The 21st Century Cures Act is a major act of legislation that contains numerous changes to drug and device regulation. The House of Representatives passed the Act after considerable interest group lobbying, but the bill and the key changes made during its drafting remain controversial. Using publicly disclosed records of written comments on the bill, we reviewed the key areas of lobbying activity and the compromises made in the final text. We focused on legislative provisions relating to management of (...) the National Institutes of Health, incentives for medical product development, and approval standards for new drugs and devices. By the end of the first comment period, the Committee received 118 comments. Most respondents were patient organizations, professional societies, and pharmaceutical and device companies. Overall, the majority of public comments were positive, although public health and consumer organizations were underrepresented in the number of submitted comments. As the legislative process continued, the draft bill underwent several changes relating to NIH funding, market exclusivity provisions, and scrutiny of regulatory evidentiary standards. Understanding the key statutory provisions and how they have evolved could help patients, researchers, and advocates make more informed comments on the bill and future health care legislation. (shrink)

Randomized controlled trials test new drugs using various debiasing devices to prevent participants from manipulating the trials. But participants often dislike controls, arguing that they impose a paternalist constraint on their legitimate preferences. The 21st Century Cures Act, passed by US Congress in 2016, encourages the Food and Drug Administration to use alternative testing methods, incorporating participants’ preferences, for regulatory purposes. We discuss, from a historical perspective, the trade-off between trial impartiality and participants’ freedom. We argue that the only (...) way out is considering which methods improve upon the performance of conventional trials in keeping dangerous or inefficacious compounds out of pharmaceutical markets. (shrink)

Through expanded access protocols, the Food and Drug Administration (FDA) allows patients with serious or immediately life-threatening diseases access to experimental drugs outside the clinical trial setting when no satisfactory alternative treatment is available. While the FDA has established a mechanism for providing patients with unapproved drug access, the regulations do not require the pharmaceutical company to provide the drug. The drug company’s permission to use its experimental drug is a necessary prerequisite to using the FDA’s expanded access mechanism. Increasingly, (...) drug companies are coming under scrutiny regarding the programs governing that decision-making power. Historically, disclosing whether a company has an expanded access program, and whether or how it would respond to an expanded access request, has been left to discretion of the drug companies themselves. Few manufacturers publish adequate expanded access protocols. As a result, patients were provided with little insight into how companies evaluate expanded access requests and are naturally skeptical as to the ethical integrity of the process. The recently passed 21st Century Cures Act changes that practice by requiring drug companies to have, and make publically available, their expanded access procedures including criteria for evaluating and responding to patient requests. In this article, we contend that complying with the new transparency provisions will require drug companies to respond to several unresolved expanded access issues. Namely, how to reconcile a patient’s desire to access lifesaving experimental therapies alongside the company and society’s interest in the efficient development of new drugs. Even more challenging, how can companies devise practices for evaluating and processing expanded access requests that also fairly and equitably acknowledge those concerns? In addressing these questions, this article explores the legal, regulatory, business, and societal influences that have shaped expanded access policies and practices. From there, we provide companies a framework that balances appropriately the desires of individuals and gaining the requisite approvals ensure access not just for one person but for society. (shrink)

__Augustine and the Cure of Souls __situates Augustine within the ancient philosophical tradition of using words to order emotions. Paul Kolbet uncovers a profound continuity in Augustine's thought, from his earliest pre-baptismal writings to his final acts as bishop, revealing a man deeply indebted to the Roman past and yet distinctly Christian. Rather than supplanting his classical learning, Augustine's Christianity reinvigorated precisely those elements of Roman wisdom that he believed were slipping into decadence. In particular, Kolbet addresses the manner in (...) which Augustine not only used classical rhetorical theory to express his theological vision, but also infused it with theological content. This book offers a fresh reading of Augustine's writings--particularly his numerous, though often neglected, sermons--and provides an accessible point of entry into the great North African bishop's life and thought. "For someone who does not know Augustine well this book will be an excellent introduction to his thought from an absolutely crucial viewpoint. Augustine's preaching, teaching, and attempts to reach the minds and hearts of his congregation have been largely overlooked. This book has the great virtue of demonstrating why these were important." --_Carol Harrison, Durham Universi_ty "In this insightful and lucid study Kolbet leads his readers across the boundaries of ancient philosophy, psychology, rhetoric, and theology. He examines the ancient practice of the 'cure of the soul' and charts its Christian appropriation by Augustine. The volume offers its own medicinal promise--the reordering of our contemporary understanding of early Christianity and its complex association with classical culture." --_John Peter Kenney, St. Michael's College_. (shrink)

Although COVID-19 pandemic has re-orientated humans to be more physically healthy and hygienic, it has also persuaded humans to create affiliations and experience a sense of belongingness through social networks and digital technologies. However, amidst these changes, experiences of COVID-19 patients and their perception of the outside world's attitudes toward them appears to be less attended in literature which formed the basis for the current study's objectives. Using qualitative methodology, the present study explored the experiences, perceptions and attitudes of patients (...) and their care-givers' toward COVID-19. The thematic analysis emerged with four major themes. Psychological Experiences of People was generated prominently with sub-themes indicating the perceived experiences like fear of spreading diseases to others, and the need for psychological counseling. Attitude of others toward patients and caregivers revealed that family members and relatives played a major positive role on the patient's mental health, however, the neighbor's stigmatized attitude led to several undesired behaviors. Social Connectedness was another major theme derived from the study. Altruistic volunteers, a sub-theme of Social connectedness have indicated that amidst these negative factors, one can spread social harmony by motivating and supporting the victims with basic needs, financial support, hope and social empathy. Opinions of participants for digital technology through technological aids and preventive measures emphasized an overall positive attitude as it helped the society, in general to maintain social connections as well to curb the rate of COVID-19 cases. (shrink)

