Amyotrophic lateral sclerosis (ALS; also called motor neuron disease) is a devastating medical condition that progressively robs patients of their ability to move, speak and eventually breathe. At present, many physicians are hesitant to propose tracheostomy and respiratory support in the terminal phase of ALS. In accordance with the principle of patient autonomy, physicians should respect the right of the ALS patient to accept or refuse any treatment, including mechanical ventilation. Also, in environments where euthanasia or physician-assisted death is legal, (...) such requests can be acceptable. At least two conditions are necessary for full autonomy. To have a claim on full autonomy, people need to have intact cognitive abilities, and to exercise this right they must be able to communicate. In the past, the first condition was in doubt (indeed, overlap with other neurodegenerative diseases is sometimes suspected and some patients with ALS are thought to have associated frontotemporal dementia) and the second was severely compromised in patients with devastating motor impairment (communication being limited to the twitch of a finger or the blink of an eye). In this issue of J Neurol Neurosurg Psychiatry, Lakerveld and colleagues1 investigated cognition in 11 patients with late stage ALS (see page 25). They showed preserved cognitive functioning (ie, language, executive function, intelligence, learning and long term memory) compared with healthy controls. Assessments were exclusively based on a ‘‘yes–no’’ response mode. Because of the absence of verbal and motor communication, the neuropsychological assessment of these patients is complicated, and adapted testing is needed. By using a ‘‘yes–no’’ response mode based on the remaining motor abilities of the patient, this study proves the possibility of assessing patients with minimal motor capacities. (shrink)

The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We note (...) the ethical importance of such understanding: proper interpretation and communication facilitate health care decision making. Communication that facilitates interpretation is of moral significance since better communication can attenuate ethical problems and inform choices. Much of what is communication worthy about QOL assessments is determined by the particular QOL instrument used in the assessment and how it is administered. In practice, these choices will be driven by the purpose of the assessment, but, it is argued, to maximize understanding, we should combine the information garnered from traditional standardized QOL instruments, from individualized QOL assessments, and from a recently proposed dialogic paradigm, where QOL is determined by shared conversation regarding the interpretation of texts. And, while some studies can surely succeed using abbreviated methods of administration (e.g., postal surveys may suffice for certain purposes), we will focus on methods of administration involving interviewer–respondent interaction. We suggest that during the QOL elicitation process, interviewer and respondent should engage in a two-way conversation in order to achieve a shared understanding of the “answers” to QOL “questions” and, finally, to reach a shared interpretation of the individual’s QOL. (shrink)

We propose a new approach for tracing value change. Value change may lead to a mismatch between current value priorities in society and the values for which technologies were designed in the past, such as energy technologies based on fossil fuels, which were developed when sustainability was not considered a very important value. Better anticipating value change is essential to avoid a lack of social acceptance and moral acceptability of technologies. While value change can be studied historically and qualitatively, we (...) propose a more quantitative approach that uses large text corpora. It uses probabilistic topic models, which allow us to trace values that are latent. We demonstrate the approach for five types of value change in technology. Our approach is useful for testing hypotheses about value change, such as verifying whether value change has occurred and identifying patterns of value change. The approach can be used to trace value change for various technologies and text corpora, including scientific articles, newspaper articles, and policy documents. (shrink)

O livro almeja ser representativo nos principais debates contemporâneos, oferecendo uma visão panorâmica sobre o campo na atualidade e permitindo-se aprofundar em algumas discussões selecionadas.O ambiente não pode ser reduzido ao “meio ambiente”, à natureza não humana. Ele não é meramente algo que “nos envolve”, um envoltório: o ambiente somos também nós, seres humanos, histórica e culturalmente situados. Quanto aos territórios, eles se estabelecem em íntima conexão com os ambientes em suas dimensões paisagística e material, quer sejam os processos geoecológicos, (...) quer sejam as formas e as dinâmicas socialmente produzidas. Analisar os territórios significa examinar como, a cada momento, os ambientes, seus recursos e significados são disputados e viram objeto de conflitos.O público-alvo principal são os estudantes dos últimos anos da graduação, além daqueles em nível de pós-graduação, de todas as áreas que lidam com problemas e conflitos ambientais. Afora os pesquisadores iniciantes e os jovens universitários em geral, porém, podemos presumir que profissionais experientes também poderão tirar proveito do material de diversos capítulos. É razoável, por fim, nutrir a expectativa de que muito do que este livro contém possa (retro)alimentar o ativismo ambiental crítico e a prática de combater as iniquidades e as distorções que se acumulam em nossas sociedades, principalmente as muitas situações de flagrante injustiça ambiental. (shrink)

