El presente artículo ha sido pensado como un análisis introductorio que explora la presencia de Schopenhauer en la novela filosófica Rupertine del Fino del filósofo y literato alemán Philipp Mainländer, debido a la exigua investigación que se ha realizado al respecto y a la ineluctable influencia que desplegó el filósofo pesimista en la obra de Mainländer, asimismo, dicho análisis se entreteje con algunos puntos de la Filosofía de la redención de Mainländer. El esquema que se sigue es, primero, desarrollar una (...) reflexión en torno a la búsqueda de sentido, relacionando esto con las diferentes posiciones que asumen los personajes de la novela filosófica ante la vida, los modos en que se desenvuelven en el mundo, entre otros aspectos, centrándonos en el personaje de Rupertine con el propósito de entrever otros aspectos que no se limiten a presentarla simplemente como una mujer apasionada, puesto que nos proponemos resignificar y repensar al personaje. Por último, ahondar en las antípodas de estas filosofías, en las que la constatación de los avatares de la existencia humana y el desenvolvimiento del mundo son el referente principal de este análisis. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Abstract It would be puzzling if the morally best agents were not so good after all. Yet one prominent account of the morally best agents ascribes to them the exact motivational defect that has famously been called a “fetish.” The supposed defect is a desire to do the right thing, where this is read de dicto . If the morally best agents really are driven by this de dicto desire, and if this de dicto desire is really a fetish, then (...) the morally best agents are moral fetishists. This is puzzling. I resolve the puzzle by showing that on a proper understanding of the interaction between de dicto and de re moral motivation, it is not only not fetishistic, but quite possibly desirable, to be motivated by a de dicto desire to do the right thing. My argument relies partly on an appeal to a non-buck-passing account of moral rightness, according to which rightness is itself an additional reason-giving property over and above the right-making properties of an action. If this account of moral rightness is correct, then we would expect the morally best agents to exhibit de dicto moral motivation. However, since their de dicto desire acts in concert with de re desires, there is no reason to consider it a fetish. Content Type Journal Article Pages 1-19 DOI 10.1007/s11098-011-9825-z Authors Vanessa Carbonell, Philosophy Department, University of Cincinnati, P.O. Box 210374, Cincinnati, OH 45221-0374, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116. (shrink)

I argue for the existence of a ‘ratcheting-up effect’: the behavior of moral saints serves to increase the level of moral obligation the rest of us face. What we are morally obligated to do is constrained by what it would be reasonable for us to believe we are morally obligated to do. Moral saints provide us with a special kind of evidence that bears on what we can reasonably believe about our obligations. They do this by modeling the level of (...) sacrifice a person can realistically bear. Exposure to moral saints thus ‘ratchets-up’ our obligations by combating a type of ignorance that would otherwise defeat those obligations. (shrink)

The moral community is a social community, and as such it is vulnerable to social problems and pathologies. In this essay I identify a particular way in which participation in the moral community can be constrained by social factors. I argue that features of the social world—including power imbalances, oppression, intergroup conflict, communication barriers, and stereotyping—can make it nearly impossible for some members of the moral community to hold others responsible for wrongdoing. Specifically, social circumstances prevent some marginalized people from (...) engaging in what Stephen Darwall calls “felicitous moral address” (Darwall 2006). We should think of some members of the moral community as having “second-class moral citizenship” in ways that parallel second-class political citizenship. The injustice of second-class moral citizenship can be understood by drawing an analogy with Miranda Fricker’s notion of “epistemic injustice” (Fricker 2007). Fricker’s account of how people can be undermined in their capacity as knowers can be extended to show how people can be undermined in their capacity as makers of moral claims, which can be called “claimant injustice”. (shrink)

Susan Wolf famously claimed that the life of the moral saint is unattractive from the “point of view of individual perfection.” I argue, however, that the unattractive moral saints in Wolf’s account are self-defeating on two levels, are motivated in the wrong way, and are called into question by real-life counter-examples. By appealing to a real-life case study, I argue that the best life from the moral point of view is not necessarily unattractive from the individual point of view.