An invigorating exploration of the pleasures and social benefits of conversation Talking Cure is a timely and enticing excursion into the art of good conversation. Paula Marantz Cohen reveals how conversation connects us in ways that social media never can and explains why simply talking to each other freely and without guile may be the cure to what ails our troubled society. Drawing on her lifelong immersion in literature and culture and her decades of experience as a teacher and critic, (...) Cohen argues that we learn to converse in our families and then carry that knowledge into a broader world where we encounter diverse opinions and sensibilities. She discusses the role of food in encouraging conversation, the challenges of writing dialogue in fiction, the pros and cons of Zoom, the relationship of conversation to vaudeville acts, and the educational value of a good college seminar where students learn to talk about ideas. Cohen looks at some of the famous groups of writers and artists in history whose conversation fed their creativity, and details some of the habits that can result in bad conversation. Blending the immediacy of a beautifully crafted memoir with the conviviality of an intimate gathering with friends, Talking Cure makes a persuasive case for the civilizing value of conversation and is essential reading for anyone interested in the chatter that fuels culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:122 HUME ON CURING SUPERSTITION In the first volume of his masterful treatment of the Enlightenment Peter Gay says that "David Hume proclaimed philosophy the supreme, indeed the only, cure for superstition." The context suggests that Hume had great "confidence" in this project and that he shared Diderot's view of the philosopher as the apostle of truth who would teach all mankind. Certainly Hume, in common with his philosophical (...) compatriots, thought that superstition was a great evil. He may also have thought that philosophy was the best weapon with which to oppose superstition. But did he think that it was a "cure" and that the philosopher was a pathfinder for a new and glorious dawn of universal enlightenment? He seems rather to have held a somewhat more modest and circumspect view of what philosophy can accomplish by way of liberating humanity from superstition than did some of his more optimistic contemporaries — a view 2 worthy of closer examination. The purpose of this paper is to explain just what he did think by examining those texts where he writes about the curative virtues of philosophy. So that any shifts in Hume's views may be more apparent, the relevant passages will be considered according to their chronological order. In the conclusion to Book I of the Treatise (1738) Hume characterizes the results of his reasoning as a "forelorn solitude" in which he is separated, not only from the crowd, and from "metaphysicians, logicians, mathematicians, and even theologians," but also from philosophers, who, like all others, follow the inconsistent dictates of imagination in alternating between belief in the continual existence of sensible matter and the 123 reliability of causal reasoning, which teaches us that sensible objects are in us, rather than in external nature (T 265-6). His own philosophical reflections have led to the realization that even the causal "connexion, tie, or energy lies merely in themselves," as certainly as do sensed qualities. Thus the philosophical quest itself, which seeks a knowledge of "the ultimate and operating principle... which resides in the external object," is revealed as a contradictory or meaningless enterprise. We are left with a "very dangerous dilemma, whichever way we answer it," whose horns are precisely superstition and philosophy. That is, we may either "assent to every trivial suggestion of the fancy... often contrary to each other... [which will] lead us into such errors, absurdities, and obscurities, that we must at last become asham'd of our credulity;" or we may "take a resolution to reject all the trivial suggestions of the fancy, and adhere to the understanding" which will lead us to the conclusion that there is "not the lowest degree of evidence in any proposition, either in philosophy or common life" (T 266-8). He believes that philosophy has come to an impasse which he does not know how to escape, and which we commonly deal with by simply ceasing to think about the problem, finding ourselves "absolutely and necessarily determin'd to live, and talk, and act like other people in the common affairs of life" (T 269). Observation of the actual effects of philosophy upon conduct warrants the conclusion that "refin'd reflections have little or no influence upon us," excepting, of course, for that brief time in which those reflections leave us quite agitated and confounded by our inability to provide answers to the questions which most trouble us. 124 Philosophy is here characterized, not as a cure for superstition, but as an equal and opposite mental disposition, whose reflections ultimately undermine its own rational credentials, so that they seem no more valid than those of superstition. He does indeed resort to the therapeutic metaphor, but only to make nature the physician which "cures me of this philosophical melancholy and delirium" by applying that "carelessness and inattention" which he earlier identified as that which "alone can afford us any remedy" for philosophical despair (T 218). So philosophy is itself in need of the cure afforded by amusement and the various "common affairs of life" with which gentlemen occupy themselves. When engaged in those pursuits, philosophy seems individually and socially useless, in effect "an abuse of time" (T 270). If one returns to... (shrink)

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study (...) nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

The leading question of this article is whether it is acceptable, from a moral point of view, to take wild animals that are ill out of their natural habitat and temporarily bring them under human control with the purpose of curing them. To this end the so-called 'seal debate' was examined. In the Netherlands, seals that are lost or ill are rescued and taken into shelters, where they are cured and afterwards reintroduced into their natural environment. Recently, this practice has (...) been criticised because it is thought to interfere with the wildness of the animals and population. In this research, the moral assumptions behind the arguments of both the proponents and opponents of sheltering have been analysed within a morally pluralistic framework. It is concluded that sheltering on too large a scale would be contrary to the efforts of the last few decades to maintain an independent or wild seal population, which means that a certain amount of caution is called for. However, in the current situation there is no decisive reason to completely prohibit shelters either. Good arguments can even be given in favour of sheltering. It also becomes clear that the acceptability of sheltering wild animals depends on the specific circumstances in which an animal is encountered. (shrink)

Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)

Skeptical theism is a popular response to the evidential problem of evil, but it has recently been accused of proving too much. If skeptical theism is true, its detractors claim, then we not only have no good reason for thinking that God’s reasons for action should be available to creatures like us, but we also have no good reason for thinking that the reasons which govern how we ought to act should be available to creatures like us. And given this (...) ignorance, we would be morally paralyzed, unable to decide what we ought to do in ordinary situations that call for a moral decision. In this paper, I present a simple solution to this problem of moral paralysis by drawing on Peter Geach’s now famous argument for the attributivity of “good.”. (shrink)

McDonnell, Justin The psychologist wishes to balance man psychologically. The spiritual father aims at his divinisation... the psychologist employs the method of questioning and listening and tries to make man aware of his problem and to mature psychologically. The spiritual father, illumined by the grace of God, locates the problem-which is the darkness of the nous-and tries to lead man to the theoria of God by the means of the Orthodox method of purification and illumination. The psychologist acts anthropocentrically using (...) thoughts and ideas. The spiritual father acts in a theocentric way. He uses the therapeutic method, but also the mysteries through which the heart receives the grace of God. (shrink)

