The least infringement principle has been widely endorsed by public health scholars. According to this principle, public health policies may infringe upon “general moral considerations” in order to achieve a public health goal, but if two policies provide the same public health benefit, then policymakers should choose the one that infringes least upon “general moral considerations.” General moral considerations can encompass a wide variety of goals, including fair distribution of burdens and benefits, protection of privacy and confidentiality, and respect for (...) autonomy.In this article, we argue that the Center for Disease Control and Prevention's 2006 HIV screening recommendations may violate the least infringement principle. This is a concern because, although not legally binding, the Recommendations appear to have already influenced state laws and will likely continue to do so as legislative proposals continue to be passed. At a minimum, therefore, the Recommendations have important implications for HIV screening within the United States. (shrink)

The Trump Administration has exposed both the durability and vulnerability of the Patient Protection and Affordable Care Act's insurance reforms. One of the Administration's first strikes at “Obamacare” was to discontinue federal government payment of cost-sharing reductions, which insurers pay to low-income enrollees on the exchanges to reduce their out-of-pocket share of medical spending. The states struck back with a clever solution that could hold insurers and enrollees harmless. This article examines this strategy and why, while impressive, it reaffirms larger (...) problems with the ACA's market-based approach to health reform and the need for new pathways forward. (shrink)

The contents of our conscious mind can seem unpredictable, whimsical, and free from external control. When instructed to attend to a stimulus in a work setting, for example, one might find oneself thinking about household chores. Conscious content thus appears different in nature from reflex action. Under the appropriate conditions, reflexes occur predictably, reliably, and via external control. Despite these intuitions, theorists have proposed that, under certain conditions, conscious content resembles reflexes and arises reliably via external control. We introduce the (...) Reflexive Imagery Task, a paradigm in which, as a function of external control, conscious content is triggered reliably and unintentionally: When instructed to not subvocalize the name of a stimulus object, participants reliably failed to suppress the set-related imagery. This stimulus-elicited content is considered ‘high-level’ content and, in terms of stages of processing, occurs late in the processing stream. We discuss the implications of this paradigm for consciousness research. (shrink)

Misophonia has been characterized as intense negative reactions to specific trigger sounds. However, recent research suggests high-level, contextual, and multisensory factors are also involved. We recently demonstrated that neurotypicals’ negative reactions to aversive sounds are attenuated when the sounds are synced with positive attributable video sources. To assess whether this effect generalizes to misophonic triggers, we developed a Sound-Swapped Video database for use in misophonia research. In Study 1, we created a set of 39 video clips depicting common trigger sounds (...) and a corresponding set of 39 PAVS temporally synchronized with the OVS videos. In Study 2, participants rated the 39 PAVS videos for their audiovisual match and pleasantness. We selected the 20 PAVS videos with best match scores for use in Study 3. In Study 3, a new group of participants observed the 20 selected PAVS and 20 corresponding OVS and judged the pleasantness or unpleasantness of each sound in the two contexts accompanying each video. Afterward, participants completed the Misophonia Questionnaire. The results of Study 3 show a robust attenuating effect of PAVS videos on the reported unpleasantness of trigger sounds: trigger sounds were rated as significantly less unpleasant when paired with PAVS with than OVS. Moreover, this attenuating effect was present in nearly every participant regardless of their score on the MQ. In fact, we found a moderate positive correlation between the PAVS-OVS difference and misophonia severity scores. Overall our results provide validation that the SSV database is a useful stimulus database to study how misophonic responses can be modulated by visual contexts. Here, we release the SSV database with the best 18 PAVS and 18 OVS videos used in Study 3 along with aggregate ratings of audio-video match and pleasantness. We also provide detailed instructions on how to produce these videos, with the hope that this database grows and improves through collaborations with the community of misophonia researchers. (shrink)

Śrīgupta, a Buddhist philosopher in the Middle Way tradition, was born in Bengal in present-day India in the seventh century. He is best known for his Introduction to Reality with its accompanying auto-commentary,1 in which he presents the first Middle Way iteration of the influential "neither-one-nor-many argument."2 This antifoundationalist line of reasoning sets out to prove that nothing enjoys ontologically independent being.Gottfried Wilhelm Leibniz was born some one thousand years later, in the city of Leipzig, situated on the outskirts of (...) European learning and thought. He is best known today for having co-invented the infinitesimal calculus, for his... (shrink)

