An historical review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action) and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-nonself differentiation. Furthermore, the social other, through very early social and emotional interactions, provides meaning to the infant’s perception and contributes to the development of his/her (...) symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using the mirror as an experimental paradigm to study self- and other- image and body recognition. (shrink)

Les violences subies pendant l’enfance peuvent gravement affecter le développement et la santé des mineurs. La clinique de la violence chez l’enfant et l’adolescent et son traitement sont très spécifiques. Pédiatres et médecins légistes ont ainsi créé la Société française de pédiatrie médico-légale ( sfpml ) afin de penser les violences faites aux mineurs, du repérage à l’expertise, pour proposer des actions adaptées à leur particulière vulnérabilité et penser la prévention. L’enfant doit être un sujet de soins et non pas (...) un objet d’investigation. La pédiatrie médico-légale promeut une pratique intégrée dans une dynamique de parcours de soins. L’expérimentation nationale « Santé protégée » a pour objectif d’améliorer la santé globale de ces enfants et adolescents en facilitant l’accès aux soins, le suivi et la coordination. Il paraît important aujourd’hui de mener des actions de prévention et de soins et d’assurer un accompagnement sécurisant des enfants pour limiter l’impact des violences et leur permettre de bien grandir. (shrink)

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged – that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, (...) care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care – thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to physical integrity, autonomy, freedom, social provision, impartial quality of government, social bases of self-respect or communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their (...) validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two (...) London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

Claude Rolley, Juliette Langlois, Nathalie Balcar και Martine Regert Από την άσφαλτο στη ρητίνη : το γέμισμα του αυτιού ενός γρύπα από τους Δελφούς σ. 55-65 Το γέμισμα του κενού στο αυτί μιας σφυρήλατης προτομής γρύπα από τους Δελφούς έγινε με άσφαλτο. Ένα ακόμη επιχείρημα για την προέλευση κατασκευής από την Εγγύς Ανατολή των σφυρήλατων προτομών των στερεωμένων στους λέβητες που βρέθηκαν στην Ελλάδα και την Ετρουρία.

Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs (...) for Neglected Diseases Initiative, an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis. The project involved the implementation of a novel ‘pre-review’ process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process. (shrink)

The aim of this article is to investigate and discuss the notions of difference and representation in Emmanuel Levinas and Gilles Deleuze, articulating such notions through the example of a university extension project involving the formation of a musical ensemble composed of autistic children. Our research involved a review of four major philosophical works—Emmanuel Levinas’ Totality and Infinity; Among Us: Essays On Alterity; and “The Concept Of Difference In Bergson”; and Gilles Deleuze’s Difference and Repetition--in addition to secondary references. The (...) main articulations of the investigation carried out in the project consist of aspects such as: taking responsibility for the autistic child through cultivating asymmetrical relationships, a process that takes place through sensibility, below any representation; and not totalizing the alterity involved while maintaining, at the same time, its radical difference. In addition, there is an emphasis in the work on the difference of each child, beyond his or her diagnostic identity, understanding that all participants are undergoing unique processes of differentiation, and that some differences are not more privileged than others, in that that such hierarchies are determined by power relations. Another contribution of this research is the emphasis on the intensive affective flows of children, and the construction of relationships of mutual affection, which increases the circulation of vital energy in each one. Finally, the results of the project are offered as guidelines for clinical practice, and for the cultivation of a politics of difference, as an alternative to hegemonic practices in autism studies in contemporary times. (shrink)

BackgroundThe UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer’s disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, (...) which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the ‘spatial intervention study’ of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. MethodsPeople with a suspected or confirmed diagnosis of dementia in Alzheimer’s disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed.DiscussionThe results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice.Trial registration: DRKS00030799. (shrink)