Over the past twenty years there has been a shift in medical law and practise to increasingly distrust the judgement of health professionals. An increasing number of codes of conduct, disciplinary bodies, ethics committees and bureaucratic policies now prescribe how health professional and health researchers should act and relate to their patients. The result of this, Mark Henaghan argues, has been to undermine trust and professional judgement in health professionals, while simultaneously failing to trust the patient to make decisions about (...) their care. This book will look at the issue of health professionals and trust comparatively in a number of countries including the USA, Canada, Australia, New Zealand and the UK. The book will show by historical analysis of legislation, case law, disciplinary proceedings reports, articles in medical and law journals and protocols produced by management teams in hospitals, how the shift from trust to lack of trust has happened. Drawing comparisons between situations where trust is respected such as in emergency situations, and where it is not for example routine decisions such as obtaining consent for an anaesthetic procedure, the book shows how this erosion of trust has the potential to dehumanise the special nature of the relationship between healthcare professionals and patients. The effect of this is that the practice of health care is turned into a mechanistic enterprise controlled by "management processes" rather than governed by trust and individual care and judgement. This book will be an invaluable resource for students and scholars of medical law and medical sociology, public policy-makers and a range of associated professionals, from health service managers to medical science and clinical researchers. (shrink)

Only 27 percent of Americans in a 1995 Harris poll said they had read or heard “quite a lot” about genetic tests. Nonetheless, 68 percent said they would be either “very likely” or “somewhat likely” to undergo genetic testing even for diseases “for which there is presently no cure or treatment.” Perhaps most astonishing, 56 percent found it either “very” or “somewhat acceptable” to develop a government computerized DNA bank with samples taken from all newborns, and their names attached to (...) the samples. This does not necessarily mean the public is unconcerned about genetic privacy. More likely it means that the public is still uninformed about the risks associated with genetic testing, and has not thought at all about the risks involved in storing identifiable DNA samples.A central question presented by genetic screening and testing is whether the genetic information so obtained is different in kind from other medical information, and, if so, whether this means that it should receive special legal protection. (shrink)

From the earliest application of modern randomized controlled trials in medical research, scientists and observers have deliberated the ethics of randomly allocating study participants to trial control arms. Adaptive RCT designs have been promoted as ethically advantageous over conventional RCTs because they reduce the allocation of subjects to what appear to be inferior treatments. Critical assessment of this claim is important, as adaptive designs are changing medical research, with the potential to significantly shift how clinical trials are conducted. Policy-makers are (...) swiftly moving to encourage greater use of adaptive designs. In 2016, the newly enacted 21st Century Cures Act instructed the Food and Drug Administration to help product sponsors incorporate adaptive methods into proposed clinical trial protocols and applications for investigational drugs and also biological products. In this article, we review the ethical justifications commonly offered for adaptive designs, explore these arguments in the context of actual trials, and contend that clinical equipoise is a useful standard for adaptive-trial ethics. We distinguish between theoretical and clinical equipoise and explain why ethical arguments related to adaptive trials tend to focus on the former. Yet we contend that theoretical equipoise can be an unreliable standard for adaptive ethics. While we contend that clinical equipoise is the most critical principle for the primary ethical concerns posed by adaptive trials, we suggest ethical approaches to deal with some additional concerns unique to adaptive designs. (shrink)

The market can produce skewed information about investigational products awaiting FDA approval. But the FDA rarely steps in to correct such misleading information, despite statutory authority to do so. This article evaluates a recommendation by the FDA Transparency Working Group that FDA more clearly signal when and how it will correct misleading information about investigational products, and why such a recommendation is particularly important after the 21st Century Cures Act.

Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information—a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in patient privacy and confidentiality if not managed properly through proxy accounts. (...) We present an ethical framework that guides policy and clinical workflow development for healthcare institutions to support the best use of patient portals. Caregivers are vital members of the care team and should be supported through novel forms of health information technology (IT). Patients, however, may not want all information to be shared with their proxies so healthcare institutions must support the development and use of separate proxy accounts as opposed to using the patient’s own account as well provide controls for limiting the scope of information displayed in the proxy accounts. Lastly, as socioeconomic barriers to adoption of health IT persist, healthcare providers must work to ensure multiple streams of patient communication, to prevent further propagating health inequities. (shrink)

The OpenNotes (ON) mandate in the 21st Century Cures Act requires that patients or their legally authorized representatives be able to access their medical information in their electronic medical record (EMR) in real time. Ethics notes fall under the domain of this policy. We argue that ethics notes are unique from other clinical documentation in a number of ways: they lack best-practice guidelines, are written in the context of common misconceptions surrounding the purpose of ethics consultation, and often answer (...) questions of a different nature than other documentation. Thus, we believe the clinical ethics community would benefit from clarification on when the withholding of ethics notes is justified. We provide recommendations for excluding information from ethics documentation based on the likelihood and magnitude of harm that may occur with particular disclosures and suggest approaches to decrease the potential harms that may occur. We define and explain six types of reasons to exclude information from ethics notes based on significant harms that are not addressed in the ON policy: (1) harmful revelations from a protected chart note; (2) negative emotional effects on patients or families; (3) the purpose of the consultation is undermined by harmful consequences; (4) avoidable negative impact on interpersonal dynamics; (5) inappropriate labeling or disclosure of medical, social, or financial information; and (6) inclusion of biasing or otherwise unfair information. We also suggest approaches to mitigate harm when excluding, including, reframing, or delaying release of information that is perceived to be relevant to an ethics case. Overall, we hope our analysis and recommendations will initiate a much-needed discussion about the impact of the ON mandate on clinical ethics documentation. (shrink)

Current guidelines and regulatory frameworks create a dilemma that threatens the effectiveness of much needed communication between patients and medical providers: How can patients be presented with detailed facts without creating cognitive “overload”? We explain how this is a false dichotomy and illustrate, using three examples, how fuzzy-trace theory offers a third way of informing patients.