In spring 2020, COVID-19 and the ensuing social distancing and stay-at-home orders instigated abrupt changes to employment and educational infrastructure, leading to uncertainty, concern, and stress among United States college students. The media consumption patterns of this and other social groups across the globe were affected, with early evidence suggesting viewers were seeking both pandemic-themed media and reassuring, familiar content. A general increase in media consumption, and increased consumption of specific types of content, may have been due to media use (...) for coping strategies. This paper examines the relationship between the stress and anxiety of university students and their strategic use of media for coping during initial social distancing periods in March-April 2020 using data from a cross-sectional survey. We examine links between specific types of media use with psychological well-being concepts, and examine the moderating roles of traits as buffers against negative relationships between stress and anxiety and psychological well-being. Our findings indicate that stress was linked to more hedonic and less eudaimonic media use, as well as more avoidant and escapist media-based coping. Anxiety, on the other hand, was linked to more media use in general, specifically more eudaimonic media use and a full range of media-based coping strategies. In turn, escapist media was linked to negative affect, while reframing media and eudaimonic media were linked to positive affect. Avoidant coping was tied to poorer mental health, and humor coping was tied to better mental health. Hedonic and need-satisfying media use were linked to more flourishing. Hope, optimism, and resilience were all predictive of media use, with the latter two traits moderating responses to stress and anxiety. The findings give a nuanced portrait of college students’ media use during a pandemic-induced shutdown, showing that media use is closely intertwined with well-being in both adaptive and maladaptive patterns. (shrink)

Employee counterproductive work behavior is costly to organizations and those who work within them. Evidence suggests that employees are motivated to engage in CWB because they believe that these behaviors will make them feel better in response to negative workplace events. However, research has yet to consider the situational and individual factors that shape the extent to which employees view CWB in such a manner. In order to provide insight into the decision-making process surrounding the use of CWB as a (...) coping strategy, this study leverages coping theory to examine the factors that contribute to employees’ beliefs that CWBs will be instrumental for emotion regulation aims in response to workplace stressors. In a repeated measures scenario-based study of 297 employees, we found that individuals’ perceived coping instrumentalities for CWBs are a function of the controllability and source of the stressor as well as a more stable learned response to stressful situations at work. (shrink)

This article presents evidence supporting the claim that ethical reasoning is a skill that can be taught and assessed. We propose a working definition of ethical reasoning as 1) the ability to identify, analyze, and weigh moral aspects of a particular situation, and 2) to make decisions that are informed and warranted by the moral investigation. The evidence consists of a description of an ethical reasoning education program—Ethical Reasoning in Action —designed to increase ethical reasoning skills in a variety of (...) situations and areas of life. ERiA is housed at a public, major comprehensive U.S. university—James Madison University—and assessment of the program focuses on interventions delivered prior to and during orientation for incoming first-year students. Findings indicate that the interventions measurably enhance the ability of undergraduate students to reason ethically. ERiA’s competency-targeted program and positive student learning outcomes offers a promising model for higher education ethics programs seeking to connect classroom learning in ethics to decision-making in everyday life. (shrink)

In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...) deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis, are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically or systemically. The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

As social media becomes increasingly popular, human subjects researchers are able to use these platforms to locate, track, and communicate with study participants, thereby increasing participant retention and the generalizability and validity of research. The use of social media; however, raises novel ethical and regulatory issues that have received limited attention in the literature and federal regulations. We review research ethics and regulations and outline the implications for maintaining participant privacy, respecting participant autonomy, and promoting researcher transparency when using social (...) media to locate and track participants. We offer a rubric that can be used in future studies to determine ethical and regulation-consistent use of social media platforms and illustrate the rubric using our study team’s experience with Facebook. We also offer recommendations for both researchers and institutional review boards that emphasize the importance of well-described procedures for social media use as... (shrink)

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes (...) or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion. (shrink)

Students in 80 kindergarten to grade six classrooms photographed and captioned experiences in class which they identified as examples of democratic citizenship education. With the assistance of a teacher candidate placed in their classroom for a semester, students chose and captioned five of the photographs they considered to best represent demonstrate citizenship education. Four main categories of citizenship events emerged describing key elements associated with democratic citizenship education; shared decision making, participating in a learner-oriented classroom context in which students have (...) some individual choice of daily activities, equality of opportunity, and activities extending into the community and integrating community and classroom. Early grades students (K-3) identified activities they associated with democratic citizenship education while upper grades (4-6) students additionally presented rationales and gave evidence to support their representations. Empowerment, problem solving, and contributing to the common good were additional elements associated with democratic citizenship education in the classes sampled, although these were not strongly represented as were the four key elements. This study provides an initial portrait indicating a need for deeper investigation of K-6 students' own representations of the democratic citizenship education they experience. (shrink)

