In 2011 the English Court of Protection ruled that it would be unlawful to withdraw artificial nutrition and hydration from a woman, M, who had been in a minimally conscious state for 8 years. It was reported as the first English legal case concerning withdrawal of artificial nutrition and hydration from a patient in a minimally conscious state who was otherwise stable. In the absence of a valid and applicable advance decision refusing treatment, of other life-limiting pathology or excessively burdensome (...) suffering, the judgement makes it clear that the obligation on health professionals falls strongly in favour of preserving life. Although the Court sought to limit the judgement as closely as possible to the facts of the case, it is likely to have a significant impact on life-sustaining treatment decisions for people in states of low awareness. This paper outlines the main legal features of the judgement. (shrink)
I contend that mathematical domains are freestanding institutional entities that, at least typically, are introduced to serve representational functions. In this paper, I outline an account of institutional reality and a supporting metaontological perspective that clarify the content of this thesis. I also argue that a philosophy of mathematics that has this thesis as its central tenet can account for the objectivity, necessity, and atemporality of mathematics.
I discuss a puzzle that shows there is a need to develop a new metaphysical interpretation of mathematical theories, because all well-known interpretations conflict with important aspects of mathematical activities. The new interpretation, I argue, must authenticate the ontological commitments of mathematical theories without curtailing mathematicians' freedom and authority to creatively introduce mathematical ontology during mathematical problem-solving. Further, I argue that these two constraints are best met by a metaphysical interpretation of mathematics that takes mathematical entities to be constitutively constructed (...) by human activity in a manner similar to the constitutive construction of the US Supreme Court by certain legal and political activities. Finally, I outline some of the philosophical merits of metaphysical interpretations of mathematical theories of this type. (shrink)
The recent judgement in the case of Re:M in which the Court held that it would be unlawful to withdraw artificial nutrition and hydration from a woman in a minimally conscious state raises a number of ethical issues of wide application. Central to these is the extent to which precedent autonomous decisions should be respected in the absence of a legally binding advance decision. Well-being interests can survive the loss of many of the psychological faculties that support personhood. A decision (...) to respect precedent autonomy can contradict the well-being interests of the individual after capacity is lost. These decisions raise difficult questions about personal identity and about the threshold of evidence that is required of an earlier decision in order for it to be respected. (shrink)
At the University of Pretoria the author, a practical theologian, experiences a fruitful soil for the development of an interdisciplinary process. He referred to concrete examples of cooperation, but used the article to reflect on best practices for the interdisciplinary dialogue. He came to the conclusion that it probably made more sense to talk of Practical-theological alternatives rather than to describe the subject in a single fixed manner of understanding and action. Our goal should rather be to open up the (...) boundaries between Practical Theology, Human, Social and Natural Sciences. (shrink)
In this article, I articulate and defend an account of corporations motivated by John Searle’s discussion of them in his Making the Social World. According to this account, corporations are abstract entities that are the products of status function Declarations. They are also connected with, though not reducible to, various people and certain of the power relations among them. Moreover, these connections are responsible for corporations having features that stereotypical abstract entities lack (e.g., the abilities to take actions and make (...) profits). (shrink)
Dementia affects millions of people throughout the world. Thinking through Dementia offers a critique of the main models used to understand dementia-the biomedical, neuropsychological, and social constructionist. It discusses clinical issues and cases, together with philosophical work that might help us to better understand and treat this illness.
Background For a variety of sociological reasons, different types of centredness have become important in health and social care. In trying to characterize one type of centredness, we were led to consider, at a conceptual level, the importance of the notion of centredness in general and the reasons for there being different types of centeredness. Method We searched the literature for papers on client-, family-, patient-, person- and relationship- centred care. We identified reviews or papers that defined or discussed the (...) notions at a conceptual level. The reviews and papers were analyzed as text transcripts. Results We identified 10 themes that were common to all the types of centredness. At a conceptual level we could not identify thematic differences between the types of centredness. These findings were subjected to a philosophical critique using ideas derived from Wittgenstein. Conclusion Different types of centredness are required in different contexts. The differences are justified by their practical utility. The unifying themes of centredness, however, reflect a movement in favour of increasing the social, psychological, cultural and ethical sensitivity of our human encounters. (shrink)
Two topics figure prominently in recent discussions of mathematical structuralism: challenges to the purported metaphysical insight provided by sui generis structuralism and the significance of category theory for understanding and articulating mathematical structuralism. This article presents an overview of central themes related to these topics.