Many hold that the so-called golden era of antibiotic discovery has passed, leaving only a limited clinical pipeline for new antibiotics. A logical conclusion of such arguments is that we need to reform the current system of antibiotic drug research—including clinical trials and regulatory requirements—to spur activity in discovery and development. The United States Congress in the past few years has debated a number of bills to address this crisis, including the 2012 Generating Antibiotic Incentives Now Act and the 2016 (...) 21st Century Cures Act. Experts have also sought to advance antibiotic development by encouraging greater use of trials with noninferiority hypotheses, which are thought to be easier to conduct. The goal underlying these proposals is to stave off the post-antibiotic era by expanding the pharmaceutical armamentarium as quickly as possible. But although new antibiotic agents are necessary to combat the long-term threat of drug-resistant disease, we argue that these research policies, which effectively lower the bar for antibiotic approval, are ethically problematic. Rather, given broader public health considerations related to the full lifecycle of antibiotic use—including development of resistance—we should reject an overly permissive approach to new antibiotic approval and instead set the bar for regulatory approval at a point that will naturally direct research resources toward the most transformative chemical or social interventions. (shrink)

The HIPAA Privacy Rule is notoriously weak because of its incomplete coverage, numerous exclusions and exemptions, and limited rights for individuals. The three areas in which it provides the most protection are fundraising, marketing, and research. Provisions of the 21st Century Cures Act, pending in Congress, and the Notice of Proposed Rulemaking to amend the federal research regulations, awaiting final regulatory action, would weaken the privacy protections for research. If these measures are adopted, the HIPAA Privacy Rule would have (...) so little value that it might not be worth the aggravation and burden. (shrink)

For observers of pharmaceutical regulation and the Food and Drug Administration, these are uncertain times. Events in late 2016 raised concerns that the FDA's evidentiary standards were being weakened, compromising the agency's ability to adequately perform its regulatory and public health responsibilities. Two developments most directly contributed to these fears—the approval of eteplirsen, a treatment for Duchenne muscular dystrophy, against the recommendations of both FDA staff and an advisory committee and the December 2016 signing of the 21st Century Cures (...) Act, which encouraged greater use by the FDA of “real-world” evidence not obtained through randomized controlled trials. The arrival of the Trump administration—with its deregulatory, industry-friendly approach—has only amplified concerns over the future of the FDA. It is too early to know whether the recent developments are truly harbingers of an FDA less likely to prevent unsafe or ineffective products from reaching the market. But elements in the two events—the role of patient narratives in deliberations regarding eteplirsen and the enthusiasm for real-world evidence in the 21st Century Cures Act—raise critical issues for the future of evidence in the FDA's work. The rigorous, inclusive approach under way to consider issues related to real-world evidence provides a model for a similarly needed inquiry regarding public participation in FDA decision-making. (shrink)

Per the OpenNotes directive of the 21st Century Cures Act implemented in 2021, patients and their legally recognized representatives must be able to access the electronic medical record in real time. This is an opportunity for clinical ethicists and other providers to reflect on their charting practices, particularly how and when they quote patients. Although using direct quotations is common because it seems to avoid misinterpretation, it may not always be appropriate. In this article, we discuss some of the (...) risks and benefits of quoting in the context of OpenNotes and provide suggestions for how clinical ethicists can leverage their unique position to help mitigate some of these risks and promote more reflective charting practices among the teams they work with. (shrink)

Partant de l’appui de Fernando Gil sur le rêve pour traiter de l’évidence, cet article se demande quel sens peut avoir l’évidence dans la cure psychanalytique. L’acte et l’hallucination présentent cette évidence dont on se propose de préciser le statut à travers l’analyse de la notion freudienne d’überdeutlich (ultra-clair). Cette notion permet de comprendre le passage du régime hallucinatoire du visuel à la compréhension verbale et consciente. L’agir (Agieren), à condition d’être interprété comme répétition, permet un autre passage analogue.

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all of us. (...) The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests. (shrink)

ArgumentSeeing a prodigious cure happen and then testifying about it certainly differs from attending an air pump experiment in order to bear witness to it. Yet early-modern saint-making and the “new” or “experimental philosophy” shared juridical roots, and thereby an understanding of the role of testimony for the establishment of “matters of fact” and for the production of legitimate knowledge. The reforms carried out after the Council of Trent, especially during Urban VIII's pontificate, of the juridical procedures for saint-making in (...) the Catholic Church implied a new attitude towards the examination of proposed miracles. Most of these miracles were healings. While the appeal to medical expertise had long been common, and skepticism had often manifested itself regarding cures or extraordinary bodily phenomena, both were now given formal status. Miracle inquests henceforth leaned towards refuting miraculousness by means of natural explanations. The procedure was systematized in a treatise published in the 1730s by Prospero Lambertini. The combination of Lambertini's work with the canonization causes in which he acted as the “devil's advocate” in charge of disputing arguments favorable to a sainthood candidate allows for a reconstruction of the interplay between the juridical and scientific economies of saint-making, and of the role of testimony in the production of trust and evidence. (shrink)

Action, reason, and causes in Kant -- Can we act without feelings? Respect, sympathy and other forms of love -- A place for affects and passion in the Kantian system -- What can Kant teach us about emotions? -- Physiology and the controlling of affects in Kant's philosophy -- Virtue as a cure for affects and passions -- The beautiful and the good: refinement as an introduction to morality -- Women and emotion -- Evil and passion -- An emotional Kant?