Machine generated contents note: Preface; Introduction; Part I. Global Health, Definitions and Descriptions: 1. What is global health? Solly Benatar and Ross Upshur; 2. The state of global health in a radically unequal world: patterns and prospects Ron Labonte and Ted Schrecker; 3. Addressing the societal determinants of health: the key global health ethics imperative of our times Anne-Emmanuelle Birn; 4. Gender and global health: inequality and differences Lesley Doyal and Sarah Payne; 5. Heath systems and health Martin McKee; (...) Part II. Global Health Ethics, Responsibilities and Justice: Some Central Issues: 6. Is there a need for global health ethics? For and against David Hunter and Angus Dawson; 7. Justice, infectious disease and globalisation Michael Selgelid; 8. International health inequalities and global justice: toward a middle ground Norman Daniels; 9. The human right to health Jonathan Wolff; 10. Responsibility for global health? Allen Buchanan and Matt DeCamp; 11. Global health ethics: the rationale for mutual caring Solly Benatar, Abdallah Daar and Peter Singer; Part III. Analyzing Some Reasons for Poor Health: 12. Trade and health: the ethics of global rights, regulation and redistribution Meri Koivusalo; 13. Debt, structural adjustment and health Jeff Rudin and David Sanders; 14. The international arms trade and global health Salahaddin Mahmudi-Azer; 15. Allocating resources in humanitarian medicine Samia Hurst, Nathalie Mezger and Alex Mauron; 16. International aid and global health Anthony Zwi; 17. Climate change and health: risks and inequities Sharon Friel, Colin Butler and Anthony McMichael; 18. Animals, the environment and global health David Benatar; 19. The global crisis and global health Stephen Gill and Isabella Bakker; Part IV. Shaping the Future: 20. Health impact fund: how to make new medicines accessible to all Thomas Pogge; 21. Biotechnology and global health Hassan Masun, Justin Chakma and Abdallah Daar; 22. Food security and global health Lynn McIntyre and Krista Rondeau; 23. International taxation Gillian Brock; 24. Global health research: changing the agenda Tikki Pang; 25. Justice and research in developing countries Alex John London; 26. Values in global health governance Kearsley Stewart, Gerald T. Keusch and Arthur Kleinman; 27. Poverty, distance and two dimensions of ethics Jonathan Glover; 28. Teaching global health ethics James Dwyer; 29. Towards a new common sense: the need for new paradigms of global health Isabella Bakker and Stephen Gill; Index. (shrink)

The project of this paper is to synthesize enactivist cognitive science and practice theory in order to develop a new account of pretend play. Pretend play is usually conceived of as a representationalist phenomenon where a pretender projects a fictional mental representation onto reality. It thus seems that pretense can only be explained in representationalist terms. In this paper, we oppose this usual approach. We instead propose not only new explanatory tools for pretend play, but also a fundamental reconceptualization of (...) the phenomena of pretend play, that is, of the very explanandum of theories of pretense. To do so, we suggest combining the turn to action and embodiment in the cognitive sciences with the practice turn in the humanities. From our point of view, pretend play has to be seen in its role in human life as a whole, which is to help children to learn to master the complex sociocultural contingencies of the manifold social practices that make up social reality. Pretend play should therefore be conceived as alternative sense-making that is always related, in varying ways, to ordinary social practices. Pretenders do not need to project mental representations onto reality, but make sense of their surroundings in different ways than encultured adults in ordinary practices. In the paper, we spell out this view and show how it enables an enactivist reconceptualization of imagination, intentions and knowledge, which are usually thought of as being available only to representationalist accounts of pretense. (shrink)

This article develops an ecological framework for understanding collective action. This is contrasted with approaches familiar from the collective intentionality debate, which treat individuals as fundamental units of collective action. Instead, we turn to social ecological psychology and dynamical systems theory and argue that they provide a promising framework for understanding collectives as the central unit in collective action. However, we submit that these approaches do not yet appreciate enough the relevance of social identities for collective action. To analyze this (...) aspect, we build on key insights from social identity theory and synthesize it with embodied and ecological accounts of perception and action. This results in the proposal of two new types of affordances. For an individual who enacts her "embodied social identity" of being a member of a particular collective, there can be what we call embodied social identity affordances. Moreover, when several individuals dynamically interact with each other against the background of their embodied social identities, this might lead to the emergence of a collective, which we understand as a dynamically constituted and ecologically situated perception-action system consisting of several individuals enacting relevant embodied social identity affordances. Building on previous work in social ecological psychology, we suggest that there can be genuine collective affordances, that is, affordances whose subject is not an individual, but a collective. (shrink)

This article re-evaluates the role of the manuscript tradition of the Historia Augusta in debates over the original contents and authorship of the text. Evidence for physical disruptions to the text before our oldest surviving manuscripts points to an earlier manuscript distributed across multiple codices. A multi-volume archetype eliminates critical arguments against the author's claims about lives missing before the Life of Hadrian as well as in the lacuna for the years a.d. 244–260. Other multi-volume codices of the eighth and (...) ninth centuries show that loss of an initial volume would have disrupted the textual tradition for the index, titles and authorial attributions. Comparison of our most complete early witness, Pal. lat. 899, to the independent branches of the textual tradition shows discrepancies between these paratextual elements as expected in a disrupted tradition. Ultimately, this article concludes that the current debates on authorship and the original scope of the Historia Augusta rest on paratextual elements from a single branch of the manuscript tradition, raising doubts about the centrality of these controversies to understanding the work. (shrink)

