BackgroundPalliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a “good action” with a potentially “bad effect,” is frequently employed to provide an ethical justification for this practice. Main textWe argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore (...) its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians’ discomfort with the complex moral, intentional, and causal aspects of end-of-life care. ConclusionsWe are concerned that this misapplication of the doctrine of double effect can consequently impair physicians’ ethical reasoning and relationships with patients at the end of life. (shrink)
Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context (...) of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)
This paper describes a method for analyzing a corpus of descriptions collected through micro-phenomenological interviews. This analysis aims at identifying the structure of the singular experiences which have been described, and in particular their diachronic structure, while unfolding generic experiential structures through an iterative approach. After summarizing the principles of the micro-phenomenological interview, and then describing the process of preparation of the verbatim, the article presents on the one hand, the principles and conceptual devices of the analysis method and on (...) the other hand several dimensions of the analysis process: the modes of structural unfolding of generic structures, the mutual guidance of the processes of structural and experiential unfolding, the tracking of analysis processes, and finally the assessment of analysis results. (shrink)
This article presents an interview method which enables us to bring a person, who may not even have been trained, to become aware of his or her subjective experience, and describe it with great precision. It is focused on the difficulties of becoming aware of one’s subjective experience and describing it, and on the processes used by this interview technique to overcome each of these difficulties. The article ends with a discussion of the criteria governing the validity of the descriptions (...) obtained, and then with a brief review of the functions of these descriptions. (shrink)
Challenging previous interpretations of Levinas that gloss over his use of the feminine or show how he overlooks questions raised by feminists, Claire Elise Katz explores the powerful and productive links between the feminine and religion in Levinas’s work. Rather than viewing the feminine as a metaphor with no significance for women or as a means to reinforce traditional stereotypes, Katz goes beyond questions of sexual difference to reach a more profound understanding of the role of the feminine in (...) Levinas’s conception of ethical responsibility. She combines feminist interpretations of Levinas with interpretations that focus on his Jewish writings to reveal that the feminine provides an important bridge between his philosophy and his Judaism. Katz’s reading of Levinas’s conception of the feminine against the backdrop of discussions of women of the Hebrew bible points to important shifts in contemporary philosophy toward the creation of life and care for the other. (shrink)
Can we make mistakes about what rationality requires? A natural answer is that we can, since it is a platitude that rational belief does not require truth; it is possible for a belief to be rational and mistaken, and this holds for any subject matter at all. However, the platitude causes trouble when applied to rationality itself. The possibility of rational mistakes about what rationality requires generates a puzzle. When combined with two further plausible claims – the enkratic principle, and (...) the claim that rational requirements apply universally – we get the result that rationality generates inconsistent requirements. One popular and attractive solution to the puzzle denies that it is possible to make rational mistakes about what rationality requires. I show why (contra Titelbaum (2015b), and Littlejohn (2015)) this solution is doomed to fail. (shrink)
A familiar part of debates about supererogatory actions concerns the role that cost should play. Two camps have emerged: one claiming that extreme cost is a necessary condition for when an action is supererogatory, while the other denies that it should be part of our definition of supererogation. In this paper, I propose an alternative position. I argue that it is comparative cost that is central to the supererogatory and that it is needed to explain a feature that all accounts (...) agree is central to the very notion of supererogation: optionality. Perhaps because of this agreement on its importance, few attempts have been made to clarify and explain the notion of optionality. I argue that giving an account of the optionality of supererogatory requires drawing a line between doing the bare minimum permissible and going beyond the bare minimum and that this line ought to be drawn based on comparative cost of alternative permissible acts. Having outlined my account and motivated it, I discuss and reject two concerns that might be raised: firstly, that it is extreme cost, not comparative cost, that matters and, secondly, that in fact no cost is needed for an act to be supererogatory. (shrink)
The Enkratic Principle enjoys something of a protected status as a requirement of rationality. I argue that this status is undeserved, at least in the epistemic domain. Compliance with the principle should not be thought of as a requirement of epistemic rationality, but rather as defeasible indication of epistemic blamelessness. To show this, I present the Puzzle of Inconsistent Requirements, and argue that the best way to solve it is to distinguish two kinds of epistemic evaluation – requirement evaluations and (...) appraisal evaluations. This allows us to solve the puzzle while accommodating traditional motivations for thinking of the Enkratic Principle as a requirement of rationality. (shrink)
