raising this problem take it to show that there must be reasons or rational requirements to follow-through with our past decisions. According to these philosophers, we can only make sense of our diachronic autonomy if our past decisions put rational pressure on us to follow through. We argue that there is no Problem of Diachronic Autonomy. There is, in other words, no puzzling situation that needs explaining. Consequently, there is no need coming from this purported puzzle to think that our future-directed decisions generate reasons or rational requirements to follow through. The correct view of our diachronic autonomy is the “naïve” one: the “future self” can do the bidding of the “past self” without giving up its autonomy because, very simply, the past self is the same agent as the future self. I am acting autonomously when I get the avocado burrito, because I was the one who decided to get the burrito. I am acting on my own freely-formed decision. (shrink)

This reply offers a detailed refutation of some of the objections raised in Christopher Coope's extended discussion of The Spiritual Dimension. It explains the ‘non-partisan’ strategy of the book, which Coope systematically misunderstands, and exposes some serious problems with Coope's own preference for a harshly exclusivist form of Christianity. Several issues connected with religious belief are then discussed, including emotional involvement versus detachment in the assessment of religious claims; layers of meaning in religious language; human autonomy and divine authority; the (...) problem of evil; apophatic theology and transcendence; divine action in the world; and the doctrine of the afterlife. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 335-342 [Access article in PDF] "Dispersing the Cogito: A Response to Vivian's Rhetorical Self" Philip Lewin Bradford Vivian ("The Threshold of the Self," Philosophy and Rhetoric 33. 4: 303-18), in seeking to disrupt the cogito, claims that acts of creative self-constitution by a "rhetorical self" become possible as subjectivity is dispersed across subject positions. However, the apparent ability of the rhetorical self to freely (...) choose which positions it will inhabit, as well as its apparent capacity to undergo subjectification without being marked by its habitation of those positions, seem to reintroduce several of the cogito's essential features.Vivian argues that "there is a historicity to our being and its expression, to our subjectivity and its elaboration" (303). His essay provides a clear and cogent account of how subjectivity might arise as the result of a series of rhetorical acts whose audience is the self. One's self, then, is a local and ongoing aesthetic formation, continually becoming and coming into being; to the extent that the aesthetic nature of this process is produced by persuading one's self to adopt some styles of life over others, then this process is a thoroughly persuasive phenomenon. The aesthetic composition molded by this continually renewed persuasion might best be described as the rhetorical self. (312; emphasis in original) Vivian clears away a good deal of the underbrush that often prevents us from getting a hold on the problematics of selfhood and subjectivity. I find much that is praiseworthy in the essay, particulary its explication of the contingent and shifting nature of the processes through which the self is formed and reformed. But there is a key theoretical elision in Vivian's argument that does much to restore the legitimacy of the Cartesian cogito that he is at pains to disrupt. The result is a model of self that revises Cartesianism by dispersing subjectivity among various subject positions, [End Page 335] but that, in a number of other important ways, preserves essential features of the cogito, as though each fragment of the dispersed cogito were itself a complete mini-cogito.Vivian's account elides the rhetorical process of self-formation. In a typical passage at the end of the essay, he comments, "In order to compose and cultivate one's being in the world, one must persuade one's self to choose and orchestrate certain styles of life from among those available into an entire aesthetics of being" (316-17). The questions this claim provokes are: How does this process of self-persuasion actually take place? What aspect or agency of psyche is doing the persuading? To conceive of the self as Vivian does--a self "conceived as a form--a rhetorical form--that exists only in its continual aesthetic creation, in its indefinite becoming" (304)--suggests a kind of autonomy and self-transparency in self-formation that has discouragingly Cartesian overtones.The terms with which Vivian has chosen to work, namely, subjectivity and the rhetorical self, do not address these issues of self-persuasion. Instead, they serve to mask them. Subjectivity, for Vivian, refers to the positions the self finds itself assuming within discursive regimes, positions whose formation entails moments both of self-persuasion and of subjection to existing social exigency. Subjectivity (so conceived) has the property of being an effect of multiple acts of subjectification, of voluntary acquiescence to preexisting subject positions. "Discourse creates subjects by first creating subject positions from which to speak" (313). The subject is not original, but rather follows from "an entire 'assemblage' of subject positions that are the willful creation of no one, but are instead formed by the complex operations of discourse" (313). The theoretical difficulty with this way of accounting for subjectivity lies in its elision of agency; how shall we make sense of the rhetorical self? More specifically, how does a necessary immersion into discursive practices couple with rhetorical acts of self-persuasion? What motivates self-persuasion? Are all the factors involved in self-persuasion fully conscious and under voluntary control? If not, how are we... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 335-342 [Access article in PDF] "Dispersing the Cogito: A Response to Vivian's Rhetorical Self" Philip Lewin Bradford Vivian ("The Threshold of the Self," Philosophy and Rhetoric 33. 4: 303-18), in seeking to disrupt the cogito, claims that acts of creative self-constitution by a "rhetorical self" become possible as subjectivity is dispersed across subject positions. However, the apparent ability of the rhetorical self to freely (...) choose which positions it will inhabit, as well as its apparent capacity to undergo subjectification without being marked by its habitation of those positions, seem to reintroduce several of the cogito's essential features.Vivian argues that "there is a historicity to our being and its expression, to our subjectivity and its elaboration" (303). His essay provides a clear and cogent account of how subjectivity might arise as the result of a series of rhetorical acts whose audience is the self. One's self, then, is a local and ongoing aesthetic formation, continually becoming and coming into being; to the extent that the aesthetic nature of this process is produced by persuading one's self to adopt some styles of life over others, then this process is a thoroughly persuasive phenomenon. The aesthetic composition molded by this continually renewed persuasion might best be described as the rhetorical self. (312; emphasis in original) Vivian clears away a good deal of the underbrush that often prevents us from getting a hold on the problematics of selfhood and subjectivity. I find much that is praiseworthy in the essay, particulary its explication of the contingent and shifting nature of the processes through which the self is formed and reformed. But there is a key theoretical elision in Vivian's argument that does much to restore the legitimacy of the Cartesian cogito that he is at pains to disrupt. The result is a model of self that revises Cartesianism by dispersing subjectivity among various subject positions, [End Page 335] but that, in a number of other important ways, preserves essential features of the cogito, as though each fragment of the dispersed cogito were itself a complete mini-cogito.Vivian's account elides the rhetorical process of self-formation. In a typical passage at the end of the essay, he comments, "In order to compose and cultivate one's being in the world, one must persuade one's self to choose and orchestrate certain styles of life from among those available into an entire aesthetics of being" (316-17). The questions this claim provokes are: How does this process of self-persuasion actually take place? What aspect or agency of psyche is doing the persuading? To conceive of the self as Vivian does--a self "conceived as a form--a rhetorical form--that exists only in its continual aesthetic creation, in its indefinite becoming" (304)--suggests a kind of autonomy and self-transparency in self-formation that has discouragingly Cartesian overtones.The terms with which Vivian has chosen to work, namely, subjectivity and the rhetorical self, do not address these issues of self-persuasion. Instead, they serve to mask them. Subjectivity, for Vivian, refers to the positions the self finds itself assuming within discursive regimes, positions whose formation entails moments both of self-persuasion and of subjection to existing social exigency. Subjectivity (so conceived) has the property of being an effect of multiple acts of subjectification, of voluntary acquiescence to preexisting subject positions. "Discourse creates subjects by first creating subject positions from which to speak" (313). The subject is not original, but rather follows from "an entire 'assemblage' of subject positions that are the willful creation of no one, but are instead formed by the complex operations of discourse" (313). The theoretical difficulty with this way of accounting for subjectivity lies in its elision of agency; how shall we make sense of the rhetorical self? More specifically, how does a necessary immersion into discursive practices couple with rhetorical acts of self-persuasion? What motivates self-persuasion? Are all the factors involved in self-persuasion fully conscious and under voluntary control? If not, how are we... (shrink)

People have a powerful interest in geneticprivacy and its associated claim to ignorance,and some equally powerful desires to beshielded from disturbing information are oftenvoiced. We argue, however, that there is nosuch thing as a right to remain in ignorance,where a right is understood as an entitlementthat trumps competing claims. This doesnot of course mean that information must alwaysbe forced upon unwilling recipients, only thatthere is no prima facie entitlement to beprotected from true or honest information aboutoneself. Any claims to be (...) shielded frominformation about the self must compete onequal terms with claims based in the rights andinterests of others. In balancing the weightand importance of rival considerations aboutgiving or withholding information, if rightsclaims have any place, rights are more likelyto be defensible on the side of honestcommunication of information rather than indefence of ignorance. The right to free speechand the right to decline to acceptresponsibility to take decisions for othersimposed by those others seem to us moreplausible candidates for fully fledged rightsin this field than any purported right toignorance. Finally, and most importantly, ifthe right to autonomy is invoked, a properunderstanding of the distinction between claimsto liberty and claims to autonomy show that theprinciple of autonomy, as it is understood incontemporary social ethics and English law,supports the giving rather than the withholdingof information in most circumstances. (shrink)

