We consider the moral and social ingredients in physicians' relationships with patients of diminished capacity by considering certain claims made about friendship and the physician's role. To assess these claims we look at the life context of two patients as elaborated examples provided in two novels: Woman on the Edge of Time (1976) by Marge Piercy, a radical feminist; and It's Hard to Leave While the Music's Playing (1977) by I. S. Cooper, a prominent physician-researcher. At issue is (...) how the doctor-patient relationship should be structured. In question is whether the physician's friendship and professional expertise, together with the diminished capacity of the patient, authorize medical paternalism. From our examination, we find compelling insights against appealing to friendship both in good doctor-patient relationships and in more typical, not-so-good ones. (shrink)

We join McCarthy and Howard (2023) in advocating supported decision-making for patients with diminished mental capacity that meaningfully expands the role of trustees beyond merely channeling the i...

One objection to xenotransplantation is that it will require the large-scale breeding, raising and killing of genetically modified pigs. The pigs will need to be raised in designated pathogen-free facilities and undergo a range of medical tests before having their organs removed and being euthanised. As a result, they will have significantly shortened life expectancies, will experience pain and suffering and be subject to a degree of social and environmental deprivation. To minimise the impact of these factors, we propose the (...) following option for consideration—ethically defensible xenotransplantation should entail the use of genetic disenhancementifit becomes possible to do so and if that pain and suffering cannot be eliminated by other means. Despite not being a morally ideal ‘solution’, itismorally better to prevent unavoidable pain until a viable non-animal alternative becomes available. (shrink)

In this paper, I discuss whether it is ever morally permissible to diminish the cognitive abilities or capacities of some cognitively gifted offenders whose ability to commit their crimes successfully relies on them possessing these abilities or capacities. I suggest that, given such cognitive diminishments may prevent such offenders from re-offending and causing others considerable harm, this provides us with at least one good moral reason in favour of employing them. After setting out more clearly what cognitive diminishment may consist (...) of, I then critically discuss variations of four plausible arguments against a proposal of using them on cognitive gifted offenders related to autonomy, harm, narrative identity, and a right to mental self-determination. I argue that none of these concerns should have us reject the use of cognitive diminishments. (shrink)

The ability to reflect on and monitor memory processes is one of the most investigated metamemory functions, and one of the important ways consciousnesses interacts with memory. The feeling-of-knowing is one task used to evaluate individual’s capacity to monitor their memory. We examined this reflective function of metacognition in older adults. We explored the contribution of metacognition to episodic memory impairment, in relation to the idea that older adults show a reduction in memory awareness characteristic of episodic memory. A (...) first experiment showed that age affects the accuracy of FOK when predictions are made on an episodic memory task but not on a semantic memory task, suggesting a particular role for episodic memory awareness in metacognitive evaluations. A second experiment showed that the age-difference in episodic FOK accuracy was removed if one took into account subjective reports of memory awareness, or recollection. We argue that the FOK deficit specific to episodic memory is based on a lack of memory awareness manifest as a recollection deficit. (shrink)

Some theories of language, thought, and experience require their adherents to say unpalatable things about human individuals whose capacities for rational activity are seriously diminished. Donald Davidson, for example, takes the interdependence of the concepts of thought and language to entail that thoughts may only be attributed to an individual who is an interpreter of others’ speech. And John McDowell's account of human experience as the involuntary exercise of conceptual capacities can be applied easily only to individuals who make (...) some reasonable judgments, because conceptual capacities are paradigmatically exercised in judgments. In both cases, we seem forced towards an error theory about any ordinary understanding of impaired human individuals as minded, or as undergoing human experience. (shrink)

The meteoric rise of CRISPR/Cas9 gene editing technology has ignited discussions of engineering agricultural animals to improve their welfare. While some have proposed enhancing animals, for instance by engineering for disease resistance, others have suggested we might diminish animals to improve their welfare. By reducing or eliminating species-typical capacities, the expression of which is frustrated under current conditions, animal diminishment could reduce or eliminate the suffering that currently accompanies industrial animal agriculture. Although diminishment could reduce animal suffering, there is a (...) widespread intuition that it would be wrong. One attempt to justify this intuition has been to claim that inhibiting the development of species-typical functions is wrong, even if it improves welfare. This has often been couched in terms of violating an animal’s dignity. I argue that the dignity objection to diminishment fails. In the first place, it fails to apply to some of the most troubling cases of diminishment, the creation of so-called animal microencepahlic lumps. In the second place, dignity views misplace the normative relevance of species norms; I argue that considerations from evolutionary biology should lead us to treat species norms - such as the possession of typical capacities - as merely a heuristic for rendering judgments about welfare. But diminishment cases are precisely the cases where the heuristic breaks down, and becomes a bias. I close my discussion with a sketch of my Historical Injustices Approach to animal ethics, and how it may help us vindicate our intuition that diminishment is wrong without appeal to species norms. (shrink)

