: Ulysses contracts have faced paternalism objections since they first were proposed. Since the contracts are designed to override a present request from a legally competent patient in favor of a past request made by that patient, enforcement of these contracts was argued to be unjustifiable strong paternalism. Recent legal developments and new theories of practical reasoning suggest that the discussion of Ulysses contracts should be revived. This paper argues that with a proper understanding of the future-directed planning (...) embodied in Ulysses contracts, the charge of strong paternalism can be answered, and the enforcement of some Ulysses contracts may be justified under the rubric of weak paternalism. (shrink)

Ulysses contracts are a method by which one person binds himself by agreeing to be bound by others. In medicine such contracts have primarily been discussed as ways of treating people with episodic mental illnesses, where the features of the illness are such that they now judge that they will refuse treatment at the time it is needed. Enforcing Ulysses contracts in these circumstances would require medical professionals to override the express refusal of the patient at the time (...) treatment is required, something that is generally problematic both ethically and legally. In this paper I will argue that despite appearances Ulysses contracts can make it the case that treating a patient in such circumstances is an instance of treating him with his consent, although safeguards are needed to ensure that this is the case. Given the potential benefits to patients I further argue that modified Ulysses contracts should be made legally enforceable. (shrink)

This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment, they may still be less competent than they were when they signed the Ulysses Contract. As such, even if competent (...) at time 1 and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people’s most meaningful concerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis, this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)

Introduction Compulsory care is controversial, since respect for the patient’s autonomy is a standard requirement in health care. Many psychiatrists have experienced that patients with borderline personality syndrome sometimes demand compulsory care for themselves in order not to exert self-harm—like Ulysses contracts. The aim of this study was to examine the possible existence and extent of borderline personality syndrome-patient demands for Ulysses contracts regarding compulsory care in acute psychiatry, and how external influences and demands could affect the caregivers’ (...) decisions about compulsory care. Method An anonymous questionnaire, with three questions with fixed answers, was distributed to 42 licensed medical doctors on call at the psychiatric emergency unit in the city of Stockholm. Thirty-three questionnaires were answered, giving a response rate of 79%. Results Ninety-four percent of the respondents recognized the phenomenon of borderline personality syndrome patients requesting compulsory care, 21% stated that this request had affected their clinical decision, and 55% had used compulsory care for other reasons than the patient’s best interest. Discussion The results indicate that compulsory care is sometimes given in the form of Ulysses contracts for borderline personality syndrome patients. Also, compulsory care is sometimes used for other reasons than the borderline personality syndrome patient’s best interest. Psychological mechanisms affect the decisions of both patients and caregivers. More research should be done concerning to whom, why, and with what consequences compulsory care is prescribed. (shrink)

‘Ulysses contracts’ are an instrument through which a psychiatric patient may prearrange involuntary commitments to be put into effect if the patient satisfies certain diagnostic criteria in the future. Proposals for Ulysses contracts typically impose numerous safeguards. This paper argues against the intuitively plausible safeguard which permits only presently remitted patients to contract. Instead of requiring a patient's remission, it is argued that the appropriate safeguard is the patient's ability, whether remitted or not, to offer good reasons (...) for wishing to contract. In short, what matters is not an executive's character, but an executive's reasons, and a bad executive may have good reasons. Attempts to deny the accessibility of good reasons in unremitted patients are rejected on the ground that psychiatric diagnosis requires psychiatrists to be able to distinguish between good and bad reasons in both remitted and unremitted patients. If psychiatrists cannot do that, psychiatric diagnosis is impossible. (shrink)

Patients with borderline personality disorder sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: the patient lacking free will, Ulysses contracts as self-paternalism, the patient lacking decision competence, Ulysses contracts as (...) a defence of the authentic self, and Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding BPD patients. Hence, Ulysses contracts including compulsory care should not be used for this group of patients. (shrink)

The American Journal of Bioethics, Volume 12, Issue 3, Page 37-39, March 2012.

Women recognise that labour represents a mind-altering event that may affect their ability to make and communicate decisions and choices. For this reason, birth plans and other pre-labour directives can represent a form of Ulysses contract: an attempt to make binding choices before the sometimes overwhelming circumstances of labour. These choices need to be respected during labour, but despite the reduced decisional and communicative capacity of a labouring woman, her choices, when clear, should supersede decisions made before labour.