Howard J. Curzer - Aristotle's Painful Path to Virtue - Journal of the History of Philosophy 40:2 Journal of the History of Philosophy 40.2 141-162 Aristotle's Painful Path to Virtue Howard J. Curzer [P]unishment . . . is a kind of cure . . . . We think young people should be prone to shame . . . . 1. Two Questions FOR ARISTOTLE, THE GOAL OF MORAL development is, of course, to become virtuous. Aristotle provides a partial description of (...) the virtuous person in the following familiar passage. The virtuous person performing virtuous acts, must have knowledge, secondly he must choose the acts, and choose them for their own sakes, and thirdly his actions must proceed from a firm and unchangeable character. By my count, this passage lists five components of virtue. Presumably, the virtuous agent's knowledge consists in true beliefs concerning which acts are virtuous plus a correct account of why they are virtuous. Virtue thus includes both the ability to identify which acts are virtuous in a given situation and an understanding of why they are virtuous. Choice is deliberate desire, so choosing virtuous acts is a combination of determining and desiring virtuous acts. People want to carry out virtuous acts for various reasons. For example, some choose virtuous acts merely because they are fashionable or instrumentally valuable. But Aristotle specifies that the virtuous person desires virtuous acts for their.. (shrink)

On the ethics of extending human life: healthy people have a right to carry on livingHumanity has long demonstrated a paradoxical ambivalence concerning the extension of a healthy human lifespan. Modest health extension has been universally sought, whereas extreme health extension has been regarded as a snare and delusion—a dream beyond all others at first blush, but actually something we are better off without. The prevailing pace of biotechnological progress is bringing ever closer the day when humanity will be able (...) to act on the latter view by rejecting a clear and present opportunity for much longer healthy lives. Indeed, some biogerontologists contend that that day has already arrived, to the extent that our hesitation in embarking on a vigorous “war on ageing” is already delaying the point at which a cure for ageing will be developed. Here I consider whether our present caution concerning the wisdom of truly curing ageing is likely to survive the increased scrutiny that it will receive in coming years as a result of these technical advances. I conclude that it will not, because of its irreconcilability with values that are more deeply held by the large majority of humanity than any values that argue against the quest for a cure. I further conclude that all the major current reasons given for not curing ageing are mere crutches to help us cope with the immutability of ageing that we have been brought up to accept. Our failure to set aside such irrationality is already shortening potential longevity—quite probably of those already alive today—to a staggering degree. Once we realise this, our determination to consign human ageing to history will be second …. (shrink)

The increasing attention to the brain in science and the media, and people’s continuing quest for a better life, have resulted in a successful self-help industry for brain enhancement. Apart from brain books, foods and games, there are several devices on the market that people can use to stimulate their brains and become happier, healthier or more successful. People can, for example, switch their brain state into relaxation or concentration with a light-and-sound machine, they can train their brainwaves to cure (...) their Attention Deficit Hyperactivity Disorder (ADHD) or solve their sleeping problems with a neurofeedback device, or they can influence the firing of their neurons with electric or magnetic stimulation to overcome their depression and anxieties. Working on your self with a brain device can be seen as a contemporary form of Michel Foucault’s ‘technologies of the self’. Foucault described how since antiquity people had used techniques such as reading manuscripts, listening to teachers, or saying prayers to ‘act on their selves’ and control their own thoughts and behaviours. Different techniques, Foucault stated, are based on different precepts and constitute different selves. I follow Foucault by stating that using a brain device for self-improvement indeed constitutes a new self. Drawing on interviews with users of brain devices and observations of the practices in brain clinics, I analyse how a new self takes shape in the use of brain devices; not a monistic (neuroscientific) self, but a ‘layered’ self of all kinds of entities that exchange and control each other continuously. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Mitochondrial donation or mitochondrial transfer enables a woman with mitochondrial disease to have a genetically related child without transmitting the disease to the child. The techniques used for mitochondrial donation or transfer which are maternal spindle transfer or pro-nuclei transfer, require three gametes to ultimately produce a healthy embryo. Both these techniques result in the child inheriting nuclear DNA from the intending parents and mitochondrial DNA from the female donor. Following the legalisation of mitochondrial donation in the UK, after a (...) rigorous process of scientific and ethical review, and the birth of another baby using the technique, coupled with the fact that there is no cure for mitochondrial disease, suggests that it is prudent for us to consider this reproductive intervention and its application in the South African setting. In addition, the 2019 UNESCO Report of the International Bioethics Committee (IBC) on assisted reproductive technologies (ART) and parenthood, encourages debate on changes in models of parenthood influenced by ART including the emergence of new models of families and forms of parenthood that extend beyond the classical rule of mater semper certa est (the mother is always known). ART, in particular mitochondrial donation, challenges this rule. The aim of this paper is to provide an outline of the legal and ethical positions of mitochondrial donation and resume the discussion with specific focus on the South African context. (shrink)