There are legitimate worries about gaps between scientific evidence of brain states and function (for example, as evidenced by fMRI data) and legal criteria for determining criminal culpability. In this paper I argue that behavioral evidence of capacity, motive and intent appears easier for judges and juries to use for purposes of determining criminal liability because such evidence triggers the application of commonsense psychological (CSP) concepts that guide and structure criminal responsibility. In contrast, scientific evidence of neurological processes and (...) function – such as evidence that the defendant has a large brain tumor – will not generally lead a judge or jury to directly infer anything that is relevant to the legal determination of criminal culpability . (Vincent 2008) In these cases, an expert witness will be required to indicate to the fact-finder what this evidence means with regard to mental capacity; and then another inference will have to be made from this possible lack of capacity to the legal criteria for guilt, cast in CSP terms.<br><br>To reliably link evidence of brain function and structure and assessment of criminal responsibility, we need to re-conceptualize the mental capacities necessary for responsibility, particularly those that are recognized as missing or compromised by the doctrines of “legal capacity” (Hart 1968) and “diminished capacity.” I argue that formulating these capacities as executive functions within the brain can provide this link. I further claim that it would be extremely useful to consider evidence of executive function as related to the diminished capacity doctrine at sentencing. This is because it is primarily at this stage in criminal proceedings where the use of the diminished capacity doctrine is most prevalent, as evidenced by the recent Supreme Court cases of Atkins v. Virginia (536 U.S. 304 (2002)) and Roper v. Simmons (543 U.S. 551 (2005)).<br>. (shrink)

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly (...) contribute to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a _welfarist_ conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing. (shrink)

This chapter develops the concept of heterogeneous political space as an alternative to the exclusively human political sphere which dominates Western political thinking about collective action and justice. The aim is to make evident that capacities for action are constituted in heterogeneous milieus and to argue that insofar as political thought does not register this it is inadequate to thinking justice and flourishing in a world where ecological change renders human and nonhuman modes of life increasingly precarious. Heterogeneous political spaces (...) are constituted by compositions of material, affect and desire which are occluded by humanist and individualist theories of action that theorise collective action at the register of a macro-political order made up of unified rational subjects with clear intentions and commitments. Gilles Deleuze and Félix Guattari’s concepts of following and assembling enable accounts of a molecular or micro-political register composed of het- erogeneous collectivities in processes of composition. In their insistence that human action cannot be separated from the productions of nature, we find that heterogeneity, rather than human plurality, is given as a condition of action. Conceiving of political action in terms of heterogeneity brings into view the processes by which capacities for political action are constituted by non- human forces, entities and elements. It focuses attention on that in virtue of which political action occurs, rather than on the intentional aspect of actions which aim to achieve an individualised interest (whether it be the interests of a human individual or individuated group). Heterogeneous political space complexifies our thinking about political action and diffuses the agency of political subjects so as to render our thinking more adequate in several sig- nificant regards. It provides a conceptual resource that brings the diverse human-nonhuman entanglements to the fore and thus acknowledges the differing ways that capacities for political action are constituted in different assemblages that always cmprise nonhumans. This disrupts the liberal, humanist view of politics where nonhumans are excluded from the domain of action and appear only as passive resources to be exploited for human plans and actions. Further, by challenging the view of the more-than-human world as passively ‘standing-reserve’ for the purposes of human agents, the concept of heterogeneous political space invites a critical questioning whether the conception of political space as exclusively human is capable of attending to issues of ecological justice where the well-being of humans and ecosystems is inextricable. In short, when the more-than-human world is excluded from conceptions of political space neither the needs of nonhumans (plants, animals, ecosystems, waterways) nor the constitution of human cap- acities in relation with nonhumans (co-habitation, dependence, care) register as politically significant. This, in effect, obscures the ways that different human-nonhuman assemblages increase and diminish capacities for action. (shrink)