Stereotypes of social construction suggest that the existence of social constructs is accidental and that such constructs have arbitrary and subjective features. In this paper, I explore a conception of social construction according to which it consists in the collective imposition of function onto reality and show that, according to this conception, these stereotypes are incorrect. In particular, I argue that the collective imposition of function onto reality is typically non-accidental and that the products of such imposition frequently have non-arbitrary (...) and objective features. These conclusions are interesting in and of themselves since they debunk important aspects of our socially constructed conception of social construction. Yet, additionally, they have important implications for the viability of mathematical social constructivism since resistance to such constructivism is frequently grounded in the observation that mathematics is non-accidental, non-arbitrary, and objective. As a secondary focus, I explore these implications in this paper. (shrink)
This article forms part of a study which was inspired by the ever-growing need for significance expressed both by my life coaching and pastoral therapy clients as well as the need for existential meaning reported both in the lay press and academic literature. The study reflected on a life that matters with a group of co-researchers in a participatory action research relationship. The study has been positioned within pastoral theology and invited the theological discourse into a reflection of existential meaning. (...) Adopting a critical relational constructionist epistemology, the research was positioned within a postmodern paradigm. The implications for meaning and research were explored and described. This article tells the story of how spirituality was positioned in the narratives of meaning by my fellow researchers. (shrink)
Although the concept of randomized assignment in order to control for extraneous confounding factors reaches back hundreds of years, the first empirical use appears to have been in an 1835 trial of homeopathic medicine. Throughout the 19th century there was a growing awareness of the need for comparison groups, albeit often without the realization that randomization could be a clean method to achieve that goal. In the second and more crucial phase of this history, four separate but related disciplines introduced (...) randomized control trials within a few years of one another in the 1920s: agricultural science; clinical medicine; educational psychology; and social policy. This brought increasing rigor to fields that were focusing more on causal relationships. In a third phase, the 1950s through 1970s saw a surge of interest in more applied randomized experiments in economics and elsewhere – both in the lab and especially in the field. (shrink)
1.1 ContextIn the period following the demise of logicism, formalism, and intuitionism, contributors to the philosophy of mathematics have been divided. On the one hand, there are those who tend to focus on such issues as: Do mathematical entities exist? If so, what type of entities are they and how do we know about them? If not, how can we account for the role that mathematics plays in our everyday and scientific lives? Contributors to this school—let us call it the (...) analytic school—do not, on the whole, concern themselves with careful analyses of important historical developments in mathematics. On the other hand, there are those who contribute to an historical school in the philosophy of mathematics. Contributors to this school tend to concern themselves almost exclusively with detailed historical analyses of important developments in mathematics. They are typically interested in answering questions concerning the growth of mathematical knowledge.In recent years, interest in the historical school has been growing, as has its influence on the analytic school. This book marks another stride in this direction. Oliveri aims to employ tools developed for use within the historical school to address one of the major issues investigated by the analytic school, i.e., whether we should be realists or anti-realists about mathematics. This is a laudable objective, since even a successful partial integration of these two schools would be valuable to contributors within both.1.2 Noteworthy ContributionsIn attempting a partial integration of these two schools, Oliveri makes several noteworthy contributions. The most significant is his development of a new type of argument for structural realism about mathematics. This argument exploits tools for theorizing about mathematics that were developed by Imre Lakatos  in his work on scientific research programs . It focuses attention on the progressive mathematical research program that started with …. (shrink)