I examine current models of self-destructive addictive behaviour, and argue that there is an important place for Ulysses contracts in coping with addictive behaviour that stems from certain problematic preference structures. Given the relevant preference structures, interference based on a Ulysses contract need not involve questionably favouring an agent’s past preferences over her current preferences, but can actually be justified in terms of the agent’s current concerns and commitments.

Pre-commitment directives or Ulysses contracts are often defended as instruments that may strengthen the autonomous self-control of episodically disordered psychiatric patients. Autonomy is understood in this context in terms of sovereignty ("governing" or "managing" oneself). After critically analyzing this idea of autonomy in the context of various forms of self-commitment and pre-commitment, we argue that what is at stake in using Ulysses contracts in psychiatry is not autonomy as sovereignty, but autonomy as authenticity. Pre-commitment directives do not function (...) to protect autonomous self-control. They serve in upholding the guidance that is provided by one's deepest identity conferring concerns. We elucidate this concept of autonomy as authenticity, by showing how Ulysses contracts protect the possibility of being "a self.". (shrink)

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging (...) for healthcare providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

In a Ulysses contract, A gets B, at t1, to agree (i) to act at t2 in such a way that A is made to abide by her own earlier intentions and (ii) to ignore A’s later attempt to rescind the authorization. But why does A’s will at t2 lack the authority it had at t1? This article makes the case that a person has authority to enter a Ulysses contract only insofar as her expressed will (...) at t1 is a better expression of the values that remain attributable to her at t2 than is her expressed will at t2. (shrink)

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as “mental health advance directives.” How can health care providers justify enforcing such contracts over an agent’s current, competent refusal? I argue that providers respect an agent’s autonomy not retrospectively—by reference to his or her past wishes—and not merely synchronically—so that (...) the agent gets what he or she wants right now—but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers’ actions over time. Mental health directives accomplish this, so they are a way of respecting the agent’s autonomy even when providers override the agent’s current competent refusal. (shrink)

Résumé Le rapprochement de Whitehead avec le courant émergentiste, notamment Samuel Alexander, Conwy Lloyd Morgan et Charlie Dunbar Broad, met en lumière l’articulation entre la dimension processuelle de sa philosophie et son effort pour rendre compte du caractère signifiant de l’univers. Pour tous, la philosophie se doit de montrer que ce qui relève de l’esprit appartient pleinement à la nature, et n’a pas à être rejeté dans un non-lieu métaphysique. Mais, chez Whitehead, cet effort prend une tournure différente, impartiale, en (...) décentrant la notion d’« esprit » de la référence exclusive à la mentalité humaine. (shrink)

O objetivo deste artigo é mostrar a semântica da palavra Eros dentro da tradição cristã. Limita-se a algumas dessas significações. A reflexão mostra a limitação dessa expressão na língua portuguesa. Seu significado é muito mais rico na língua grega. Se a tradição cristã carregou esta palavra de forma negativa, outros Padres leram-na em sintonia com Ágape e com outros significados. A relação mística a interpreta como uma relação “erótica” entre homem e Deus. Esta intimidade procura explicar o aspecto do desejo (...) de Deus e da relação mútua entre aquele que ama e o amado, que tem sua raiz na busca mais íntima da humanidade. Negar por preconceitos palavras carregadas de desejos não divinos e nem dignos da humanidade, como na Antigüidade, é reduzir demais seu campo semântico na história. Esta palavra reflete o amor da alma para com Deus numa perspectiva mística, assume variações significativas, dentre tantas, como o amor de Jesus Cristo, como sinônimas de Ágape, do amor de Deus para com os homens, como amor individual ligado a Deus, o Eros como virtude e como castidade. A compreensão das dimensões do amor se realiza na capacidade de ver que todas elas são positivas e importantes para obtermos o equilíbrio da vida humana, numa harmonia destas dimensões constitutivas e importantes para a vida. Palavras-chave: Eros; Patrística; Amor; Alma; Mística; Virtude; Castidade e Ágape. ABSTRACT This article aims at demonstrating the semantics of the term Eros in Christian tradition, pointing out the limitations of the term in Portuguese. The scope of its meaning is much wider in Greek. If Christian tradition has charged the word with a negative feature, other priests have read it in tune with Agape and other meanings. The mystical perspective interprets it as an ‘erotic’ relationship between man and God. Such intimacy attempts to explain God’s desire and the mutual relation between the one who loves and the beloved, rooted in mankind’s most intimate longing. To deny, on account of prejudice, words charged with non-divine desires unworthy of humanity, as happened in antiquity, is to reduce their semantic field in history. That word reflects the soul’s love for God in a mystical perspective and assumes meaningful variations, among which Christ’s love, ‘Agape’ or God’s love for men, and individual love connected with God: ‘Eros’ as virtue and chastity. The comprehension of the dimensions of love takes place in the capacity to realize that they are all positive and relevant to human life’s balance, in the harmony of those dimensions that constitute life. Key words: Eros; Patristics; Love; Soul; The mystical; Virtue; Chastity; Agape. (shrink)