:My main aim in this essay is to argue that “narrative capacity” is a genuine feature of our mental lives and a skill that enables us to become full-fledged morally responsible agents. I approach the issue from the standpoint of reasons-responsiveness. Reasons-responsiveness theories center on the idea that moral responsibility requires sufficient sensitivity to reasons. I argue that our capacity to understand and tell stories has an important role to play in this sensitivity. Without such skill we would (...) be cut off from the full range of reasons to which moral agents need access and/or we would be deficient in the ability to weigh the reasons that we recognize. After arguing for the relevance of narrative skill, I argue that understanding the connection between reasons-sensitivity and narrative confers additional benefits. It illuminates important psychological structures and helps to explain some cases of diminished blame. (shrink)

Making good decisions depends on having accurate information – quickly, and in a form in which it can be readily communicated and acted upon. Two features of medical practice can help: deliberation in groups and the use of scores and grades in evaluation. We study the contributions of these features using a multi-agent computer simulation of groups of physicians. One might expect individual differences in members’ grading standards to reduce the capacity of the group to discover the facts on (...) which well-informed decisions depend. Observations of the simulated groups suggest on the contrary that this kind of diversity can in fact be conducive to epistemic performance. Sometimes, it is adopting common standards that may be expected to result in poor decisions. (shrink)

Principle 2 of the 2005 Mental Capacity Act (MCA) requires that decision-making capacity should be assumed, unless there is conclusive evidence, on a balance of probabilities, to the contrary (Department of Constitutional Affairs 2005). In his article “The Paradox of the Assessment of Capacity Under the Mental Capacity Act 2005,” Ajit Shah (2011) raises the concern that the new Deprivation of Liberty Safeguards (DOLS), introduced through the Mental Health Act (Department of Health 2007), conflict with this (...) principle (henceforth, the principle of presumed capacity) because, in practice, they will encourage the routine assessment of capacity even in the absence of any positive evidence of diminished capacity .. (shrink)

Economics today cannot predict the likely outcome of specific events any better than it could in the time of Adam Smith. This is Alexander Rosenberg's controversial challenge to the scientific status of economics. Rosenberg explains that the defining characteristic of any science is predictive improvability--the capacity to create more precise forecasts by evaluating the success of earlier predictions--and he forcefully argues that because economics has not been able to increase its predictive power for over two centuries, it is not (...) a science. (shrink)

Current suggestions for capacities that should be targeted for moral enhancement has centered on traits like empathy, fairness or aggression. The literature, however, lacks a proper model for understanding the interplay and complexity of moral capacities, which limits the practicability of proposed interventions. In this paper, I integrate some existing knowledge on the nature of human moral behavior and present a formal model of prosocial motivation. The model provides two important results regarding the most friction-free route to moral enhancement. First, (...) we should consider decreasing self-interested motivation rather than increasing prosociality directly. Second, this should be complemented with cognitive enhancement. These suggestions are tested against existing and emerging evidence on cognitive capacity, mindfulness meditation and the effects of psychedelic drugs and are found to have sufficient grounding for further theoretical and empirical exploration. Furthermore, moral effects of the latter two are hypothesized to result from a diminished sense of self with subsequent reductions in self-interest. (shrink)

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

Spearman’s Law of Diminishing Returns holds that correlation between general /fluid intelligence factor and other cognitive abilities weakens with increasing ability level. Thus, cognitive processing in low ability people is most strongly saturated by g/gf, whereas processing in high ability people depends less on g/gf. Numerous studies demonstrated that low g is more strongly correlated with crystallized intelligence/creativity/processing speed than is high g, however no study tested an analogous effect in the case of working memory. Our aim was to investigate (...) SLODR for the relationship between Gf and WM capacity, using a large data set from our own previous studies. We tested alternative regression models separately for three types of WM tasks that tapped short-term memory storage, attention control, and relational integration, respectively. No significant SLODR effect was found for any of these tasks. Each task shared with Gf virtually the same amount of variance in the case of low- and high-ability people. This result suggests that Gf and WM rely on one and the same cognitive mechanism. (shrink)