We emerge from certain activities with an altered sense of self. Whether returning from a warzone or from an experience as common as caring for an aging parent, one might remark, “I’m not the same person I was.” I argue that such transformations are relevant to debates about what morality requires of us. To undergo an alteration in one’s self is to make a special kind of sacrifice, a sacrifice of self. Since projects can be more or less morally obligatory (...) to the extent that they require more or less sacrifice, we must incorporate these unique sacrifices into any accounting of the contours and limits of moral obligation. But sacrifices of self pose a special difficulty for any such accounting, precisely because of their transformative nature. Unlike most other sacrifices, they cannot be analyzed entirely in terms of wellbeing. Using real-world case studies and examples, I argue for the existence of two types of sacrifice of self, involving changes in identity and moral agency. I argue that sacrifices of self require particular attention because they may be extra difficult to compare with other costs and with moral gains. (shrink)

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; (...) and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

If the traditional problem of demandingness is that a theory demands too much of all agents, for example by asking them to maximize utility in every decision, then we should ask whether there is a related problem of “differential demandingness”, when a theory places vastly different demands on different agents. I argue that even according to common-sense morality, the demands faced by particular agents depend on a variety of contingent factors. These include the general circumstances, the compliance of others, the (...) available resources, the agent’s relevant relationships, the agent’s psychological constitution, and the agent’s knowledge. Some agents, for instance, find themselves in a “sacrifice hazard”: a situation where morality calls for a huge unforeseen sacrifice. I argue that if moral demands are differential, it is harder than one might think to assess a theory’s general level of demandingness in the abstract. (shrink)

Malicious moral envy is an aversive reaction to a rival’s moral properties or accomplishments, accompanied by a tendency to level-down the target by morally tarnishing or sabotaging them. In this essay I give an account of malicious moral envy, showing how it is a sub-type of envy more generally. I describe Donald Trump’s behaviors toward Barack Obama and Anthony Fauci as a case study of malicious moral envy. I argue that malicious moral envy is puzzling, first because it is self-defeating, (...) and then—more interestingly—because it betrays an ambivalence about morality and moral requirements. I explore how malicious moral envy relates to other issues in the literature on moral ambivalence, including moral exemplars, moral saints, admirable immorality, and the pathologizing of moral outliers. Ultimately I suggest that mild forms of malicious moral envy may play an important role in helping agents navigate the socially complex and constantly changing landscape of moral requirements. (shrink)

In “Materialized Oppression in Medical Tools and Technologies”, we show how oppression can be inscribed in medical devices. We consider oximeters and spirometers, drawing heavily on the work of anthropologist Amy Moran-Thomas and historian Lundy Braun. Both devices encode racial biases: oximeters because they do not correct for race, and spirometers because they do. We zoom out from these particular devices to examine a wide range of tools and technologies, and we build a theoretical framework that covers not only race (...) but other axes of oppression: gender, ability, class, etc. -/- We are inspired by the peer commentaries and the guest editorial, and we are grateful to the contributors for engaging with our work and sharing their expertise. Their responses to our target article advance our understanding in three directions. First, a set of responses contextualize our framework within the histories of medicine, bioethics, and science and technology studies. Second, a set of responses provide additional examples of oppressive medical tools and technologies: not only material artifacts like oximeters and spirometers, but also spatial environments like inpatient psychiatric units, and cognitive niches comprised of digital technologies like electronic medical records and medical data classifications. Third, a set of responses propose countermeasures: operationalizing anti-oppressive practices for device design and testing; mapping the complex causal relationships involved in real-world problems; and repairing the harms done by materialized oppression through racism-conscious praxis. We reply to these three sets of responses—respectively, the “past, present, and future” of oppressive medical objects and spaces—in what follows. (shrink)