De Re Significance accounts of moral appraisal consider an agent’s responsiveness to a particular kind of reason, normative moral reasons de re, to be of central significance for moral appraisal. Here, I argue that such accounts find it difficult to accommodate some neuroatypical agents. I offer an alternative account of how an agent’s responsiveness to normative moral reasons affects moral appraisal – the Reasonable Expectations Account. According to this account, what is significant for appraisal is not the content of the (...) reasons an agent is responsive to, but rather whether she is responsive to the reasons it is reasonable to expect her to be responsive to, irrespective of their content. I argue that this account does a better job of dealing with neuroatypical agents, while agreeing with the De Re Significance accounts on more ordinary cases. (shrink)
In search of the origins of some of the most fundamental problems that have beset philosophers in English-speaking countries in the past century, Claire Ortiz Hill maintains that philosophers are treating symptoms of ills whose causes lie buried in history. Substantial linguistic hurdles have blocked access to Gottlob Frege's thought and even to Bertrand Russell's work to remedy the problems he found in it. Misleading translations of key concepts like intention, content, presentation, idea, meaning, concept, etc., severed analytic philosophy (...) from its roots. Hill argues that once linguistic and historical barriers are removed, Edmund Husserl's critical study of Frege's logic in his 1891 Philosophy of Arithmetic provides important insights into issues in philosophy now. She supports her conclusions with analyses of Frege's, Husserl's, and Russell's works, including Principia Mathematica, and with linguistic analyses of the principal concepts of analytic philosophy. She re-establishes links that existed between English and Continental thought to show Husserl's expertise as a philosopher of mathematics and logic who had been Weierstrass's assistant and had long maintained ties with Cantor, Hilbert, and Zermelo. (shrink)
Reexamining Emmanuel Levinas’s essays on Jewish education, Claire Elise Katz provides new insights into the importance of education and its potential to transform a democratic society, for Levinas’s larger philosophical project.
Is normative uncertainty like factual uncertainty? Should it have the same effects on our actions? Some have thought not. Those who defend an asymmetry between normative and factual uncertainty typically do so as part of the claim that our moral beliefs in general are irrelevant to both the moral value and the moral worth of our actions. Here I use the consideration of Jackson cases to challenge this view, arguing that we can explain away the apparent asymmetries between normative and (...) factual uncertainty by considering the particular features of the cases in greater detail. Such consideration shows that, in fact, normative and factual uncertainty are equally relevant to moral assessment. (shrink)
Most areas of philosopher Edmund Husserl’s thought have been explored, but his views on logic, mathematics, and semantics have been largely ignored. These essays offer an alternative to discussions of the philosophy of contemporary mathematics. The book covers areas of disagreement between Husserl and Gottlob Frege, the father of analytical philosophy, and explores new perspectives seen in their work.
Incoherence is usually regarded as a bad thing. Incoherence suggests irrationality, confusion, paradox. Incoherentism disagrees: incoherence is not always a bad thing, sometimes we ought to be incoherent. If correct, Incoherentism has important and controversial implications. It implies that rationality does not always require coherence. Dilemmism and Incoherentism both embrace conflict in epistemology. After identifying some important differences between these two ways of embracing conflict, I offer some reasons to prefer Incoherentism over Dilemmism. Namely, that Incoherentism allows us to deliberate (...) about what we ought to believe using ordinary epistemology, and it does a better job of accommodating the positive features of incoherence. (shrink)
The well-known experiments of Nisbett and Wilson lead to the conclusion that we have no introspective access to our decision-making processes. Johansson et al. have recently developed an original protocol consisting in manipulating covertly the relationship between the subjects’ intended choice and the outcome they were presented with: in 79.6% of cases, they do not detect the manipulation and provide an explanation of the choice they did not make, confirming the findings of Nisbett and Wilson. We have reproduced this protocol, (...) while introducing for some choices an expert guidance to the description of this choice. The subjects who were assisted detected the manipulation in 80% of cases. Our experiment confirms Nisbett and Wilson’s findings that we are usually unaware of our decision processes, but goes further by showing that we can access them through specific mental acts. (shrink)
Reading Nietzsche’s many remarks on freedom and free will, we face a dilemma. On the one hand, Nietzsche levels vehement attacks against the idea of the freedom of the will in several places throughout his writing. On the other hand, he frequently describes the sorts of people he admires as ‘free’ in various respects, as ‘free spirits’, or as in possession of a ‘free will’. So does Nietzsche think that we are or perhaps could be free, or not? I argue (...) that we ought to read these seemingly conflicting claims as part of one unified project, which is to try to understand what true freedom would look like. Nietzsche’s attacks on ‘free will’, I suggest, are not intended to establish that we are not free, but rather to show that a certain tempting picture of freedom is confused and totally inadequate for purpose. The positive half of Nietzsche’s project, then, should be read as his attempt to do a better job – to provide an account of freedom that better articulates what we were trying, via the confused picture, to get at. (shrink)
One of the twentieth-century's most exciting and challenging intellectuals, Gilles Deleuze's writings covered literature, art, psychoanalysis, philosophy, genetics, film and social theory. This book not only introduces Deleuze's ideas, it also demonstrates the ways in which his work can provide new readings of literary texts. This guide goes on to cover his work in various fields, his theory of literature and his overarching project of a new concept of becoming.
