When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

PurposeTo examine the contribution of “values-based reasoning” in evaluating older adults’ capacity to make medical decisions.Design and MethodsOlder men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics.ResultsParticipants varied widely in the activities and relationships they most valued, the extent to which (...) religious beliefs would influence healthcare decisions, and in ratings of the importance of preserving quality versus length of life. Most participants preferred shared decision making with doctor, family, or both. Individuals with schizophrenia or dementia performed worse than a primary care comparison group in reasoning measured by the ability to list risks and benefits and compare choices. Individuals with dementia performed comparably to the primary care group in reasoning measured by the ability to justify choices in terms of valued abilities or activities, whereas individuals with schizophrenia performed relatively worse compared to the other two groups. Compared to primary care patients, participants with schizophrenia and with dementia were impaired on the ability to explain treatment choices in terms of valued relationships.ConclusionMedical decision making may be influenced by strongly held values and beliefs, emotions, and long life experience. To date, these issues have not been explicitly included in structured evaluations of medical decision-making capacity. This study demonstrated that it is possible to inquire of and elicit a range of healthcare related values and preferences from older adults with dementia or schizophrenia, and individuals with mild to moderate dementia may be able to discuss healthcare options in relation to their values. However, how best to incorporate a values assessment into a structured capacity evaluation deserves further research attention. (shrink)

Two essays on utilitarianism, written from opposite points of view, by J. J. C. Smart and Bernard Williams. In the first part of the book Professor Smart advocates a modern and sophisticated version of classical utilitarianism; he tries to formulate a consistent and persuasive elaboration of the doctrine that the rightness and wrongness of actions is determined solely by their consequences, and in particular their consequences for the sum total of human happiness. In Part II Bernard Williams offers a sustained (...) and vigorous critique of utilitarian assumptions, arguments and ideals. He finds inadequate the theory of action implied by utilitarianism, and he argues that utilitarianism fails to engage at a serious level with the real problems of moral and political philosophy, and fails to make sense of notions such as integrity, or even human happiness itself. This book should be of interest to welfare economists, political scientists and decision-theorists. (shrink)

In this article I try to refute the so-called "libertarian" theory of free will, and to examine how our conclusion ought to modify our common attitudes of praise and blame. In attacking the libertarian view, I shall try to show that it cannot be consistently stated. That is, my dscussion will be an "analytic-philosophic" one. I shall neglect what I think is in practice an equally powerful method of attack on the libertarian: a challenge to state his theory in such (...) a way that it will fit in the modern biology and psychology, which are becoming increasingly physicalistic. (shrink)

In twelfth-century Europe schools flourished in many centres. There were schools in monasteries and cathedrals, primarily for the education of monks and priests but often open also to laymen. In Italian towns, especially, there were lay schools teaching law and commercial skills to fee-paying students. In France, especially, also in England and other countries, there were schools for feepaying students of the liberal arts. The traditional list of the liberal arts included seven: grammar, logic and rhetoric (the "trivium"), and arithmetic, (...) geometry, astronomy and music (the "quadrivium"): most of the schools we're talking about taught the trivium, grammar, logic and rhetoric. These three disciplines in one way or other taught language skills; they were sometimes called the artes sermocinales. Students who had completed these "trivial" studies sometimes moved on to theology, or sometimes set up as teachers themselves of grammar, logic and rhetoric. Some students travelled from country to country looking for a good school, and sometimes made their living for a while by teaching before becoming students again. (shrink)

In this essay I propose to offer some observations in due course on how Christian thought and practice in general might profit from a central theme in the theology of Rāmānuja, a Tamil Vaisnava Brahmin whose traditional date straddles the eleventh and twelfth centuries of the Christian era. The central theme I have in mind is expressed in Rāmānuja's view that the ‘world’ is the ‘body’ of Brahman or God. We shall go on to explain what this means, but let (...) me state first that my overall aim is to further inter-religious understanding, especially between Christian and Hindu points of view. In professing a concern for inter-religious dialogue I know that I reflect a longstanding interest of Professor H. D. Lewis. I shall seek to show that the Christian religion can profit both from the content and the method of Rāmānuja's body-of-God theology. To this end this essay is divided into two sections. Section I is the longer: it contains an analysis of what Rāmānuja did mean by his body-of-God theme – doubtless unfamiliar ground for most of the readers of this essay – and serves as a propaedeutic for what follows in section 2. In section 2 I shall attempt to ‘extrapolate’ Rāmānuja's thinking into a Christian context, with dialogue in mind. Section 2 cannot be appreciated for the promise I hope it holds out without the detail of the first section. (shrink)