Knowledge is necessary for certain moral obligations. In learning something new, one sometimes triggers a moral obligation. This paper argues that the existence of these knowledge-based obligations poses a problem for the view that we are not only free to choose the course of our own lives, including our careers and personal projects, but also free to change our minds and quit at any time to pursue something else. For if our choice of life path has generated knowledge-based moral obligations (...) that we must fulfill, then it is apparently not true that we can quit at any time. To resolve this tension, this paper proposes a relatively demanding set of conditions under which it is permissible to swap one career or life project for another. The resulting compromise reconciles the moral force of knowledge-based obligations with the basic freedom to choose less-than-optimal careers and projects. It also highlights the distinctive role played by knowledge and expertise in generating the intractable problem of morality’s demandingness. (shrink)

The purpose of this essay is to make the case that the ethical issues raised by the current U.S. practice of direct-to-consumer prescription drug advertising are worthy of study in philosophy courses, and to provide instructors with some ideas for how they might approach teaching the topic, despite the current relative scarcity of philosophical literature published on it. This topic presents a unique opportunity to cover ground in ethics, critical thinking, and scientific literacy simultaneously. As a case study, the practice (...) of DTC advertising is both theoretically rich and universally relevant to students’ lives. The nature of these ads—numerous, diverse, visually and thematically entertaining—makes them delicious fodder for in-class activities, small group work, discussion-based learning, creative projects, and customizable essay topics. I offer a set of suggestions for approaching the study of DTC drug ads that is informed by my own experience doing so in bioethics courses. Ultimately, including this topic on your syllabus not only contributes to students’ philosophical skills and knowledge, but also helps them become better informed as citizens and potential “consumers” of health care. (shrink)

In “The Ethics of Advertising for Health Care Services” (2014), Schenker, Arnold, and London argue that advertisements for physicians, hospitals, and other health care services are morally problematic and ought to be regulated by the Food and Drug Administration (FDA) as it regulates prescription drug ads. I argue that the regulation of prescription drug ads has been so ineffective that, if the harms of health care service ads are similar to the harms of drug ads, such regulation is bound to (...) fail. This is a major public health concern, because any good produced by these ads does not necessarily morally compensate for the harm caused. If the ads cannot be banned entirely, I propose a regulatory strategy that involves redesigning them from the ground up. (shrink)

The well-being account of sacrifice says that sacrifices are gross losses of well-being. This account is attractive because it explains the relationship between sacrifice and moral obligation. However, sacrifices made on behalf of loved ones may cause trouble for the account. Loving sacrifices occur in a context where the agent’s well-being and the beneficiary’s well-being are intertwined. They present a challenge to individualism about well-being. Drawing inspiration from feminist philosophers and bioethicists, I argue that a notion of ‘relational well-being’, analogous (...) to ‘relational autonomy’, can help account for loving sacrifices without either undermining the well-being theory of sacrifice or minimizing the very real sacrifices made in caregiving situations. (shrink)

Is a painful experience less bad for you if you will not remember it? Do you have less reason to fear it? These questions bear on how we think about medical procedures and surgeries that use an anesthesia regimen that leaves patients conscious – and potentially in pain – but results in complete ‘drug-induced amnesia’ after the fact. I argue that drug-induced amnesia does not render a painful medical procedure a less fitting object of fear, and thus the prospect of (...) amnesia does not give patients a reason not to fear it. I expose three mistakes in reasoning that might explain our tendency to view pain or discomfort as less fearful in virtue of expected amnesia: a mistaken view of personal identity; a mistaken view of the target of anticipation; and a mistaken method of incorporating past evidence into calculations about future experiences. Ultimately my argument has implications for whether particular procedures are justified and how medical professionals should speak with anxious patients about the prospect of drug-induced amnesia. (shrink)

In “Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness” (2013), Fischer and Truog argue that recent studies showing that some patients diagnosed as being in a vegetative state are in fact in a minimally conscious state raise various ethical questions for clinicians and family members. I argue that these findings raise a further ethical dilemma about how and whether to seek the involvement of the minimally conscious person herself in decisions about her care. There may be (...) a conflict between doing what is believed to accord with the patient’s prior stated wishes and/or her best interests, on the one hand, and respecting her own potential decision-making capacity and epistemic authority, on the other. (shrink)