Students in 80 kindergarten to grade six classrooms photographed and captioned experiences in class which they identified as examples of democratic citizenship education. With the assistance of a teacher candidate placed in their classroom for a semester, students chose and captioned five of the photographs they considered to best represent demonstrate citizenship education. Four main categories of citizenship events emerged describing key elements associated with democratic citizenship education; shared decision making, participating in a learner-oriented classroom context in which students have (...) some individual choice of daily activities, equality of opportunity, and activities extending into the community and integrating community and classroom. Early grades students (K-3) identified activities they associated with democratic citizenship education while upper grades (4-6) students additionally presented rationales and gave evidence to support their representations. Empowerment, problem solving, and contributing to the common good were additional elements associated with democratic citizenship education in the classes sampled, although these were not strongly represented as were the four key elements. This study provides an initial portrait indicating a need for deeper investigation of K-6 students' own representations of the democratic citizenship education they experience. (shrink)

This study examined within-person co-occurrence of self-focus, negative affect, and stress in a community sample of adolescents with or without emotional disorders. As part of a larger study, 278 adolescents were interviewed about emotional disorders. Later, they completed diary measures over three days, six times a day, reporting their current thoughts, affect, and levels of stress. Negative affect was independently related to both concurrent stress and self-focus. Importantly, the association between negative affect and self-focus was stronger among participants with a (...) recent unipolar mood disorder, compared to those with an anxiety disorder, comorbid anxiety and depression, or those without an emotional disorder. The implications of these findings to theories of self-focus and its role in emotional disorders are discussed. (shrink)

Elimination of state laws that preempt local antismoking ordinances is a national health objective. However, the tobacco industry and its supporters have continued to pursue statelevel preemption of local tobacco control ordinances as part of an apparent strategy to avoid the difusion of grassroots antismoking initiatives. And, an increasing number of challenges to local ordinances by the tobacco industry and persons supported by the tobacco industry are being decided in state supreme courts and courts of appeals. The outcomes of seemingly (...) similar cases about the validity of local smoke-free air ordinances vary signifcantly by state. This paper examines the common and unique aspects of the decisions and the potential implications of court rulings on preemption for future state tobacco control eforts and achievement of national health objectives around the elimination of preemption. Using a search strategy developed for the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System, cases where a state or federal appellate level court made a fnding on the validity of a local smoke-free air ordinance or regulation were identifed in 19 states. In contrast to previous studies, we found that cases in approximately half of states were decided for local governments. We also found that across the states, courts were considering similar factors in their decisions including the extent to which: the local government possessed the authority to pass the ordinance, the ordinance conficted with the state constitution, and state statutes preempt the ordinance. (shrink)

Despite governmental and private antismoking initiatives, tobacco smoking remains a significant public health and economic challenge. The Centers for Disease Control and Prevention estimates that for each year between 1997 and 2001, cigarette smoking and exposure to secondhand smoke caused approximately 438,000 U.S. residents to die prematurely, resulting in 5.5 million years of potential life lost, and in $92 billion dollars of lost productivity. Also, despite convincing scientific data that laws against indoor smoking protect people from the negative health effects (...) of cigarette smoke, not all states have afforded their residents this protection. As of July 2007, 16 states neither restricted nor banned indoor smoking in restaurants, private worksites, or government worksites, and many state statutes only required separate rooms for smokers rather than eliminating all smoking inside buildings. In several states, local governments have attempted to fill this gap by adopting their own antismoking measures. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