It is seemingly bad for animals to have their desires modified in at least some cases, for instance where brainwashing or neurological manipulation takes place. In humans, many argue that such modification interferes with our positive liberty or undermines our autonomy but this explanation is inapplicable in the case of animals as they lack the capacity for autonomy in the relevant sense. As such, the standard view has been that, despite any intuitions to the contrary, the modification of animals’ (...) desires is not harmful (at least not in itself). In this article, I offer a different perspective on this issue, laying the foundations of a novel argument in defence of the view that animals _can_ be harmed by desire modification directly. I suggest that the modification of an animal’s desires (under certain circumstances) is harmful for that animal because it undermines their agency. (shrink)

People whose person-making capacities or status are diminished or who lack them altogether are mostly ignored in mainstream theories of recognition. This entry clarifies the conceptual landscape around and some of the key questions about recognition in relation to these people. The concept of personhood is analyzed into three different sub-concepts – juridical, moral and psychological – and the connection of these to recognition on relevant concepts of recognition is discussed.

Depletion of mitochondrial endo/exonuclease G‐like (EXOG) in cultured neonatal cardiomyocytes stimulates mitochondrial oxygen consumption rate (OCR) and induces hypertrophy via reactive oxygen species (ROS). Here, we show that neurohormonal stress triggers cell death in endo/exonuclease G‐like‐depleted cells, and this is marked by a decrease in mitochondrial reserve capacity. Neurohormonal stimulation with phenylephrine (PE) did not have an additive effect on the hypertrophic response induced by endo/exonuclease G‐like depletion. Interestingly, PE‐induced atrial natriuretic peptide (ANP) gene expression was completely abolished in (...) endo/exonuclease G‐like‐depleted cells, suggesting a reverse signaling function of endo/exonuclease G‐like. Endo/exonuclease G‐like depletion initially resulted in increased mitochondrial OCR, but this declined upon PE stimulation. In particular, the reserve capacity of the mitochondrial respiratory chain and maximal respiration were the first indicators of perturbations in mitochondrial respiration, and these marked the subsequent decline in mitochondrial function. Although pathological stimulation accelerated these processes, prolonged EXOG depletion also resulted in a decline in mitochondrial function. At early stages of endo/exonuclease G‐like depletion, mitochondrial ROS production was increased, but this did not affect mitochondrial DNA (mtDNA) integrity. After prolonged depletion, ROS levels returned to control values, despite hyperpolarization of the mitochondrial membrane. The mitochondrial dysfunction finally resulted in cell death, which appears to be mainly a form of necrosis. In conclusion, endo/exonuclease G‐like plays an essential role in cardiomyocyte physiology. Loss of endo/exonuclease G‐like results in diminished adaptation to pathological stress. The decline in maximal respiration and reserve capacity is the first sign of mitochondrial dysfunction that determines subsequent cell death. (shrink)

While the concept of humanity is most often referred to as the moral source of the Responsibility to Protect’s motivational capacity, humanity’s normative status and value has continued to be left assumed and/or unexplored. Consequently, there remains a considerable lack of analysis into humanity’s role in supposedly helping to both locate moral harm and subsequently provide a motivational cause that can drive protection practices in support of the Responsibility to Protect principle. In response to this lacuna, this article puts (...) forward three hypotheses regarding the motivational role of humanity in this process: humanity functioning as a rhetorical tool with no motivational qualities, humanity as a concept that works to redefine sovereignty in support of the Responsibility to Protect and humanity as a motivating principle that ultimately diminishes in influence as the Responsibility to Protect principle is diffused into action. Through this analysis, the article offers a more rigorous and sy... (shrink)

Persons of diminished capacity, especially those who are still legally competent but are de facto incompetent should still be able to participate in moderately risky research projects that benefit the class of persons with similar diseases. It is argued that this view can be supported with a modified communitarianism, a philosophy ofmedicine that holds that health care is a joint responsibility that meets foundational human needs. The mechanism for obtaining a substituted consent I call ``community consent,'' and distinguish (...) this from the usual family or surrogate consent for treatment. Care givers are included in the community that might consent for an individual who has no identifiable family members. (shrink)