The notion of fitness is usually equated to reproductive success. However, this actualist approach presents some difficulties, mainly the explanatory circularity problem, which have lead philosophers of biology to offer alternative definitions in which fitness and reproductive success are distinguished. In this paper, we argue that none of these alternatives is satisfactory and, inspired by Mumford and Anjum’s dispositional theory of causation, we offer a definition of fitness as a causal dispositional property. We argue that, under this framework, the distinctiveness (...) that biologists usually attribute to fitness—namely, the fact that fitness is something different from both the physical traits of an organism and the number of offspring it leaves—can be explained, and the main problems associated with the concept of fitness can be solved. Firstly, we introduce Mumford and Anjum's dispositional theory of causation and present our definition of fitness as a causal disposition. We explain in detail each of the elements involved in our definition, namely: the relationship between fitness and the functional dispositions that compose it, the emergent character of fitness, and the context-sensitivity of fitness. Finally, we explain how fitness and realized fitness, as well as expected and realized fitness are distinguished in our approach to fitness as a causal disposition. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

Experiences of substitute decision-makers with requests for consent to non-therapeutic research participation during the dying process, including to what degree such requests are perceived as burdensome, have not been well described. In this study, we explored the lived experiences of family members who consented to non-therapeutic research participation on behalf of an imminently dying patient. We interviewed 33 family members involved in surrogate research consent decisions for dying patients in intensive care. Non-therapeutic research involved continuous physiological monitoring of dying patients (...) prior to and for 30 min following cessation of circulation. At some study centres participation involved installation of bedside computers. At one centre electroencephalogram monitoring was used with a subset of participants. Aside from additional monitoring, the research protocol did not involve deviations from usual end-of-life care. Thematic analysis of interviews suggests most family members did not perceive this minimal-risk, non-therapeutic study to affect their time with patients during the dying process, nor did they perceive research consent as an additional burden. In our analysis, consenting for participation in perimortem research offered families of the dying an opportunity to affirm the intrinsic value of patients’ lives and contributions. This opportunity may be particularly important for families of patients who consented to organ donation but did not proceed to organ retrieval. Our work supports concerns that traditional models of informed consent fail to account for possible benefits and harms of perimortem research to surviving families. Further research into consent models which integrate patient and family perspectives is needed. All data relevant to the study are included in the article. (shrink)

In the original publication of the article, errors in the production stages resulted in Vanessa Munro being listed as sole author.

En la actualidad, el festival literario Centroamérica Cuenta tiene en su haber seis ediciones realizadas desde 2013. Esta iniciativa internacional, coordinada por el escritor nicaragüense Sergio Ramírez, año con año ha forjado un espacio de intercambio y reflexión para la narrativa centroamericana, proyectando las identidades, literaturas y realidades de la región a diversas zonas del orbe. Desde su inicio, el festival ha contado con la participación de más de 500 escritores del istmo, entre los cuales se encuentran la salvadoreña (...) class='Hi'>Vanessa Núñez y el nicaragüense Alberto Sánchez Argüello, representantes de una nueva generación centroamericana de narradores. En el caso de la escritora Vanesa Núñez (1973, San Salvador), también abogada, docente y editora, incluimos un cuento inédito; “La familia”, de carácter amargo y afilado en su desenlace, como las vidas de muchas personas centroamericanas. Núñez ha publicado los libros: Los locos mueren de viejos (FyG Editores, 2008 y La Pereza, 2015), Dios tenía miedo (FyG Editores, 2011 y Editorial Piedrasanta, 2016), La caja de cuentos (libro objeto) (Alas de Barrilete, 2015), Espejos (Uruk Editores, 2015), Animales Interiores (en coautoría con Frida Larios, 2015), así como varios relatos en diversas antologías y revistas de España, Francia, Alemania, Suiza, Estados Unidos, Colombia, Nicaragua, Costa Rica, El Salvador, Guatemala y México. Su obra ha sido igualmente traducida al francés, alemán e inglés. En cuanto al narrador Alberto Sánchez Argüello (1976, Managua), también psicólogo, ilustrador y reconocido tuitero (de la aplicación Twitter), quien ha creado varios libros de micro-relatos a partir de tuits entrelazados (Parafernalia Ediciones Digitales), publicamos el micro-cuento “La estatua”. El relato se encuentra en diálogo con el cuento de Núñez, a partir de una visión cruda de los mandatos patriarcales imperantes en nuestras sociedades. Sánchez se ha enfocado en literatura juvenil e infantil, con la publicación de las siguientes obras: La casa del agua (Fondo Editorial Libros para niños, 2003), Mi amigo el dragón (Fondo Editorial Libros para niños, 2014), Los Monstruos bajo la cama (Loqueleo Santillana, 2016), Chico Largo y Charco Verde (Loqueleo Santillana, 2017) e Ítaca (Fondo Editorial Libros para niños, 2017). Su obra se ha publicado en antologías en Nicaragua, México, España, El Salvador, Bolivia, Chile y Perú. Algunos de sus cuentos están traducidos al inglés, portugués, italiano, alemán y vietnamita. (shrink)