Recent developments in Continental philosophy have included the emergence of a school of “speculative realism,” which rejects the human-centered orientation that has long dominated Continental thought. Proponents of speculative realism differ on several issues, but many agree on the need for an object-oriented ontology. Some speculative realists identify realism with materialism, while others accord equal reality to objects that are non-material, even fictional. Several thinkers retain a focus on difference, a well-established theme in Continental thought. This paper looks at speculative (...) realism from the perspective of systems theory. Many of the tenets of speculative realism have long been features of systems metaphysics and are expressed clearly in a systems framework. However, some views of some speculative realists differ substantially from systems theoretic ideas. (shrink)

Journal of Political Philosophy, EarlyView.

Based on a comparison of various sources, such as different editions, correspondence, reviews, and lecture transcripts, it is shown that Ludwig Heinrich Jakob’s Outline of the General Logic and Critical Elements of Metaphysics in General uses one or more transcripts of Kant’s Logic Lectures as a source. In addition to the thus far known texts by Kiesewetter and Hippel, Jakob’s textbook should therefore also be added to the list of secondary transmissions of Kant’s Logic Lectures.

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

A physician and spokesman for the French Ideologues, Pierre-JeanGeorges Cabanis (1757-1808) stands at the crossroads of several influential developments in modern culture--Enlightenment optimism about human perfectibility, the clinical method in medicine, and the formation and adaptation of liberal social ideals in the French Revolution. This first major study of Cabanis in English traces the influences of these developments on his thought and career. Originally published in 1980. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously (...) out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

For regular sets in Euclidean space, previous work has identified twelve ‘basic’ computability notions to which many previous notions considered in literature were shown to be equivalent. With respect to those basic notions we now investigate on the computability of natural operations on regular sets: union, intersection, complement, convex hull, image, and pre-image under suitable classes of functions. It turns out that only few of these notions are suitable in the sense of rendering all those operations uniformly computable.

Many microbes responsible for infectious diseases are known to run an asymptomatic course in a significant portion of the population. By highlighting the conceptual complexities of host-microbe interactions, this paper elucidates the fact that while many infections remain asymptomatic, this does not necessarily mean that such infections are of no concern for health. The paper builds on the so-called damage-response framework and considers several developments required to gain a more comprehensive perspective on infections and their relationship to diseases. Irrespective of (...) their (short-term) clinical manifestation, infections leave an imprint with consequences for health. Finally, these considerations regarding host-microbe interactions must be incorporated into policy decisions and public understanding of health if we hope to handle future pandemics such as Covid-19 better. (shrink)

This miscellany reports on a newly found dedication copy of Kant’s Religion within the Boundaries of mere Reason (1793) to his dear friend and former student Carl Gottlieb Fischer.

We congratulate Fox and her colleagues (2007) for contributing to the published empirical literature on ethics consultation in United States hospitals. Their study demonstrates the continued wide v...

The aim of this essay is to consider what it means to teach and learn philosophy in accordance with logotectonic thinking. The contemporary obsession with critical thinking, incessant questioning, and addressing “current problems” gains its genuine philosophical meaning only in the light of logotectonic building, which is able to differentiate philo-sophical thinking- as thanks-giving and learning·from the sofia and what has been thought – from the modern-”meditation” (Besinnung) and the submodern “anarchic” reflection.

Abstraction and idealization are the two notions that are most often discussed in the context of assumptions employed in the process of model building. These notions are also routinely used in philosophical debates such as that on the mechanistic account of explanation. Indeed, an objection to the mechanistic account has recently been formulated precisely on these grounds: mechanists cannot account for the common practice of idealizing difference-making factors in models in molecular biology. In this paper I revisit the debate and (...) I argue that the objection does not stand up to scrutiny. This is because it is riddled with a number of conceptual inconsistencies. By attempting to resolve the tensions, I also draw several general lessons regarding the difficulties of applying abstraction and idealization in scientific practice. Finally, I argue that more care is needed only when speaking of abstraction and idealization in a context in which these concepts play an important role in an argument, such as that on mechanistic explanation. (shrink)

The history of the Euclidean Steiner tree problem, which is the problem of constructing a shortest possible network interconnecting a set of given points in the Euclidean plane, goes back to Gergonne in the early nineteenth century. We present a detailed account of the mathematical contributions of some of the earliest papers on the Euclidean Steiner tree problem. Furthermore, we link these initial contributions with results from the recent literature on the problem.