J.S. Mill's plural voting proposal in Considerations on Representative Government presents political theorists with a puzzle: the elitist proposal that some individuals deserve a greater voice than others seems at odds with Mill's repeated arguments for the value of full participation in government. This essay looks at Mill's arguments for plural voting, arguing that, far from being motivated solely by elitism, Mill's account is actually driven by a commitment to both competence and participation. It goes on to argue that, for (...) Mill, much of the value of political participation lies in its unique ability to educate the participants. That ability to educate is not, however, a product of participation alone; rather, for Mill, the true educative benefits of participation obtain only when competence and participation work together in the political sphere. Plural voting, then, is a mechanism for allowing Mill to take advantage of the educative benefits that arise from the intersection of competence and participation. (shrink)

This paper begins with a Davidsonian puzzle in the epistemology of perception and introduces two solutions to that puzzle: the Truth-Maker View (TMV) and the Content Model. The paper goes on to elaborate (TMV), elements of which can be found in the work of Kalderon (2011) and Brewer (2011). The central tenant of (TMV) is the claim that one's reason for one's perceptual belief should, in all cases, be identified with some item one perceives which makes the proposition believed true. (...) I defend an argument against (TMV) which appeals to (a) the claim that the reason for which one believes should always to be identified with the explanans of the rationalising explanation to which one's belief is subject and (b) the claim that the explanantia of rationalising explanations must be identified with truths. I finish by replying to two objections to the argument. (shrink)

Abstractabstract:Vaccine hesitancy continues to pose a formidable obstacle to increasing national COVID-19 vaccination rates in the US, but this is not the first time that American vaccination efforts have confronted resistance and apathy. This study examines the history of US vaccination efforts against smallpox, polio, and measles, highlighting persistent drivers of vaccine hesitancy as well as factors that helped overcome it. The research reveals that logistical barriers, negative portrayals in the media, and fears about safety stymied inoculation efforts as early (...) as the 18th century and continue to do so. However, vaccine hesitancy has been markedly diminished when trusted community leaders have guided efforts, when ordinary citizens have felt personally invested in the success of the vaccine, and when vaccination efforts have been tied to broader projects to improve public health and social cohesion. Deliberately cultivating such factors could be an effective strategy for lessening opposition today, when COVID-19's distinctive characteristics make addressing vaccine hesitancy more urgent than it has ever been. (shrink)

This article engages various critiques of Fair Trade, from its participation in commodification to providing a cover for "Fair-washing" corporations, and argues that Fair Trade has the potential to answer the challenges contained within them if and when it initiates an ongoing process of developing the "ethical valuedadded" content of the label. This argument is made in a number of ways. First, by distinguishing between economic and human development impacts and ethics, this article argues that these impacts are necessary but (...) not sufficient conditions for ethical trade. Second, it engages the question of the possibility of ethical practice in economics generally; developing the idea that when economics is concerned with securing the material basis of a broad range of life capacities it becomes ethical. Third, Fair Trade practice itself is examined from this standpoint, and is conceived of as both comprising a promising ethical value-added practice as well as posing a problem in its current formulation that the framework of ethical valueadded can help understand and resolve. Finally, an examination of these theoretical ideas in practice is undertaken through a case study of Café Femenino, a Fair Trade coffee produced in Peru. In conclusion it is argued that for Fair Trade to build upon its economic and human impacts, and therefore remain a meaningful ethical and economic alternative to corporate capitalism and globalization, it must distinguish itself clearly in ethics from those market relations it wishes, explicitly or implicitly, to challenge. (shrink)

The primary aim of the text is to introduce the reader to the relationship between economics and ethics and to the application of economic ethics in the evaluation of the market. The reader will gain insight into: * The ethical and methodological strategy of economics and criticism of the core assumptions that underpin the economic defense of free market operation. * The characteristics of different ethical theories (utilitarianism, duty and rights ethics, justice and virtue ethics) that can be used to (...) evaluate the free market. * How to apply economics in conjunction with ethical theories to evaluate economic trends and policies that promote the free operation of the market and are subject to public debate. These insights will help to develop the reasoning and analytical skills needed to criticize economic analysis as well as to apply ethical concepts to moral issues in economic policy. (shrink)