Psychopaths exhibit diminished ability to grieve. Here I address whether this inability can be explained by the trademark feature of psychopaths, namely, their diminished capacity for interpersonal empathy. I argue that this hypothesis turns out to be correct, but requires that we conceptualize empathy not merely as an ability to relate (emotionally and ethically) to other individuals but also as an ability to relate to past and present iterations of ourselves. This reconceptualization accords well with evidence regarding (...) psychopaths’ intense focus on the temporal present and difficulties in engaging in mental time travel, as well as with the essentially egocentric and identity-based nature of grief. -/- . (shrink)

Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics Committees) can only (...) identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity. (shrink)

When should someone who may have intentionally or knowingly committed criminal wrongdoing be excused? Excusing Crime examines what excusing conditions are, and why familiar excuses, such as duress, are thought to fulfil those conditions. Setting himself against the 'classical' view of excuses, which has a long heritage, and is enshrined in different forms in many of the world's criminal codes, both liberal and non-liberal; Jeremy Horder argues that it is now time to move forwards. He contends that a wider range (...) of excuses - 'diminished capacity', 'due diligence' and 'demands of conscience' - should be recognised in law. (shrink)

Debates concerning whether Attention Deficit/Hyperactivity Disorder mitigates responsibility often involve recourse to its genetic and neurodevelopmental etiology. For such arguments, individuals with ADHD have diminished self-control, and hence do not fully satisfy the control condition for responsibility, when there is a genetic or neurodevelopmental etiology for this diminished capacity. In this article, I argue that the role of genetic and neurobiological explanations has been overstated in evaluations of responsibility. While ADHD has genetic and neurobiological causes, rather than (...) embrace the essentialistic notion that it directly diminishes self-control and, therefore, responsibility, we ought to think of ADHD as constraining only some self-control practices. In particular, situational self-control strategies remain feasible for people with ADHD. However, not all individuals have access to these strategies. I suggest a way to evaluate responsibility in terms of situational rather than agential pleas, which tracks whether the individual had access to self-control behaviors. While I restrict my discussion to ADHD, the access-based approach is also relevant for assessments of responsibility for other cases where self-control failures are at stake. (shrink)

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when (...) similarly situated incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death. (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

Philosophical writing on the welfare state has taken a defensive turn in recent years, largely in response to two related phenomena: the re-emergence of pro-market ideologies in the larger political culture and the imperiled condition of real world welfare states in a global economy in which national governments have diminishing capacities for shaping the social and economic lives of their citizens. But thanks in part to the tireless advocacy of Philippe Van Parijs, an even more radically redistributive form of public (...) provision than the welfare state has come onto the intellectual agenda—and the political agenda too, at least in Belgium and the Netherlands. Van Parijs proposes that all citizens be accorded an unconditional “basic income grant” as large as is compatible with the need to generate as much wealth as possible for redistribution. By now, this idea has many defenders. It also boasts a genealogy extending back to such writers as Tom Paine, François Huet, Edward Bellamy and G. D. H. Cole. But Van Parijs has become its best-known and most adept philosophical proponent, and this book represents his most sustained effort to date to investigate its normative foundations. (shrink)

Peterson, Karlawish and Largent offer a defense of supported decision making in health care for people with dynamic and diminishing capacity. They are to be warmly commended for bringing sup...

I argue that emotional sensitivity (or insensitivity) has a marked negative influence on ethical perception. Diminished capacities of ethical perception, in turn, mitigate what we are morally responsible for while lack of such capacities may altogether eradicate responsibility. Impairment in ethical perception affects responsibility by affecting either recognition of or reactivity to moral reasons. It follows that emotional insensitivity (together with its attendant impairment in ethical perception) bears saliently on moral responsibility. Since one distinguishing mark of the psychopath is (...) emotional insensitivity, emotional insensitivity and the resulting impairment in moral perception either excuses the psychopath from moral culpability or moderates the degree to which he is culpable. (shrink)

Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as _the responsibility problem_, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients’ potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to (...) do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model. (shrink)