Efforts have been dedicated to the understanding of social-ecological systems, an important focus in ethnobiological studies. In particular, ethnobiological investigations have found evidence and tested hypotheses over the last 30 years on the interactions between human groups and their environments, generating the need to formulate a theory for such systems. In this article, we propose the social-ecological theory of maximization to explain the construction and functioning of these systems over time, encompassing hypotheses and evidence from previous ethnobiological studies. In proposing (...) the theory, we present definitions and two conceptual models, an environmental maximization model and a redundancy generation model. The first model seeks to address biota selection and its use by human populations. The second emphasizes how the system organizes itself from the elements that were incorporated into it. Furthermore, we provide the theoretical scenario of plant selection and use from an evolutionary perspective, which explicitly integrates the phylogenetic relationships of plants and human beings. (shrink)

Efforts have been dedicated to the understanding of social-ecological systems, an important focus in ethnobiological studies. In particular, ethnobiological investigations have found evidence and tested hypotheses over the last 30 years on the interactions between human groups and their environments, generating the need to formulate a theory for such systems. In this article, we propose the social-ecological theory of maximization to explain the construction and functioning of these systems over time, encompassing hypotheses and evidence from previous ethnobiological studies. In proposing (...) the theory, we present definitions and two conceptual models, an environmental maximization model and a redundancy generation model. The first model seeks to address biota selection and its use by human populations. The second emphasizes how the system organizes itself from the elements that were incorporated into it. Furthermore, we provide the theoretical scenario of plant selection and use from an evolutionary perspective, which explicitly integrates the phylogenetic relationships of plants and human beings. (shrink)

Part of the task of doing moral philosophy is to strengthen our confidence in morality or to bring back the gravitas of morality. I argue that this cannot be done by a representational view of moral reality and by downplaying the importance of human sentiments that make our moral assertions more natural and authentic.

According to contemporary moral realism a moral property, like goodness or badness, is either a natural property or a non-natural property of actions or situations. Contemporary moral naturalists like Richard Boyd, Nicholas Sturgeon, and David Brink are a group of philosophers who are often referred to as Cornell realists because of their connection with Cornell University. Frank Jackson is another contemporary moral naturalist who is one of the leaders of The Canberra Planners at the Australian National University with which he (...) is connected. Jackson defends “the most extreme form of naturalism.” Jackson’s view is considered extremeby those who disagree with him because he believes that moral properties are reducible or identical to natural properties. This view of Jackson is opposed by contemporary non-naturalists like Jonathan Dancy, Derek Parfit, and Russ Shafer-Landau for reasons which in my view are not successful. Despite Jackson’s reductionism about the ethical, the Cornell realists, nevertheless, agree with him that moral properties are natural properties. (shrink)

TRECHO DO DISCURSO DE PROMULGAÇÃO DA CONSTITUIÇÃO FEDERAL DE 1988, EM 5 DE OUTUBRO.