In a single volume intended for philosophy students of all levels as well as their teachers, this reader provides modern, accurate translations of the texts necessary for a careful study of most aspects of Aristotle's philosophy. Professor Ackrill has drawn on his broad experience of teaching graduate classes in selecting the texts, and his choice reflects issues of current philosophical interest as well as the perennial themes. Only recent translations which achieve a high level of accuracy have been chosen: the (...) aim is to place the reader without Greek, as nearly as possible, in the position of a reader of Greek. As an aid to study, a valuable guide to the key topics covered is also suppied, giving references to works or passages contained in the reader, an indication of their interrelation, and a currnet bibliography. (shrink)

The definition of acedia presents unique conceptual problems among the eight Evagrian logismoi. Its descriptions are so complex and varied as to render the concept seemingly incoherent. This article argues that the conceptual unity of acedia has been obscured by the translation of Evagrian logismoi into the ‘deadly sins’ tradition, resulting in a category error. Acedia is more properly understood, not as a psychological state or a sin, but rather as an array of demonic temptations with the unifying end-goal of (...) interrupting the anchoritic ideal of sustained contemplation. (shrink)

What would be sufficient to show of some apparently higher-level property that it is 'nothing over and above' some complex configuration of more basic properties? This paper defends a new method for justifying reductions by demonstrating its comparative advantages over two methods recently defended in the literature. Unlike its rivals, what I'll call "the semantic method" makes a reduction's truth epistemically transparent without relying on conceptual analyses.

We argue that Parfit's "Triviality Objection" against some naturalistic views of normativity is not compelling. We think that once one accepts, as one should, that identity statements can be informative in virtue of their pragmatics and not only in virtue of their semantics, Parfit's case against naturalism can be overcome.

This essay applies to the morality of lying and other deception a sketch of a kind of virtues-based, input-driven, role-centered, patient-focused, ethical theory. Among the questions treated are: What is wrong with lying? Is it always and intrinsically immoral? Can it be correct, as some have vigorously maintained, that lying is morally wrong in some circumstances where other forms of deliberate dissimulation are not? If so, how can that be? And how can it be that lying to someone is immoral (...) when other, harsher ways of treating her are permissible? The essay examines several responses to the first question, and suggests that lying violates morality as an excessive departure from the role-derived virtues of charity and justice: the liar wills another person the evil of false belief precisely in the proposition for which the speaker offers her assurance and takes special responsibility in asserting. So conceived, lying is an especially egregious form of treachery and degrading manipulation of another person. Appeal is then made to the gravity inherent in lying so conceived to suggest ways of answering the other questions which would support the traditional Augustinian claim that lying is inherently impermissible and ineligible in circumstances where other forms of deliberate deception may not be, and even in situations where violent attack may be permissible.At the end, a taxonomy of more and less rigorist positions of lying is offered. A tentative proposal is made that, while consistent with the traditional Augustinian rigorist position that Iving is always immoral, nevertheless has some features that may slightly soften that view’s practical application. The proposed view does this in a way similar to that in which allowing moral dilemmas may soften it, for allowing dilemmas means there may be cases where an act of a type always immoral may still be more eligible than any alternative. However, it is maintained that the view here proposed need not countenance genuine dilemmas. (shrink)

The ArgumentA brief review of the Merton thesis shows that its restriction to England is arbitrary. An example from the historiography of modern physics suggests the possible payoff of an ecumenical Merton thesis and the means to explore it. A summary of the careers of men who practiced science literally in the church – men who built meridian lines in Italian cathedrals – indicates the range of social support of astronomical studies by Catholic institutions in the seventeenth and eighteenth centuries.

This is an invited response to Peter Forrest’s review of my trilogy on the philosophy of religion, which appeared in a previous issue of this journal.