Vanessa Carbonell argues that sacrifices of self, unlike most other sacrifices, cannot be analyzed entirely in terms of wellbeing. For this reason, Carbonell considers sacrifices of self as posing a problem for the wellbeing theory of sacrifice and for discussions about the demandingness of morality. In this paper I take issue with Carbonell’s claim that sacrifices of self cannot be captured as prudential harms. First, I explain why Carbonell considers sacrifices of self particularly problematic. In (...) order to determine whether some state of affairs is harmful for someone, it is necessary to assume a particular account of welfare. In this paper, I assume the self-fulfillment account of welfare. I introduce this theory and show that it can account for the harm of sacrifices of self. (shrink)

Roy W. Perrett argues that the Hindu sage, like the western moral saint, seems precluded from pursuing non-moral ends for their own sakes. If he is precluded from pursuing non-moral ends for their own sakes, then he is precluded from pursuing non-moral virtues, interests, activities, relationships, and so on for their own sakes. A life devoid of every such pursuit seems deficient. Hence, the Hindu sage seems to forsake the good life. In response, I adapt a reply that Vanessa (...) Carbonell offers in the context of the moral saint. The Hindu sage might pursue non-moral virtues, interests, activities, relationships, and so on for their own sakes, so long as his motivation to pursue moksa is read de re rather than de dicto. Indeed, this reply is more convincing in the case of the Hindu sage than it is in the case of the moral saint. (shrink)

The recent explosion of philosophical papers on Confederate and Colonialist statues centers on a central question: When, if ever, is it permissible to admire a person? This paper contends it’s not just Confederates and slavers whose reputations are on the line, but also pacifists like Martin Luther King, Jr., and Daisy Bates whose commitments to pacifism meant they were unwilling to save others using defensive violence, including others they talked into endangering themselves for the sake of racial equality. Other things (...) being equal, that’s gravely immoral if pacifism is false, and we shouldn’t admire people guilty of grave immorality. So, it appears that we shouldn’t admire Bates or King, which is counterintuitive. To solve this problem, I explore several possibilities: that only selective traits of Bates and King are admirable, that Bates and King are admirable despite their grave immorality, and that Bates and King are admirable by virtue of their integrity. However, each of these proposals fails: the first because it inadequately captures our moral phenomenology (we admire people, not just their traits), the second because it ignores the extent to which gravely immoral commitments are constitutive of a person’s moral character, and the third because we ought not to admire people for acting on their immoral beliefs. The paper concludes, first, that either pacifists like Bates and King aren’t admirable or they are, and the latter presupposes the truth of pacifism. Second, I borrow from Vanessa Carbonell’s ratcheting-up argument from moral sainthood to argue that pacifists like Bates and King provide epistemic defeaters to the objection that pacifism is unreasonably costly. Thus, not only are pacifists admirable only if they’re right—they are right. (shrink)