Today, an extensive body of research has been produced on the history of mobilisation by residents of working-class neighbourhoods in France and by those who identify with them. These analyses have changed our understanding of contemporary mobilisations, but the existing discourse should not prevent us from reflecting on the alternative modes of engagement that are emerging in these neighbourhoods. These commitments contribute to the “making” of a distinct political culture, rooted in practices and discourses hybridised within working-class lifestyles. Is there (...) an elective affinity between Bourdieu’s theoretical framework and the mobilisations of working-class neighbourhoods? If so, how can this framework provide a productive interpretation of the ordinary actions interwoven into the daily fabric of these social spaces? One way of answering these questions is to consider these actions as a form of political knowledge that reveals alternative ways of considering politics. (shrink)

Comment éviter les contradictions et les impasses de la double conscience inhérentes à la prise de parole depuis la subalternité? En s’appuyant sur les travaux de l’historien algérien Daho Djerbal, cet article d’Ulysse Rabaté instruit une lecture décoloniale des mobilisations dans les « quartiers populaires », depuis la marche pour l’égalité et contre le racisme de 1983 jusqu’à aujourd’hui. L’auteur, militant et chercheur en sciences politiques, propose de comprendre comment ces activismes des banlieues ou des cités, comme on les a (...) nommés, ont été marginalisés voire exclus du domaine de la politique légitime. (shrink)

Les mobilisations qui émergent depuis plusieurs décennies dans les quartiers populaires français se font à distance des structures établies d’énonciation de la politique. Ce que nous pourrions considérer avec le vocabulaire de Guattari comme un mouvement de déterritorialisation s’est réalisé dans le cadre de rapports de pouvoirs spécifiques, invisibilisés par la grammaire des conflits politiques. Identifier les lignes de fuite élaborées dans la pratique par des mobilisations souvent considérées hors-radars (« ce n’est pas de la politique »), impose de « (...) sortir de la langue » et contourner les modes de signification qui sont aussi modes de confiscation. Les outils légués par Félix Guattari nous aident à affronter une question qui demeure : réside-t-il dans cette brèche creusée en conflit avec les « données » de la domination, un mouvement irrépressible vers la transformation des rapports sociaux du capitalisme, et donc une cohérence des subjectivations et des pratiques en direction de cet objectif? (shrink)

La place qu’occupe la matière dans la définition de la substance sensible évolue au cours des livres Z et H de la Métaphysique : là où les chapitres 10 et 11 du livre Z affirment que la matière doit être exclue du definiens de la substance sensible, le chapitre 2 du livre H affirme, au contraire, qu’il se doit de l’inclure. Le présent article montrera que cette différence de doctrine est issue d’un approfondissement de la manière dont la priorité causale (...) de la forme est exprimée dans la définition. Elle l’est d’abord, dans le livre Z, au moyen d’une réduction des termes du definiens aux seules « parties de la forme », réduction qui est d’emblée jugée superflue et insatisfaisante. Elle le sera ensuite, dans le livre H, par la position de prédicat de la matière qu’elle occupe et qui a précisément vocation à exprimer sa priorité. En ce sens, les deux ensembles de textes ne constituent pas une volte-face théorique de la part d’Aristote, mais l’approfondissement d’un seul et unique modèle de définition visant à exprimer la priorité de la forme. (shrink)

Si Marx aujourd'hui doit retrouver la radicalité qui a porté en ses premiers commencements sa pensée révolutionnaire, il faut rompre définitivement avec les évidences les mieux établies de son interprétation. La pensée de Marx, loin de pouvoir être rattachée au sol du matérialisme, s'enracine au plus profond de l'idéalisme allemand dans ce mouvement de pensée qui vient contester en ses fondements ultimes la métaphysique et son ordre, l'ordre d'un entendement captif de l'horizon borné de la positivité. Pensée de subversion de (...) l'ordre de la positivité, la pensée de Marx se laisse alors définir comme un mouvement de déstabilisation du monde, mise en abyme de son fondement. Cette disqualification an-archique de l'arche est au principe de la pensée de la révolution radicale et de la mise en question fondamentale du pouvoir. Dans l'espace ouvert par cette double Bestimmung, idéaliste, an-archique, la pensée de Marx, en opposition à toute interprétation qui y voit une pensée du social, définit un individualisme radical qui se veut la critique absolue de toute volonté d'édification d'un nouvel ordre, individualisme qui ne laisse plus rien prévaloir qui fasse violence à la valeur de sens de l'autonomie.The road to Marx's thought supposes as its condition a movement of radical depositioning in relation to the classically established guidelines for journeying through his work. Marx's thought, in opposition to any interpretation which sees therein a reflection on the social sphere, defines a radical form of individualism which is intended as the absolute criticism of any desire to construct a new order, an individualism which allows absolutely nothing which might obstruct the value of the meaning of autonomy to prevail. (shrink)