With more people in the world living into older age, Alzheimer's and other Dementias: The Facts takes a comprehensive look at the spread of dementia, and provides authoritative information and practical advice for sufferers, their families, and the medical professionals who care for them. -/- Written by a consultant in old age psychiatry, the book provides an overview of all the different types of dementia (including younger-onset dementias), from the most-recognized - Alzheimer's - to the less-frequent types, such as those (...) caused by inherited metabolic disorders or HIV. The book guides the reader step-by-step through how the brain works, and explains in clear and simple language the effect of dementias on the brain, and the impact on an individual's cognitive function. -/- A dedicated chapter explains how a diagnosis is reached, including the different modes of assessment, from blood tests carried out by a GP, to specialist scans, highlighting how the brain actually works. Detailed sections cover the latest treatments available, including the controversial use of antipsychotic medication, and the possibility of disease-modifying treatments in the future. -/- The book also explains how the multi-disciplinary team works together to look after the sufferer's social needs, such as bathing and washing, as well as their spiritual and palliative needs. Alzheimer's and other Dementias: The Facts provides all the relevant information and guidance for sufferers, family and their care-givers to choose the right intervention at the right time, to create - as the book advocates - a unique and personalized management plan. (shrink)
This paper introduces the notion of patterns of practice and shows the extent to which it is useful at the level of practice and at a profound philosophical level. The notion makes deep connections with ideas in the realm of the philosophy of language and thought and, in addition, it connects to virtue ethics. Using the example of whether or not to admit someone using compulsory powers or whether to treat them in the community, the notion of patterns of practice (...) can be used to demonstrate the internal and external coherence of decisions in psychiatric care and thus to offer clinical and ethical justification. (shrink)
How are we to understand dementia? The main argument involves an analysis (in Chapter 2) of intentional mental states, using Wittgenstein's discussion of rule-following, which suggests that such states demonstrate an irreducible, transcendental normativity. This externalist account of intentional mental states highlights the worldly embedding of practices. In Chapters 3,4 and 5, this analysis is applied respectively to the disease, cognitive neuropsychology and social constructionist models of dementia. Whilst clinically and scientifically useful, none generates an adequate account of normativity. The (...) Wittgensteinian analysis supplies a constitutive (as opposed to causal) account that supports the notion of dementia-in-the-world (Chapter 6). A full understanding of dementia requires the human-person-perspective in order to accommodate all that dementia amounts to in the normatively-constrained world. The sub-plot considers our understanding of the person. Rather than the Locke-Parfit view, which stresses psychological continuity, the Wittgensteinian analysis supports the situated-embodied-agent view of the person (Chapters I and 6). This view and the notion of the human-person-perspective are mutually supportive, so that main and subplot both encourage a broader understanding. The works of Wittgenstein have acted as a primary source, with secondary literature commenting on his works. In discussing the models of dementia, I have cited primary sources. I have also considered philosophical works pertinent to the particular models, usually in connection with the mind-brain problem. The thesis concludes that there is no single way to understand dementia, but any understanding will be from the human-person-perspective, in accord with the situated-embodied-agent view and reflecting an externalist construal of intentional psychological states. This has implications for further research in philosophy, medical ethics and gerontology. The unique application of the Wittgensteinian philosophical analysis to clinical reality suggests an approach to people with dementia that stresses personhood in the context of embedded, embodied histories and continuing relationships with others. (shrink)
BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)
Humanitarian organisations often work alongside those responsible for serious wrongdoing. In these circumstances, accusations of moral complicity are sometimes levelled at decision makers. These accusations can carry a strong if unfocused moral charge and are frequently the source of significant moral unease. In this paper, we explore the meaning and usefulness of complicity and its relation to moral accountability. We also examine the impact of concerns about complicity on the motivation of humanitarian staff and the risk that complicity may lead (...) to a retreat into moral narcissism. Moral narcissism is the possibility that where humanitarian actors inadvertently become implicated in wrongdoing, they may focus more on their image as self-consciously good actors than on the interests of potential beneficiaries. Moral narcissism can be triggered where accusations of complicity are made and can slew decision making. We look at three interventions by Médecins Sans Frontières that gave rise to questions of complicity. We question its decision-guiding usefulness. Drawing on recent thought, we suggest that complicity can helpfully draw attention to the presence of moral conflict and to the way International Non-Governmental Organisations can be drawn into unintentional wrongdoing. We acknowledge the moral challenge that complicity presents to humanitarian staff but argue that complicity does not help INGOs make tough decisions in morally compromising situations as to whether they should continue with an intervention or pull out. (shrink)
Achievement test differences between boys and girls and between young men and young women, mostly favoring males, extend far beyond mathematics. Such pervasive differences, illustrated here, may require an explanatory theory broader than Geary's.