The Last Judgement, heaven, hell, purgatory, the wrathful God: today, these notions seem to belong to a remote past we have - thank goodness! - left behind. The more remarkable is that, today, prisoners sometimes refer to the representation of God as Judge, as in the proposition ‘Only God can judge me’ you can find as graffito on a cell wall, or tattooed on the body of an inmate. Is this statement born from defiance of the constitutional state, from fundamentalism, (...) or from the fiction of an all-forgiving God? Nowadays, we, modern democrats, have a suspicion towards criminals and fanatics who seem to think that they can get away with an Only God can judge me. Much more common today is the reversal: not a judging God but people assuming judgement over God and over those who persist in referring to God. But the tradition of the ‘theodicee’ shows that this reversed movement of man judging God is not in the least a gesture limited to those outside the religions. In a theodicee, man summons God to appear in front of an imaginary tribunal, only for God to be defended and subsequently acquitted. As Odo Marquard argues, the modern problem of the theodicee – bringing into question God’s justice – in the end favoured atheism. Human autonomy which exonerates God by eliminating him, would imply something like an ‘atheism ad maiorem Dei gloriam’. But when humankind becomes responsible for the creation of its own history, God can no longer be summoned to any tribunal. Now only man can be summoned, and more particularly: humans which may be held accountable for the persistence of evil, responsible for our enduring discontent, obstacles of human progress or annoying remnants of the past. Here we find the beginning of the secularization of the Last Judgement. As Peter Sloterdijk argues, the vindictive God who judges and punishes at the end on times is succeeded by revolutionary groups from the nineteenth century onwards. These not only transform feelings of humiliated anger and powerlessness into those of pride and hope, but also into an effective force of revenge. In short, the theological constellation of rage and eternity has been succeeded by a political-psychological constellation of rage and history. Our representative democracy can be seen as an answer to the dangerous modern tendency to ‘tribunalising’ , because conditions of division and conflict are regarded as normal and lasting, and not as Fremdkörper or indicative of pathology. The Last Judgement becomes indefinitely suspended. However, a certain kind of ‘populism’ holds that unity and homogeneity can very well be made visible and audible’; and nowadays this seems to be accompanied by the longing to give evil, thus a form of negative transcendence, a face and parade it in front of the tribunal of the people. For prisoners, this is bad news. Against its background, the Only God can judge me may yet well up from a different source than that which I had suggested at the beginning of my argument. (shrink)

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the (...) psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

Various philosophers have argued that in order to be morally responsible, we need to be the "ultimate sources'' of our choices and behavior. Although there are different versions of this sort of argument, I identify a "picture'' that lies behind them, and I contend that this picture is misleading. Joel Feinberg helpfully suggested that we scale down what might initially be thought to be legitimate demands on "self-creation,'' rather than jettison the idea that we are truly and robustly responsible. I (...) follow Feinberg in rejecting various "inflated'' demands on "origination,'' "initiation,'' or ultimate sourcehood. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Experience, and TherapyDominic Murphy (bio)The contemporary philosophical idea of autonomy has a psychological implication, to wit, that there exists a comprehensive set of ideal competences, realized in our mind/brain, that enable a person to be self-governing. Autonomy is normally accorded individuals who enjoy a certain kind of psychological functioning and, perhaps, a certain sort of psychological history (Christman 1991). We think that autonomous individuals critically evaluate their life (...) and actions, endorse them as self-determined rather than imposed from without, and guide their own lives in accordance with the plans and values they have worked out for themselves. Such self-government has to depend on some psychological structures, but philosophers have tended to theorize about what these structures might be at a considerable distance from what the behavioral sciences can tell us. Anderson and Lux's paper is a welcome contribution to the growing literature that tries to connect issues in ethics with empirical considerations. This sort of methodological, as opposed to merely metaphysical, naturalism, is only just coming into vogue in ethics, even in moral psychology.1 Anderson and Lux are, as far as I am aware, the first people to reflect seriously on what we can learn about autonomy from clinical experience. Theirs is a very suggestive and fruitful paper that looks at real-life cases of loss of autonomy and tries to reach conclusions about what the deficits in performance tell us about the psychological preconditions of autonomy. Their paper also opens the way for an investigation into the precise neurologic and computational underpinnings of these capacities, which is essential if we are to get a serious