In lieu of an abstract, here is a brief excerpt of the content:Kant's Critique of Berkeley HENRY E. ALLISON THE CLAIMTHAT KANT'S IDEALISM,or at least certain strands of it, is essentially identical to that of Berkeley has a long and distinguished history. It was first voiced by several of Kant's contemporaries such as Mendelssohn, Herder, Hamann, Pistorius and Eberhard who attacked the alleged subjectivism of the Critique of Pure Reason. 1 This viewpoint found its sharpest contemporary expression in the (...) notorious Garve-Feder review to which Kant responded at length in the Prolegomena. In subsequent times it has been championed by Schopenhauer, and most nineteenth century German commentators on the relation between the two philosophers. 2 In addition, it has been, and continues to be, the prevailing view of the vast majority of British writers on Kant, including, with significant qualifications, Norman Kemp Smith. 3 This tradition continues despite the fact that Kant specifically, and in no uncertain terms, repudiated this identification in the Prolegomena and the second edition of the Critique. In both works he responds to the charges of subjectivism, and in so doing distinguishes his position from that of Berkeley, who in the eighteenth century was commonly regarded as a solipsist and denier of the "external world." 4 In contra-distinction to Kant's own critical or transcendental idealism, which explains the possibility of synthetic a priori knowledge within the realm of possible experience, Berkeley is characterized as a "dogmatic" or "visionary idealist." He is judged guilty of "degrading bodies to mere illusion" (B69), of regarding things in space as "merely imaginary entities" (B274), and of holding with all "genuine idealists" that: "all knowledge through the senses and experience is i Cf. Hans Vaihinger, Commentar zu Kant's Kritik der Reinen Vernunft (Stuttgart, Berlin, Leipzig, 1892), II, 494-505. Cf. Friederich Fredericks, Der Phainomenale Idealisraus Berkeley's und Kant's (Berlin, 1871); Robert Zimmerman, "Ober Kant's Widerlegung des Idealismus yon Berkeley" (Sitzungsberichte der Akademie der Wissenschaften, Vienna, Philox.-hist. Kl.), LXVIII (1871); Gustav Dieckert, tiber dos Verhiiltnis des Berkeleyschen ldealismus zu Kantischen Vernun]tkritik (Konitz, 1888). Tiffs is a consequence of the general British tendency to view Kant in phenomenalist terms. A typical recent example is found in P. F. Strawson, The Bounds of Sense (London, 1966). Kemp Smith in his Commentary to Kant's Critique o[ Pure Reason (2nd ed., rev., 1923) takes greaZ pains to distinguish between the subjectivist strand in Kant's thought, which is essentially identical to Berkeley's position, and the genuine critical doctrine which stands side by side with it in the text. 9 Cf. I-I.M. Bracken, The Early Reception of Berkeley's Materialism 1710-1733, rev. ed. (The Hague: Martinus Nijhoff, 1965). [43] 44 HISTORY OF PHILOSOPHY nothing but sheer illusion, and only in the ideas of pure understanding is there truth" (374). 5 One of the chief reasons for the continuation of the Kant-Berkeley tradition is that these, and similar statements about Berkeley, which we find in these works and in Kant's correspondenc e with Beck, have not been taken very seriously by Kant's critics. They are usually dismissed as obvious misinterpretations, due to Kant's ignorance of Berkeley's actual writings, and of his reliance upon distorted second and third hand accounts of Berkeley's thought such as is to be found in Beattie. Furthermore, this view is often supported by the philological reflection that Kant did not read English, and that Berkeley's writings were not yet available in German translation. 6 The philological argument, however, loses much of its force when we consider that there was indeed a German translation of Berkeley's Dialogues, which although apparently unknown to nineteenth century scholars, was readily accessible to Kant. This is to be found, together with a translation of Collier's Clavis Universalis and critical analyses, in a work by the professor of philosophy at Rostock, Johann Christian Eschenbach, entitled: Samlung der vornehmsten Schri[tsteller die die tFirklichkeit ihres eignen K~rpers und der ganzen Ki~rperwelt leugnen (Rostock, 1756). Furthermore, in addition to this work, which was probably known to Kant, there is Berkeley's important Latin work, De Motu (1721), as well as French translations of many of... (shrink)

The inclusion of engineering standards in US science education standards is potentially important because of how limited engineering education for K-12 learners is, despite the ubiquity of engineering in students’ lives. However, the majority of learners experience science education throughout their compulsory schooling. If improved engineering literacy is to be achieved, then its inclusion in science curricula is perhaps the most efficient means. One significant challenge that arises, however, is in the framing of engineering relative to science by both teachers (...) and curriculum. Science and engineering are both distinct and interdependent. The nature of the contributions of science and engineering to one another has been an area of some examination in philosophy of technology and engineering, but little framing of this relationship has been conducted with K-12 science and engineering education contexts in mind. Nature of science is a critical layer of scientific understanding that has been used to explicitly support literacy in K-16 science classrooms for decades. However, engineering cannot be authentically and appropriately supported by NOS framing. There is an immediate need for discourse on the nature of engineering knowledge but not in isolation of NOS. Given the increasing inclusion of engineering in science classrooms, relationships between NOS and NOEK are in need of explication and argument. Our purpose is to promote a discussion about NOS, engineering, and the relationship between them without misrepresenting engineering as a subdomain of science or as an oversimplification of itself. (shrink)