The present book explores a variety of fundamental questions that all of us secretly share. Its twenty-one chapters, written by some of the world’s leading Melville and Conrad scholars, indicate possible directions of comparativist insight into the continuity and transformations of western existentialist thought between the 19th and 20th centuries. The existential philosophy of participation—so mistrustful of analytical categories—is epitomized by the lives and oeuvres of Melville and Conrad. Born in the immediacy of experience, this philosophy finds its expression in (...) uncertain tropes and faith-based actions; rather than muffle the horror vacui with words, it plunges head first into liminality, where logos dissolves into a “positive nothing.” Unlike analytical philosophers, both Melville and Conrad refrain from talking about reality: they expose those who would listen to a first-hand experience of participation in an interpretive act. Employing literary tropes to denude the essence of the human condition, they allow their readers to transgress the limitations of language. Mistrustful of language, they accept the necessity of discourse which, to make sense, must be actively reshaped, endlessly questioned, and constantly revised. And if uncertainty is the only certainty available to us, our lowly human condition also necessitates compassion: an existential cure against the liquid, capricious reality we are afforded. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Belief in destiny is one of the principles of faith. Although the belief in fate is not explicitly mentioned in the Qur’an, there are many verses that indicate this belief. There are many hadiths about fate that have reached us from the Prophet. Although there are schools that deny destiny, Ahl al-Sunnah schools Ash‘aris and Maturidis accept the existence of belief in destiny. The definitions of destiny of these schools are expressed with words that can be used interchangeably. However, fate (...) should not be evaluated in a single category. It also has varieties. If destiny is perceived as only one kind of Forced destiny, it is inevitable to cause misunderstandings. Forced fate; it is destiny that does not give freedom to beings; It happens with the knowledge, will, power and creation of Allah. Some destinies of inanimate substances, plants, animals and humans are of this type. Jabr and responsibility are incompatible. Although some actions take place in their own bodies, people are not responsible for their forced destiny. Man is a freely created being within certain limits. The ability of intellect, will, power, and carrying out actions has been granted to them. By using them, a person performs his acts of will, and as a result, he becomes responsible for his actions. Having free will and freedom distinguishes humans from other living things. Where there is no human freedom, there is no responsibility. Human life is not uniform, it is in a state of constant change and transformation. In addition to these two types of fate, there is also a type of fate that turns into willful fate, although it was forced in the beginning. In addition to this, there are some actions that start with the will of man and later turn into forced fate. There are also types of disability that we have examined in connection with the belief in destiny and its types. Allah has sent humans to the world to be tested. Illness and disability are also part of the test. Diseases; they may be due to genetic, environmental factors, and food-related. Congenital diseases and disabilities can sometimes cause the world test to be difficult. The biological rules set by Allah are also valid for humans. Genetic hereditary diseases and disabilities occur when the genes carried by the parents are passed on to the child. While some genes are recessive, some genes are dominant. Genes that cause hereditary diseases and disabilities show an uneven distribution depending on their geographical habitats, sharing the same environment in the historical process, and the extent of intermingling of their lineages through marriages. While recessive genes can be passed on from generation to generation, dominant genes that cause death generally do not have the opportunity to pass on to the next generation. In today’s context, the diagnosis of genetic diseases and disabilities is attainable, enabling the implementation of necessary precautions accordingly; furthermore, partial or even complete treatment opportunities can be available depending on the circumstances. In this respect, all of the congenital diseases and disabilities due to genes are a forced fate that is not in the hands of man. As for those diseases and disabilities for which treatment opportunities exist, they fall under the category of fate that transitions from forced fate to willful destiny. Some genetic diseases and disabilities of people may appear in later ages. However, non-genetic diseases and disabilities are also facts of life. Every individual can become ill and experience disability during certain periods of their life. Diseases and disabilities can occur with a number of factors that do not depend on an individual's will, actions, or behaviors. Such diseases are also within the scope of forced fate. A person can also be disabled due to one’s own mistakes and negligence. However, it is a behavior befitting a Muslim to be treated in cases of all kinds of diseases and disabilities. The treatment of diseases for which there is a cure is a willed destiny. Diseases and obstacles that cannot be cured are forced fate. (shrink)

The book concerns what I take to be the least controversial normative principle concerning action: you ought to perform your best option—best, that is, in terms of whatever ultimately matters. The book sets aside the question of what ultimately matters so as to focus on more basic issues, such as: What are our options? Do I have the option of typing out the cure for cancer if that’s what I would in fact do if I had the right intentions at (...) the right times (e.g., the intention to type the letter T at t1, the intention to type the letter H at t2, the intention to type the letter E at t3, etc.)? If I can’t form intentions voluntarily, does that mean that I don’t have the option of forming the intention that I ought to form? Which options do we assess directly in terms of their own goodness and which do we assess in terms of their relations to the goodness of other options? What do we hold fixed when assessing how good an option is? Do we, for instance, hold fixed the agent’s future beliefs, desires, and intentions? And do we hold fixed the agent’s predictable future misbehavior? Lastly, how do the things that ultimately matter determine the goodness of an option? If one of the things that ultimately matters in determining the goodness of an option is that the option doesn’t involve violating anyone’s rights, do we evaluate the option itself in terms of whether it involves violating anyone’s rights or do we evaluate the option’s prospect in terms of this and then the option in terms of its prospect? And what if there is indeterminacy or uncertainty with regards to whether an option would involve violating someone’s rights? (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

My aim in this article is to propose that an insightful way of articulating the feminist concept of epistemic injustice can be provided by paying significant attention to recognition theory. The article intends to provide an account for diagnosing epistemic injustice as a social pathology and also attempts to paint a picture of some social cure of structural forms of epistemic injustice. While there are many virtues to the literature on epistemic injustice, epistemic exclusion and silencing, current discourse on diagnosing (...) as well as explicating and overcoming these social pathologies can be improved and enriched by bringing recognition theory into the conversation: under recognition theory, social normative standards are constructed out of the moral grammar of recognition attributions. I shall argue that the failure to properly recognize and afford somebody or a social group the epistemic respect they merit is an act of injustice in the sense of depriving individuals of a progressive social environment i... (shrink)