Over the course of an illustrious career, the late Bernard Diamond established himself as the preeminent forensic psychiatrist of the century. _The Psychiatrist in the Courtroom_ brings together in a single volume Diamond's pivotal contributions to a variety of important issues, including the nature of diminished capacity, the fallacy of the impartial expert, the predictability of dangerousness, and the unacceptability of hypnotically facilitated memory in courtroom proceedings. Ably introduced and edited by Jacques M. Quen, M.D., a close colleague (...) of Diamond's and leading historian of forensic psychiatry, these writings enable experts and neophytes alike to track Diamond's evolving positions while clarifying where current legal and psychiatric opinion converge -- and diverge -- on a host of critical topics. For the forensic specialist, _The Psychiatrist in the Courtroom_ is not only an invaluable reference work but a compassionate reminder of the clinician's obligation to protect patients in legal proceedings. And in an age when clinicians are increasingly called into court, the book will be no less valuable to psychoanalysts and other mental health professionals eager for an introduction to the intricacies of judicial reasoning. Then, too, owing to Diamond's clinical acumen, the book is a compelling human document. With great erudition and deep compassion, Diamond tackles these and other knotty questions, always with an eye to clarifying the legal and clinical implications of the answers. By combining superb clinical gifts with an incisive understanding of legal principle, Diamond produced a seminal corpus whose relevance to discussions of therapeutic ethics and to legal debates will continue well into the next century. (shrink)

In this Article I will challenge the tendency to discount the severity of domestic homicide, a phenomenon I call "the domestic discount." I will argue against automatic mitigation-the imputation of provocation or diminished capacity-simply or merely because the relationship" between victim and defendant is domestic or sexually intimate. I will argue that the traditional hot blood/cold blood dichotomy is an imperfect guide to the moral grading of homicide offenses. In particular, reliance on it has led to the under (...) evaluation of the seriousness of some domestic homicides. It is my contention, or hypothesis, that the conclusions I draw from the study of capital domestic cases can be generalized to the entire domain of domestic homicides: If homicide laws were purged of patriarchal values, the remaining principles that underlie our grading of homicide offenses would be consistent with the rejection of a domestic discount; the worst domestic murders like the worst predatory murders would rank among the most reprehensible crimes. (shrink)

Do persons from disadvantaged backgrounds deserve as much blame for their immoral or criminal acts as persons who have had all the advantages? Many liberals feel inclined to say ‘no.’ After all, there is a high correlation between criminal activity and a disadvantaged background; indeed, it might fairly be said that poverty breeds crime. Taken in its most obvious direction, however, this line of argument has dangerous deterministic implications. The price of diminished blame is diminished responsibility. We absolve (...) the disadvantaged by portraying them as persons with a diminished capacity for free action. In the extreme case, we view them as victims of circumstance, utterly unable to act other than they do. Thus is born the demeaning parentalism of the worst sort of liberal social worker.Still, there is something correct in the liberal impulse to deny or diminish blame in at least many of these cases for something like the reason that the liberal offers. The task of this paper is to explain what is right about it. More generally, I want to show how we can take a person’s background into account in judging her for her acts without falling into total or partial determinism. In other words, my task is to establish that diminished blame is compatible with full freedom and responsibility. Roughly, I shall argue that we cannot blame someone for her acts if they are permitted or required by moral conclusions that are rational for someone in her position to reach. (shrink)

This essay review addresses the central responsibility thesis of David Brink's "Fair. Opportunity and Responsibility" and then considers two applications of the central. Thesis: legal insanity and diminished capacity.

The constant threats to scientific progress are complacency and the diminished capacity for self-criticism. There have been great advances in our understanding of the functional anatomy of the nervous system, advances that stand in vivid contrast to our understanding of the moral, aesthetic and political dimensions of human life. The contrast is so great as to encourage the belief that these dimensions are found beyond the ambit of scientific explanation. How pathetic, then, to witness strident and smug attacks (...) on those who have reached this plausible and profound conclusion. (shrink)

The prevention of sexual violence is a major goal of sexual health. In cases of accused sexual offenders, the assessment of diminished criminal responsibility of the accused is one of the most important procedures undertaken by experts in the German legal system. This assessment follows a two-stage method assessing first the severity of a paraphilic disorder and then second criteria for or against diminished capacity. The present study examines the predictive validity of two different sets of criteria (...) for the assessment of criminal responsibility in the context of paraphilic disorders combined with sexual offending. Two exemplary case vignettes of two suspected sexual offenders were developed to assess the criteria. For each participant, one of the two exemplary case vignettes was randomly presented. The presentation of the two different sets of criteria was also randomized, so that each participant was assigned only one of the two criteria sets to rate one of the presented cases. N = 349 participants from different professional backgrounds completed their assessments and were included in the data analysis. The data were evaluated using logistic regression. Results show that the more recently published criteria set predicts both the severity of the disorder as well as the diminished capacity twice as good as the older criteria set of Boetticher et al. currently used regularly for forensic court reports. In preliminary conclusion, the new criteria of Briken and Müller form an empirically based assessment of criminal responsibility. However, the proposed criteria cannot replace an extensive exploration of the accused person and a careful file analysis. Validity and reliability of the results are also limited due to the methodical choice of a vignette study. (shrink)