This book constitutes one of the most important contributions to recent Kant scholarship. In it, one of the pre-eminent interpreters of Kant, Henry Allison, offers a comprehensive, systematic, and philosophically astute account of all aspects of Kant's views on aesthetics. The first part of the book analyses Kant's conception of reflective judgment and its connections with both empirical knowledge and judgments of taste. The second and third parts treat two questions that Allison insists must be kept distinct: the (...) normativity of pure judgments of taste, and the moral and systematic significance of taste. The fourth part considers two important topics often neglected in the study of Kant's aesthetics: his conceptions of fine art, and the sublime. (shrink)

Is conceptual engineering feasible? Answering that question requires a theory of semantic change, which is sometimes thought elusive. Fortunately, much is known about semantic change as it occurs in the wild. While usage is chaotic and complex, changes in a word’s use can produce changes in its meaning. There are several under-appreciated empirical constraints on how meanings change that stem from the following observation: word use finely reflects equilibrium between various communicative pressures. Much of the relevant work in linguistics has (...) employed the methods of empirical pragmatics and diachronic semantics. In this way, the study of meaning change can be brought to bear on the conceptual engineer’s normative project. The picture that emerges tells against the sorts of engineering projects most likely to appeal to philosophers. Some may stand to succeed, but they have significantly different contours than the typical ones. (shrink)

There’s a common line of reasoning which supposes that the phenomenal unity of conscious experience is grounded in a mind-like simple subject. To the contrary, Mādhyamika Buddhist philosophers like Śrīgupta (seventh–eighth century) argue that any kind of mental simple is incoherent and thus metaphysically impossible. Lacking any unifying principle, the phenomenal unity of conscious experience is instead an unfounded illusion. In this paper, I present an analysis of Śrīgupta’s "neither-one-nor-many argument" against mental simples and show how his line of reasoning (...) is driven by a set of implicit questions concerning the nature of and relation between consciousness and its intentional object. These questions not only set the agenda for centuries of intra-Buddhist debate on the topic, but they are also questions to which any defender of unified consciousness or a simple subject of experience arguably owes responses. (shrink)

This chapter presents an overview of the life, work, and philosophical contributions of Śāntarakṣita (c. 725–788), who is known for his synthesis of Nāgārjuna’s Madhyamaka with elements of the Dignāga-Dharmakīrti tradition of logic and epistemology. His two most important independent treatises, the Compendium of True Principles (Tattvasaṃgraha) and the Ornament of the Middle Way (Madhyamakālaṃkāra), are characterized by an emphasis on the indispensable role of rational analysis on the Buddhist path as well as serious and systematic engagement with competing Buddhist (...) and non-Buddhist schools of thought. Śāntarakṣita employs a pedagogical-rhetorical device of provisionally adopting what he deems to be successively more rational views to reject less rational ones. Using this approach, in the Ornament of the Middle Way, he recommends a gradual path to arrive at an understanding of the Madhyamaka ultimate truth by incorporating Yogācāra idealist ontology into his presentation of conventional truth. In this same text, he presents an influential iteration of the neither-one-nor-many argument for the Madhyamaka ultimate truth, the emptiness of intrinsic nature—i.e., the universal negation of ontologically independent being—leaving a lasting and significant impact on both Indian and Tibetan Madhyamaka Buddhist philosophy. (shrink)

Canonical defenders of the principle of sufficient reason (PSR), such as Leibniz and Spinoza, are metaphysical foundationalists of one stripe or another. This is curious since the PSR—which says that everything has a ground, cause, or explanation—in effect, denies fundamental entities. In this paper, I explore the apparent inconsistency between metaphysical foundationalism and approaches to metaphysical system building that are driven by a commitment to the PSR. I do so by analyzing how Indian Buddhist philosophers arrive at foundationalist and anti-foundationalist (...) positions motivated by implicit commitments to different versions of the PSR. I begin by introducing the Buddhist principle of dependent origination (pratītyasamutpāda) as a proto-PSR that is restricted to causal explanation. Next, I show how Vasubandhu’s Sautrāntika Abhidharma metaphysics is shaped by a qualified commitment to both causal and metaphysical grounding versions of the PSR. I then reveal how Nāgārjuna’s Madhyamaka metaphysics is driven by an unrestricted and exceptionless commitment to causal and metaphysical grounding versions of the PSR. Finally, I consider how Nāgārjuna’s account may put him in a unique position to respond to a common contemporary objection to the PSR from necessitarianism. I conclude by addressing a competing interpretation on which Nāgārjuna is best understood as an anti-rationalist rather than an uber-rationalist, as I characterize him. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)