Abortion and embryo destruction prevent a future of value, but that does not make them wrong.Abortion involves the killing of a fetus. One bad thing about killing a fetus is that the fetus is deprived of a future of value. Think of all the things which make your life good and worth living: understanding the world, seeing your children grow into independent, intelligent, and happy people, watching a sunset over the hills, enjoying good times with friends. By killing the fetus, (...) we are depriving it of a future life likely to contain these things. And more. The fetus would likely grow to be a person who would have contributed to the world in many ways—bringing joy to its parents, happiness, and friendship to many. That person would have laboured for society and perhaps even discovered a cure for cancer or developed the first bionic eye.The loss of these possible futures is bad. It makes the killing of a fetus wrong. This is Don Marquis's argument against abortion.1 It is one of the best arguments against abortion which does not rest on theological premises.Another way of putting this is to say that we have a good reason not to kill a fetus. A reason for acting is a fact or circumstance forming a sufficient justification for an action. Or in this case, not to perform an action. We have all sorts of reasons for action. Our reasons often conflict. I may have a good reason to visit my mother and a good reason to take my children to the park. What we have most reason to do is what it is right to do. It is what we should do. If we have most reason not to perform an act, …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Obesity Treatment:One Size Does Not Fit AllKarin KwambaiI am obese. That phrase is actually very hard for me to say out loud. Saying it feels as if I am standing at an “obesity anonymous” meeting, except there is nothing anonymous about being fat. Everyone knows it. I often feel that it is the first and only thing people notice about me. I’ve been overweight, chubby, fat my entire life. (...) My mom enrolled me in Weight Watchers when I was 12 years old; I learned to use Molly McButter in front of her and sneak oatmeal cream pies when she wasn’t looking. I’ve learned a lot of maladjusted behaviors around food over a lifetime of trying to lose weight. I’ve tried meal replacement shakes, pills, souping, juicing, and the “Master Cleanse”—a diet of lemonade with cayenne pepper and maple syrup. All of these tactics only messed up my mind and body even more. The summer before my freshman year of college, I literally ate only an apple a day because I was so worried about not making new friends because of my weight. It was not about being healthy; it was about being accepted.Twenty years of blame and shame later, and despite mixed reviews on its success, Weight Watchers is still the first recommendation for weight loss from my doctor, along with Medifast, a 1000 calorie a day diet, or bariatric surgery. My naturopath told me to make my smoothies and spinach salads smaller, and my therapist told me I think too much about exercise and should “just do it.” I have gone many rounds with Weight Watchers and had some success. I have also had success losing weight by tracking food intake and exercise on apps like My Fitness Pal. But like all attempts at losing weight, following medical advice works until it stops working, and the weight comes back—plus some.Obesity as a DiseaseI recently sought treatment with an Obesity Specialist, but after an inspiring complimentary consult where she explained her holistic approach, I found out that my health insurance won’t cover the cost because the diagnostic code for obesity is excluded from my coverage. I have heard that the Affordable Care Act is supposed to impact insurance plans covering the cost of obesity treatment, but that has not been the case for me. In fact, I’ve been forced to pay out of pocket several times for labs that doctors feel the need to run, despite my urging that I am not diabetic. Trust me, I say; I know what diabetes looks like. I have watched family die and seen clients suffer, and I am earning my Masters in Public Health. I had been hopeful that the recent classification of obesity as a disease by the American Medical Association would open treatment doors, but it has not. In fact, I’m concerned that it will close doors for treatment opportunities because of how insurance [End Page 104] companies decide what medical costs they will cover. Obesity seems to be a four–letter word for health insurance companies. My insurance plan will cover prescription medications for high blood pressure, high blood sugar, and high cholesterol, but it won’t cover weight loss medications. Where is the incentive to address weight loss before potentially developing a life–threatening disease? I believe that obesity is a disease; I just don’t trust how the healthcare system will handle the responsibility of addressing it as such.In fact, the debate on whether obesity is a disease or a lifestyle is a frustrating one for me. If we claim lifestyle is the cause of obesity, it means that there is only one factor causing obesity. If that were true, then the commonly prescribed solution of “eat less, move more” would be more effective. The reality is, there is no single cause or cure for obesity; there is no one–size–fits–all treatment approach. It is a complex problem that deserves a complex response in the forms of primary, secondary and tertiary public health interventions. I am hopeful that classifying obesity as a disease will lead to more disease model research... (shrink)

How did vanilla, once a rare luxury, become a global sensation? Rather than taking the vanilla flavor of vanilla beans as a pre-existing natural fact, this essay argues that the sensory experience that came to be recognized as vanilla was a hybrid artifact produced by an expanding global trade in a diverse set of pleasurable substances, including cured beans from artificially pollinated vanilla orchids, synthetic vanillin, sugar, and a far-flung miscellany of other botanical and chemical materials. Global trade and large-scale (...) production resulted not in the production of a homogenous, stable commodity, but in a range of local vanillas, heterogeneous mixtures with a range of qualities and virtues. As local commercial and regulatory interests competed to define the origins, and thus the market value, of authentic vanilla flavor, scientific experts were called upon to adjudicate these rival claims. In the United States, these debates played out in the context of the 1906 Pure Food and Drug Act, where efforts to define and chemically enforce a ‘standard’ vanilla extract, in contradistinction from adulterated, ‘imitation’ extracts, clashed with the interests of makers and users of both synthetic and ‘genuine’ vanilla flavorings. As regulatory chemists grappled with the growing variety of vanillas, they were required to determine the appropriate chemical components of genuine vanilla, and consequently to delimit the subjective sensory effects proper to the flavor. Nonetheless, the materials, experiences, and meanings popularly associated with vanilla flavor continued to exceed the limits prescribed by officials. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Which Kind Is It?Andy Hamilton (bio)Keywordshuman kinds, mild cognitive impairment, multiple personality disorder, practical kinds, social constructionThere is much stimulating material in the Graham and Ritchie's paper (2006), concerning not just disease-classification but also the ethics of diagnosis. My concern is with the way in which they adduce Ian Hacking's views in the philosophy of science in support of their own. The authors quote with approval his (...) "dynamic nominalism" and its influence on Zachar's concept of "practical kinds." Hacking's view, as the authors quote it, is that "People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised" (1995, 21). The act of classifying changes both the classifier and the subject of classification, resulting in facts and categories that are both socially created and real. Hacking calls this "the looping effect of human kinds," and comments that "Multiple personality [disorder] is an almost too perfect illustration of this feedback effect" (1995, 21). The authors comment that Zachar (2000) builds on Hacking's position, discarding essentialist notions of classification that are limited to inherent biological properties, and turning instead to "practical kinds—nonarbitrary cultural artifacts intended to meet pragmatic needs (e.g. therapeutic, predictive prognostic, labeling effects, and physiology)" (Graham and Ritchie 2006, 36). Practical kinds, they believe, offer a way out of the clinical approach focused on mild cognitive impairment (MCI) as a precursor to, or mild form of, Alzheimer's disease. The inclination of the authors, as I read them, is to treat MCI as a practical or human kind, and not, like Alzheimer's disease, as a natural kind.My concern is whether the "looping effect of human kinds" can be transferred to the case of MCI from Hacking's original case study in Rewriting the Soul, multiple personality disorder (MPD). Hacking wished there to undermine the traditional debate over whether MPD is a "social or psychiatric artifact." He claims, correctly I think, that the presupposition behind the question "Is MPD a real disorder as opposed to a product of social circumstances?" should be rejected. The fact that a disorder is a product of social circumstances does not make it less real (1995, 12). On the looping of human kinds, Hacking comments that "The concept of child abuse [implicated in MPD] may itself be so made and molded by attempts at knowledge and intervention, and social reaction to these studies, that there is no stable object, child abuse, to have knowledge about." This is a "no fact of the matter" response, and it [End Page 51] is based on the recognition of conceptual change. He later adds that child abuse "is a real evil, and it was so before the concept was constructed. It was nevertheless constructed. Neither reality nor construction should be in question" (1995, 61, 68). However, Hacking's conclusions about the reality of MPD express only a muted skepticism. Utilitarian skeptics approach this question by asking, "What is the most effective treatment?" Hacking writes that "in their hearts [such skeptics] suspect that the outcome of multiple therapy [therapy that condones or even encourages the development of multiples in the patient] is a type of false consciousness" (1995, 267). The skeptics about MPD are making a moral judgment, he believes; but on whether that moral judgment is correct, he is silent, although the suspicion must be that he agrees with it.How do these considerations apply to the case of MCI? Graham and Ritchie rightly note that classifying a subject as suffering from MCI, and informing them of the diagnosis, will affect them adversely—it will cause suffering not least because there is at present no cure. However, it must surely be conceded that any disease at all—physical or mental—is a social entity insofar as it involves behavioral ascriptions to the subject concerning their incapacity. The authors also note the vested interests—especially from the pharmaceutical industry—in developing a diagnostic category of MCI. These interests are present in the development of any significant diagnostic... (shrink)