Background Decision-making in end-stage dementia is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems. Aim This study aimed to understand the decision-making processes of clinical teams and relatives in (...) addressing life-threatening swallowing difficulties in ESD in long-term care in Malta. Method The study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis. Results Four themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity. Conclusion Decision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life. All data relevant to this article are derived from JD's doctoral research titled 'Moral Reasoning in End of Life Clinical Decision Making for Persons in End Stage Dementia'. The thesis is openly available for viewing at the Melitensia Section of the University of Malta Library. (shrink)
### Challenge to the abortion act 1967 dismissed In September, the High Court dismissed a judicial review of the Abortion Act 1967 that sought a judgement of incompatibility with the European Convention on Human Rights.1 The case focused on a clause in the Act which permits abortion in England, Scotland and Wales after 24 weeks if there is a substantial risk that, if the child were born, it would suffer from ‘such physical or mental abnormalities as to be seriously handicapped’. (...) The case was brought by three parties: Heidi Crowter, a 24 year old woman living independently with Downs Syndrome and a campaigner for disability rights; a 2 year old boy with DS; and his mother who, when pregnant with him, felt pressure to terminate the pregnancy. The claimants sought a declaration that the clause was incompatible with the right to life; freedom from torture, inhuman or degrading treatment; right to private and family life; and protection from discrimination. Further to this it was also argued that the Act does not permit abortion on the basis that an unborn child has been diagnosed with a non-fatal fetal disability such as DS and that such abortions should not be funded by the state. In dismissing the claim, the judges focused on the ‘margin of appreciation’ that the European law allows domestic states on this issue and the fact that a foetus has never been deemed to have personhood status under the ECHR. The judges noted the ability to provide for a disabled child would vary significantly and that some conditions would only be found late in a pregnancy, after 24 weeks. Stating that the case by its nature did not permit the Court to hear from other perspectives, including women who may be affected by any change to the law and further criminalisation of abortion, the judges emphasised …. (shrink)
Ullin Place's contributions to the literature of behaviour analysis and behaviourism span the period from 1954 to 1999. In appreciation of his scholarship and breadth of vision, this paper reviews an early widely-cited contribution ("Is consciousness a brain process?" British Journal of Psychology, 1956, pp. 47-53) and a late one which should become widely cited ("Rescuing the science of human behavior from the ashes of socialism," Psychological Record, 1997, pp. 649-659). It is noted that the sweep of Place's work links (...) behaviour analysis to its philosophical roots in the work of Ryle and Wittgenstein and also looks forward to the further functional analysis of language-using behaviour. (shrink)
This psychology textbook offers a comprehensive examination of the basic principles of behavior analysis and their application to issues of social significance. Behavioral scientists are interested in elucidating the fundamental principles that govern the behavior of human and non-human animals. Behavior Analysis is designed to meet the needs of senior undergraduate courses and postgraduate training in behavior analysis and its applications. The eleven comprehensive chapters: ·consider how fundamental principles of behavior can be used in an applied setting to identify behavior (...) to be changed, to select treatments which increase of decrease behavior, and to evaluate the effectiveness of interventions; and ·give examples from various disciplines, including dietetics, education, occupational therapy, and speech therapy, as well as clinical, social, health and community psychology. In addition to covering core material essential for courses in psychology, this volume will also provide a useful account of behavioural psychology and its applied uses for students and professionals from a wide range of fields. (shrink)