Safety-critical systems manufacturers have the duty of care, i.e., they should take correct steps while performing acts that could foreseeably harm others. Commonly, industry standards prescribe reasonable steps in their process requirements, which regulatory bodies trust. Manufacturers perform careful documentation of compliance with each requirement to show that they act under acceptable criteria. To facilitate this task, a safety-centered planning-time framework, called ACCEPT, has been proposed. Based on compliance-by-design, ACCEPT capabilities permit to design Compliance-aware Engineering Process Plans, which are able (...) to show the planning-time allocation of standard demands, i.e., if the elements set down by the standard requirements are present at given points in the engineering process plan. In this paper, we perform a case study to understand if the ACCEPT produced models could support the planning of space software engineering processes. Space software is safety and mission-critical, and it is often the result of industrial cooperation. Such cooperation is coordinated through compliance with relevant standards. In the European context, ECSS-E-ST-40C is the de-facto standard for space software production. The planning of processes in compliance with project-specific ECSS-E-ST-40C applicable requirements is mandatory during contractual agreements. Our analysis is based on qualitative criteria targeting the effort dictated by task demands required to create a CaEPP for software development with ACCEPT. Initial observations show that the effort required to model compliance and processes artifacts is significant. However, such an effort pays off in the long term since models are, to some extend, reusable and flexible. The coverage level of the models is also analyzed based on design decisions. In our opinion, such a level is adequate since it responds to the information needs required by the ECSS-E-ST-40C framework. (shrink)

Deep brain stimulation is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory (...) conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research. (shrink)

In this article, we examine the emergence of a concept of medical feeding that emphasizes artificiality and medical technology. We discuss how this concept has been created in specific contrast to the daily provision of food and water; medical definitions retain clear disjunctures with cultural and religious beliefs surrounding food, gendered aspects of eating and feeding, and the everyday practices of social and family life in the United States. We begin with an examination of the historical processes involved in creating (...) artificial nutrition and hydration as a medical concept, including the evolution of terminology and practices in relation to technology advancement, legal cases, and public discourse. We.. (shrink)

Cet article entend mettre en évidence les ressemblances dans la façon dont les processus de scolarisation et d’urbanisation produisent des effets de sens chez le sujet, ce qui amène à penser le rapport ville/école à partir d’un sujet que j’appelle « sujet urbain scolarisé », c’est-à-dire un sujet traversé par l’écriture comme mode d’inscription dans le monde. La définition de « sujet urbain scolarisé » revient à penser la relation étroite entre « être dans une position autorisée à dire » (...) (processus d’autorisation produit par l’école) et « être dans une position autorisée à avoir de l’urbanité » (civilisé). Ces ressemblances ont surgi dans l’administration des sens de l’espace occupé et dans celle des modes d’occupation de cet espace. Cette réflexion passe par les relations duelles langue/État, civilité/non-civilité, sujet/espace, unité/dispersion, scolarisation/urbanisation. (shrink)

The idea that perceptual experience is transparent is generally used by naïve realists and externalist representationalists to promote an externalist account of the metaphysics of perceptual experience. It is claimed that the phenomenal character of our perceptual experience can be explained solely with reference to the externally located objects and properties which (for the representationalist) we represent, or which (for the naïve realist) partly constitute our experience. Internalist qualia theorists deny this, and claim that the phenomenal character of our perceptual (...) experience is internally constituted. However, my concern in this paper is not with the metaphysical debate, but with transparency as a phenomenological feature of perceptual experience. Qualia theorists have presented a number of examples of perceptual experiences which, they claim, do not even seem to be transparent; these experiences involve objects or properties which seem to be internally realized. I argue, contrary to the qualia theorist’s claim, that the phenomenal character of perceptual experience can in fact be characterized solely with reference to externally located objects and properties, and the sense in which some features of our perceptual experiences do not seem external is due to cognitive, not perceptual, phenomenology. (shrink)