The notion of supererogation—going above and beyond the call of duty—is typically discussed in a moral context. However, in this paper we argue for the existence of rationally supererogatory actions: that is, actions that go above and beyond the call of rational duty. In order to establish the existence of such actions, we first need to overcome the so-called paradox of supererogation: we need to provide some explanation for why, if some act is rationally optimal, it is not the case (...) that we are rationally required to carry out that act. We argue that a response to this ‘paradox’ can be found by reflecting on normative conflicts: cases where what is best according to some normative domain is different from what is best according to some other normative domain. (shrink)
I argue for the unexceptionality of evidence about what rationality requires. Specifically, I argue that, as for other topics, one’s total evidence can sometimes support false beliefs about this. Despite being prima facie innocuous, a number of philosophers have recently denied this. Some have argued that the facts about what rationality requires are highly dependent on the agent’s situation and change depending on what that situation is like. (Bradley 2019). Others have argued that a particular subset of normative truths, those (...) concerning what epistemic rationality requires, have the special property of being ‘fixed points’—it is impossible to have total evidence that supports false belief about them. (Smithies 2012; Titelbaum 2015). Each of these kinds of exceptionality permits a solution to downstream theoretical problems that arise from the possibility of evidence supporting false belief about requirements of rationality. However, as I argue here, they incur heavy explanatory burdens that we should avoid. (shrink)
Amy saves a man from drowning despite the risk to herself, because she is moved by his plight. This is a quintessentially supererogatory act: an act that goes above and beyond the call of duty. Beth, on the other hand, saves a man from drowning because she wants to get her name in the paper. On this second example, opinions differ. One view of supererogation holds that, despite being optional and good, Beth’s act is not supererogatory because she is not (...) praiseworthy; the other agrees that Beth is not praiseworthy but holds that her act is nevertheless supererogatory because, while supererogatory actions are generally performed by praiseworthy agents, an individual need not be praiseworthy for their act to be supererogatory. In this paper, I raise a problem for this latter position, which I shall call the Anti-Motivation View of supererogation. While the Anti-Motivation View rejects the claim that the agent’s motivations are important, it accepts that the agent’s intentions are. Thus, this view assumes that a clear, coherent distinction can be drawn between intentions and motivations in the context of supererogation. This distinction is often attributed to Mill; however, his original discussion reveals an inconsistency. Consider Clara, who saves a man from drowning because she wants to torture him later. According to Mill, Clara’s act is not morally good; those who follow Mill will have to accept that it is therefore not supererogatory. Mill asserts that Clara’s act differs from Amy’s and Beth’s not just in motivation but also in intention. I question this explanation and demonstrate that the distinction between motivation and intention is not as clear as the Anti-Motivation View has supposed and that the gap between the Anti-Motivation View and the alternative Praise-Based View is either much greater or much smaller than previously thought. (shrink)
We can imagine a world in which ectogenesis provides a safe gestating space that eliminates maternal morbidity and mortality while maximising healthy outcomes for babies. In this world, women, no longer physically—and visibly—pregnant, are no longer economically, socially or physically disadvantaged due to the potential for pregnancy and birth. Because everyone can access the same technology, women are able to work without fear of pregnancy-related discrimination or restrictions, and health disparities among individuals in gestation and birth based on socioeconomic status (...) are eliminated. This imagining allows us to explore the ethical and social underpinnings of such a world, and consider how to achieve it in our current paradigm. Having explored the freedom and equality that is possible in an ideal hypothetical where all have equal access to such technologies, we can now imagine that same world without ectogenesis: women, no longer economically, socially or physically disadvantaged due to pregnancy and birth, despite still becoming pregnant. Such is the potential political perspective and provocation that can be spurred on by discussion of ectogenesis. As Cavaliere argues, the technological reality of ectogenesis may not achieve the freedom and equality that …. (shrink)
Visual artists and scientists frequently employ the labour of assistants and technicians, however these workers generally receive little recognition for their contribution to the production of artistic and scientific work. They are effectively “invisible”. This invisible status however, comes at the cost of a better understanding of artistic and scientific work, and improvements in artistic and scientific practice. To enhance understanding of artistic and scientific work, and these practices more broadly, it is vital to discern the nature of an assistant (...) or technician’s contribution to the production of a work, which is difficult as it is uncommon to discuss these workers. To address this, I investigate how different kinds of parallel working arrangements in collective artistic and scientific practices affect the creative potential of individuals involved. Different working arrangements permit different degrees of autonomy for individuals involved in these practices. Significantly, a lack of autonomy precludes the opportunity to act spontaneously and so exercise, what I term, “creative agency”. Evaluating the contribution of an assistant or technician based on the degree of autonomy that they are granted in the production of a work is an approach that I show can be used to precisely determine the nature of their contribution to the production of a work and accordingly, what kind of recognition an agent should receive for this. Importantly, this approach has the advantage of explaining the artistic and epistemic significance of different kinds of contribution to the production of artistic and scientific work. (shrink)