Se saisir de la réalité, du monde sensible, de façon subjective énonce la 1re thèse sur Feuerbach. Qu'engage pour la pensée matérialiste de Marx un tel appel ? Que faut-il comprendre sous le terme du matérialisme quand il s'agit de la philosophie de Marx ? À quel matérialisme nous renvoie la révolution théorique qui s'effectue dans les thèses sur Feuerbach ?Notre texte vise à apporter une réponse à ces questions en montrant que si le matérialisme de Marx doit définir quelque (...) chose d'inédit, il ne peut en aucun cas s'identifier à ce qu'en a fait la tradition marxiste, tout au contraire il définit une pensée nouvelle de la subjectivité, celle de la « gegenstandliche Tatigkeit», pensée que requiert l'impératif pratique de la onzième thèse sur Feuerbach : la transformation du monde.The first thesis on Feuerbach calls for a subjective apprehension of reality and of the world perceived by the senses. What does such a program entail for Marx's materialist thought ? What should be included under the term "materialism" when we consider Marx's philosophy ? To what materialism are we directed by the theoretical revolution effected in the theses on Feuerbach ?Our text attempts to answer these questions by showing that if Marx's materialism must define something theoretically unprecedented, it certainly can not be identified with this interpretation within the Marxist tradition. On the contrary, it defines a new way of thinking about subjectivity, the « gegenstandliche Tatigkeit », a way of thinking which requires the imperative of praxis enjoined in Feuerbach's eleventh thesis : the transformation of the world. (shrink)

Resumo: O artigo trata da especificidade de um dos produtos tecnológicos de vigilância e de ataque aéreos mais importantes em uso atualmente, os drones, mostrando em que sentido essa nova tecnologia traça um marco decisivo na evolução do domínio dos ares e, portanto, como sugere Carl Schmitt, na transformação do campo teológico-político das sociedades contemporâneas. A imanência radical do campo político proposta pelo liberalismo, diagnosticada por Schmitt, terá nos drones um de seus instrumentos mais exemplares. Para caracterizar a especificidade dos (...) drones frente a outros aparelhos visuais e aéreos de guerra, será proposta uma aproximação com o conceito de imagem-tempo de Gilles Deleuze, de tal modo a determinar essa sua singularidade a partir das propriedades intrínsecas da imagem gerada. A principal característica da imagem-tempo deleuziana a ser integrada à análise dos drones será seu aspecto tátil. Nesse momento, a aproximação dos livros de Deleuze sobre o cinema com sua obra escrita com Félix Guattari será essencial para determinar a dimensão política da imagem-drone.: This paper deals with the specificity that characterizes one of the most important technological aerial products dedicated to surveillance and attack being in use nowadays, the drones, showing in which sense this new technology is a decisive turning point in the evolution of the domination of the skies and therefore, as suggested by Carl Schmitt, in the transformation of the political-theological field in contemporary societies. The radical immanence of the political field proposed by liberalism, such as Schmitt described it, finds in drones one of its most typical instruments. To characterize the specificity of drones regarding other visual and aerial war machines, it will be proposed an approximation with the Deleuzian concept of image-time, in order to determine its singularity through the intrinsic properties of the images so produced. The main characteristic of the Deleuzian time-image to be integrated in the analysis of drones will be its haptic aspect. At this point, the relation between Deleuze’s cinema books and his work in collaboration with Félix Guattari will be essential to characterize the political dimension of the drone-image. (shrink)

Tradução do texto "Da verdadeira Theologia Mystica", de G. W. Leibniz.

Este artigo analisa as anotações que Leibniz escreveu, em 1678, sobre a então recém-publicada Ética de Espinosa, mostrando como elas prefiguram alguns desenvolvimentos posteriores de sua teoria metafísica. Partindo de uma análise das críticas de Leibniz à Proposição 2 da Parte I da Ética, o artigo mostrará como as discussões sobre a compatibilização entre liberdade e determinismo, que ocuparam o centro de suas preocupações metafísicas nas décadas seguintes, retomam, ainda que com modificações, temas e problemas tratados nessas notas. Particularmente, será (...) mostrado que a relação entre autonomia e poder de escolha pode ser melhor compreendida como um desenvolvimento de teses exploradas nessa leitura inicial da obra de Espinosa. (shrink)