This article, grounded in ecofeminism, considers the earth as symbolising women and girls and the liberation of women and girls as the liberation of the earth. When the environment is liberated from abuse, its capacity to sustain human life is enhanced. In the same way, when women and girls are freed from all forms of oppression and exploitation and are allowed to be self-actualising people, their capacity to contribute meaningfully to sustainable development and human welfare is enhanced. Given (...) that women and girls play key culturally prescribed roles such as being carriers of life through childbirth, nurturing, caregiving and serving as pillars of the home, their oppression and exploitation stifle their contribution to societal development, thereby curtailing sustainable development. Similarly, abuse of the earth results in environmental crises such as floods, droughts, famine, heat waves and global warming, resulting in the earth’s diminished capacity to sustain life. This study was based on literature review and informal interviews involving participants from three churches (the Reformed Church in Zimbabwe, the Apostolic Faith Mission in Zimbabwe and the Johanne Marange Apostolic Church). This article examined the extent to which religion can empower women to participate in public activities including environmental management, epitomised by the way women and girls in the selected churches are perceived and treated. It is concluded that religion can be both liberating and binding to women and girls and, by implication, Mother Earth.Contribution: This article highlights parallels between females and Mother Earth, using the treatment of women and girls in three churches as the springboard of the discussion. It considers how far such treatment can promote their participation in public spheres that include taking care of and managing the environment. (shrink)

Mein Beitrag untersucht die folgende Fragestellung: „Kann S gerechtfertigt sein, X zu tun, wobei es erlaubt ist, X zu tun, wenn die Bedingungen B vorliegen, wenn S fälschlich, aber vernünftigerweise glaubt, dass die Bedingungen B vorliegen?“ Ich plädiere für eine Bejahung dieser Frage, und zwar im Gegensatz zu der von Joachim Hruschka in seinem Aufsatz „Justifications and Excuses: A Sy-stematic Approach“ vertretenen Posi-tion. Ich bin der Auffassung, daß eine Rechtfertigung eine vernünftige Annahme voraussetzt; es ist nicht notwendig, daß diese Annahme (...) auch zutrifft. Dass S vernünftigerweise glaubt, daß p, während in Wirklichkeit p nicht vorliegt, scheint jedenfalls kein entschuldigender Umstand zu sein. Diese Situation ist vielmehr wesentlich unterschieden von krankheitsbedingter Zurechnungsunfähigkeit oder sonst verminderter geistiger Fähigkeit. Es ist daher wichtig, zwischen zwei Arten von Gründen zu unterscheiden, die dazu führen, daß eine Person nicht verantwortlich gemacht wird für X, obwohl sie X getan hat; und zwar sind dies einerseits Gründe, die im Hinblick auf Probleme der handelnden Person selbst entschuldigend wirken, und andererseits solche Gründe, die weder einen Mangel noch Verwirrung der handelnden Person selbst reflektieren, noch einen Fehler in dem Entscheidungsprozeß, der zu der Handlung geführt hat. My essay addresses the following question: "Can S be justified in doing X, where it is permissible to do X when conditions C obtain, if S mistakenly but reasonably believes that conditions C do obtain?" I defend an affirmative reply, contrary to the position taken by Prof. Hruschka in his "Justifications and Excuses: A Systematic Approach" . I understand justification as requiring reasonable belief; it is not necessary that the belief be true. That S believes on reasonable grounds that p when in fact p is false seems not to be an excusing condition. It is importantly different from insanity, or diminished capacity. I stress the importance of differentiating between two very different kinds of reasons for holding someone not to be culpable for X despite having done X, viz, reasons that exculpate due to problems with the agent himself and those that do not reflect any deficiency or disorder in the agent, or any flaw in the process by which she chose as she did. (shrink)