Standing in San Marco Cathedral in Venice, you immediately notice the exquisitely decorated spandrels: the triangular spaces bounded on either side by adjoining arches and by the dome above. You would be forgiven for seeing them as the starting point from which to understand the surrounding architecture. To do so would, however, be a mistake. It is a similar mistaken inference that evolutionary biologists have been accused of making in assuming a special adaptive purpose for such biological features as fingerprints (...) and chins. I argue that a mistake of just this sort is being made by ethicists who appeal to the intrinsic value of supererogatory acts in their efforts to make space for supererogation in ethical theory. Many cases of supererogatory action are simply spandrels: by-products of uncontroversial commitments elsewhere in our moral thought. This is not to downplay their value but rather to show that their value need not be the justification for making room for the supererogatory. I demonstrate this by examining two areas: rights and the distribution of burdens among a group. My argument has significance for those who take themselves to be defends of the possibility of supererogatory actions, as well as those who are committed to the contrary and those who believe themselves to be indifferent on the matter. (shrink)
This article is devoted to the description of the experience associated with listening to a sound. In the first part, we describe the method we used to gather descriptions of auditory experience and to analyse these descriptions. This work of explicitation and analysis has enabled us to identify a threefold generic structure of this experience, depending on whether the attention of the subject is directed towards the event which is at the source of the sound, the sound in itself, considered (...) independently from its source, the felt sound. In the second part of the article, we describe this structure. The third part is devoted to a discussion of these results and the paths they open up in various fields of theoretical and applied research. (shrink)
In the most accessible and personal of his works, Deleuze examines, through a series of discussions with Claire Parnet, such revealing topics as his own philosophical background and development, the central themes of his work, and some of his relationships, in particular with the philosopher Flix Guattari. This new edition contains a new essay, "The Actual and the Virtual.".
In this paper we list the various criticisms that have been formulated against introspection, from Auguste Comte denying that consciousness can observe itself, to recent criticisms of the reliability of first person descriptions. We show that these criticisms rely on the one hand on poor knowledge of the introspective process, and on the other hand on a naïve conception of scientific objectivity. Two kinds of answers are offered: the first one is grounded on a refined description of the process of (...) becoming aware of one's experience and describing it, the second one relies on a comparison with the methods of the experimental sciences. We conclude the article by providing a renewed definition of 'the truth' of a first person description. (shrink)
The purpose of this paper is to show through the concrete example of epileptic seizure anticipation how neuro-dynamic analysis and “pheno-dynamic” analysis may guide and determine each other. We will show that this dynamic approach to epileptic seizure makes it possible to consolidate the foundations of a cognitive non pharmacological therapy of epilepsy. We will also show through this example how the neuro-phenomenological co-determination could shed new light on the difficult problem of the “gap” which separates subjective experience from neurophysiological (...) activity. (shrink)
The critical realist and Bourdieusian conceptions of action fundamentally disagree on a number of fronts: the synthetic versus dualistic relationship between structure and agency; the social nature of the self/body; the link between morphogenesis and reflexivity. Despite these differences, this article argues that re-reading Bourdieu’s theories with attention to some of the core tenets of critical realism can provide insights into how the habitus is capable of reflexivity and social change. In particular, this article reworks Bourdieu’s theory of habitus by (...) suggesting that social selves are always situated at the intersection of multiple and competing social locations and that the habitus itself is always layered. Reflexivity arises from horizontal disjunctures and vertical disjunctures. (shrink)
Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing. Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights—the right not to know, and the child’s (...) right to an open future—frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs. (shrink)
Introduction: The problem of vitalism : active/passive -- Brain, system, model : the affective turn -- Vitalism and theoria -- Inorganic art -- Inorganic vitalism -- The vital order after theory -- On becoming -- Living systems, extended minds, gaia -- Conclusion.
_The View from Within_, edited by the late Francisco Varela in collaboration with Jonathan Shear, was published in 1999 and has proved a major stimulus to the scientific investigation of first-person methodologies in psychology and philosophy of mind. Ten years on, Claire Petitmengin has organized a collection of essays that examine and refine the research program on first-person methods defined in _The View from Within_, with contributions based on empirical research. She has kept close to the spirit of the (...) earlier book, in which Varela encouraged a precise description of the very process of becoming aware of one's experience and describing it, by gathering the contributions of researchers who not only propose first-person descriptions, but who also try to describe the process of description itself, in order to make the description reproducible -- a necessary condition for any scientific undertaking. (shrink)