moral psychology underway.I find little to quarrel with in the story that Anderson and Lux tell, but I will try to modify it slightly to bring out what I think is the important psychological point they make and explore some ramifications. I begin by claiming that they have scored a decisive point in favor of an external conception of autonomy. Second, I suggest that what Anderson and Lux have really put their finger on is less a requirement of accurate self-assessment than a requirement of sensitivity to feedback from the environment. I conclude by raising some of these issues about the relations between autonomy and assessments of psychological function when the deficit responsible is less amenable to clear cut neurologic identification.The External Perspective on AutonomyOne way of taking the paper (although this goes beyond anything that Anderson and Lux suggest) is that there is a smooth naturalistic picture of the cognitive basis of autonomy. When people have a normally functioning neurocomputational setup in their heads, we should assume that they are autonomous, and vice versa. However, autonomy cannot simply be identifiable with a mind that is working as some scientific theory says it should, because a mind that is [End Page 303] in that sense working correctly could, nonetheless, be directed by forces other than the agent. Servile or deluded individuals might endorse their lives even if those lives are the product of indoctrination, self-deception, or internalized oppression (Mackinnon 1997; Mele 1995). Normal mechanisms of belief fixation, for example, may not foster one's autonomy if the only context in which they are exercised is one in which many possible ways of life are simply unavailable for consideration, having been excluded from consideration by the dominant forces around one. We might, then, think of full autonomy as depending on relational rather than intrinsic properties. Perhaps autonomy requires a subject to have both normal psychological capacities and the right sort of environment in which to exercise them. I do not follow-up on this suggestion, but I mention it because it introduces two dimensions, within the subject and around the subject, where the externalist perspective on autonomy can get a grip. I discuss the former, but I do not mean to suggest that the latter is not important. A full account must deal with both. But even the psychological structures that foster autonomy cannot be identified with a mind working according to some scientific theory, as we shall see.Many writers on autonomy argue that we must recognize appropriate, objective constraints... (shrink)

Radical forms of geoengineering, such as stratospheric sulfate injection (SSI), raise serious concerns about justice and the plight of the most vulnerable. However, these are sometimes dismissed on the basis of a challenge: “What if, in the face of catastrophic impacts, the most vulnerable countries initiate geoengineering themselves, or beg the richer, more technically sophisticated countries to do it? Wouldn’t geoengineering then be ethically permissible? Who could refuse them?” As a US tech billionaire put it, “Frankly, the Maldives could say, (...) ‘F--- you all—we want to stay alive’. Would you blame them? Wouldn’t any reasonable country do the same?” Such questions are intended to be rhetorical: it is assumed simply to be obvious that the appeals of the desperate would justify radical geoengineering. Moreover, the framing suggests that other nations would have strong moral reasons either to respect intervention by the desperate, or even to aid them by deploying themselves. Sometimes such arguments are also used to justify accelerating research on geoengineering now. If the desperate might attempt geoengineering, it is said, we should work out how best to do it, so as to assist them through advice. In general, the overriding thought is that the threat of catastrophe coupled with the plight of vulnerable populations provides most of the justification needed for the wider pursuit of a geoengineering agenda. Desperation becomes a trump card in the policy discourse. In this article, I argue that the desperation argument misses much of what is at stake, ethically speaking, in geoengineering policy. I focus on two further questions. The more obvious—the justificatory question—asks “under what conditions would geoengineering become justified?”, where the conditions to be considered would include, for example, the threat to be confronted, the governance mechanisms, the individual protections to be provided, the compensation provisions to be made, and so on. The less obvious question is the contextual question: “What is the ethical context within which geoengineering is likely to occur, and what difference does this make to our analysis of it?” (Gardiner 2013). In light of this distinction, I argue for two claims. First, on neither of the two most obvious interpretations of it does the desperation argument clearly justify the pursuit of geoengineering. Indeed, it may even count against such pursuit. Second, in any case, the context in which SSI is actually being pursued reveals more about the live threats and ethical import of geoengineering. For example, to push the most vulnerable to the point where they feel forced to accept pronounced subjugation to those who have made them desperate is a morally horrifying prospect which we have strong ethical reason to avoid. Such possibilities should not be concealed behind the superficial bravado of “f--- you all” and “what any reasonable country would do.” None of this implies that ethical geoengineering is impossible. However, it does suggest that geoengineering is morally complex in ways unappreciated by simple appeals to desperation. (shrink)