Although moral case deliberation (MCD) is evaluated positively as a form of clinical ethics support (CES), it has limitations. To address these limitations our research objective was to develop a thematic CES tool. In order to assess the philosophical characteristics of a CES tool based on MCDs, we drew on hermeneutic ethics and pragmatism. We distinguished four core characteristics of a CES tool: (a) focusing on an actual situation that is experienced as morally challenging by the user; (b) stimulating moral (...) inquiry into the moral concepts, questions and routines in the lived experience of the CES tool user; (c) stimulating moral learning by exploring other perspectives; and (d) incorporating contextual details. We provide an example of a CES tool developed for moral dilemmas over client autonomy. Our article ends with some reflections on the normativity of the CES tool, other application areas and the importance of evaluation studies of CES tools. (shrink)

Os sites institucionais das universidades são ferramentas importantes para que os estudantes acessem as informações referentes à instituição. Espera-se que as informações distribuídas nos sites sejam de fácil acesso e contemplem informações completas. Considera-se o cuidado com a saúde mental discente um assunto muito importante, mas pouco explorado e/ou investido. Esse estudo tem por objetivo problematizar e discutir sobre os serviços de saúde mental discente encontrados através das informações apresentadas nos sites institucionais das universidades e avaliar a facilidade de acesso (...) às informações. Foram escolhidas 11 universidades federais da região sul do Brasil por amostra de conveniência, sendo uma pesquisa qualitativa onde foi utilizado o método descritivo e interpretativo com o auxílio da etnografia virtual para construção dos dados. Ao longo da pesquisa, percebeu-se uma dificuldade em encontrar informações sobre suporte à saúde mental e informações completas sobre os serviços estudados. Durante o estudo houve o questionamento sobre a necessidade de pensar a saúde mental discente além do viés biomédico centralizado em dificuldades cognitivas e/ou possíveis adoecimentos no meio acadêmico. Existe uma urgência de criar propostas de prevenção e promoção à saúde mental universitária ampliando os campos de atuação do psicólogo escolar. (shrink)

My first aim in this paper is to show that the transparency claim cannot serve the purpose to which it is assigned; that is, the idea that perceptual experience is transparent is no help whatsoever in motivating an externalist account of phenomenal character. My second aim is to show that the internalist qualia theorist's response to the transparency idea has been unnecessarily concessive to the externalist. Surprisingly, internalists seem to allow that much of the phenomenal character of perceptual experience depends (...) essentially (and not just causally) upon externally located properties. They argue that we can also be aware of internal, non-intentional qualia. I present an alternative response the internalist can make to the transparency claim: phenomenal character is wholly internal, and seeming to be aware of externally located properties just is being aware of internally constituted experiential features. (shrink)

Scientists typically use a variety of representations, including different kinds of figures, to present and defend hypotheses. In order to understand the justification of scientific hypotheses, it is essential to understand how visual representations contribute to scientific arguments. Since the logical understanding of arguments involves the truth or falsity of the representations involved, visual representations must have the capacity to bear truth in order to be genuine components of arguments. By drawing on Goodman's analysis of symbol systems, and on Tarski's (...) work on truth, I show that the figures used in science meet this criterion. (shrink)

The challenge that confronts corporate decision-makers in connection with global labor conditions is often in identifying the standardsby which they should govern themselves. In an effort to provide greater direction in the face of possible global cultural conflicts, ethicistsThomas Donaldson and Thomas Dunfee draw on social contract theory to develop a method for identifying basic human rights: Integrated Social Contract Theory (ISCT). In this paper, we apply ISCT to the challenge of global labor standards, attempting to identify labor rights that (...) could serve as guides for corporations producing or outsourcing outside of their home country. In addition to identifying areas of universal agreement, we also examine whether ISCT is, in fact, a sufficient basis for determining worker rights; we seek to define the parameters of the “sweatshop” problem; we include the application and results of our ISCT analysis as applied to labor standards: the global labor rights hypernorms; and conclude that ISCT is sufficient only for rights that are universal. We also discuss whether market-driven decisions can identify the boundaries of labor rights, or at least assure that market outcomes are compatible with maintaining labor rights, in order to respond to the shortcomings of ISCT. We conclude with some comments on directions of analysis for labor rights determination. (shrink)