Publishers love titles that begin How or Why. Better still, How and Why, combining edification with utility. The target group is that overlap between the self-help audience and the idly curious—which is to say, most of us. And since emotions are very much about self-help and self-harm, they offer rich pickings in a burgeoning market. Flanagan's How to Do things with Emotions is a philosopher's take on moral emotions, the allusion to J. L. Austin's How to Do Things with Words (...) chiming with the self-help milieu. Reviewing cases, Flanagan points out that most scientific work in this field derives from experiments on psychology students, about as unrepresentative a slice of humanity as you could find. For Flanagan, they are too WEIRD (Western, Educated, Industrialized, Rich, Democratic) to tell us much about the non-weird majority. To learn to “do emotions better,” he argues, we have to look farther afield. Although the emotional lives of cultural others are surely different from those taking Psychology 101, at some functional level they might be similar. Work out the conceptual logic and practical rationale of culturally elaborated emotions—Minangkabau “shame,” Ifaluk “righteous anger,” American “road rage”—and there is scope for comparison. Indeed, anthropology has shown as much, and it is from anthropology that Flanagan takes his cues. To mention two famous cases, what can we learn about anger management from Utku igloo-dwellers and Ilongot headhunters? Mutually dependent for survival in their snowy isolation, the Utku cannot risk getting angry. (They mercilessly tease their children into learning the futility of anger.) In the jungles of Luzon, Ilongot youths cast away their anger in externally directed violence: headhunting as cathartic sport. We can think of parallels closer to home.Flanagan's vigorously argued book, a tour de force of its kind, is both an anatomizing of anger and shame—two moral emotions we tend to “do badly”—and a proposal to “change how we do these emotions.” Indignation is fine, but anger that is vengeful or “pain-passing,” rather than righteous, is irrational and socially harmful. Shame can be incapacitating and cruel (the undeserved burn of a Twitter pile-on). What we need is reflective anger directed at injustice and a “mature sense of shame” that reminds us of the social contract and stops us misbehaving.In its How-and-Why format, the book combines theory and practice, metaethics with moralism. Here is how a prof should do self-help. But if the diagnosis is well made, the remedy is hard to imagine. As Flanagan recognizes, moral sentiments and practices are embedded in intricate forms of life and not readily detachable. Anger Utku-style is not a transferable skill, nor are educative routines forged in social ecologies remote from our own. Lacking serviceable models, Flanagan falls back on the anthropological justification that knowledge of cultural diversity expands our sense of human possibility, of other roads taken. In a globalizing world, difference is its own reward. For me, an anthropologist, that maxim is enough. Yet difference bedevils comparison, jinxing the units, warping criteria. Most languages lack a word for emotion or an equivalent umbrella concept; nor do emotion words translate well across languages. Emotion may be an incoherent notion, or at best a heuristic.Flanagan's use of the WEIRD tag makes things a bit too easy. Does it cover farmhands and factory workers? Are we so democratic, anyway? More damagingly, a typological approach blurs the circumstances of family, community, and biography that define an emotional episode and shape its phenomenology, the way it is felt and experienced—what a violent outburst or fearful exit means in the context of a life. Take Joseph Conrad's Lord Jim, who flees a scene of failure and derails his life. It requires a long narrative to unravel the implications of his jumping ship and the paralyzing shame he experiences before the judgment of society. Or consider the scene in Anna Karenina in which the dignified and self-important Karenin, apprised of Anna's adulterous liaison, agonizes over the threat to his existence. To call his response jealousy would not scratch the surface. Characteristically for Tolstoy, the emotions go unnamed. Instead, we witness Karenin's fervid deliberations (emotions involve thoughts), vacillations (emotions have action tendencies), anguished calculations of impending scandal (emotions are appraisals), and bodily changes (emotions are cognized feelings). We shudder at the brutal metaphors through which he grasps his predicament and its cure: like rooting out a bad tooth, he decides. That welter of particularities escapes the theorist who needs clear-cut, comparable units, formulaic instances of jealousy or anger. But what are you left with if you omit the details? What would remain of Karenin's existential crisis?The novelist's privileged access to subjectivity is, of course, unavailable to the scientist, but the larger context of plot and character—a history of relations that gives emotional episodes their shape and power—has its analog in the ethnographic domain. Emotions are public as well as private events, their meanings and effects depending on a fit with social reality, a clash of perspectives. In thought and feeling, we are never really alone. All of which suggests that narrative, fictional or nonfictional, can capture the ongoing moment in a way that eludes other methods. If what we are after is living emotion, it is the movie, not the snapshot, that surely matters. No point in comparing “emotions” no one ever really experienced outside of an experiment.But there's the rub. In generalization—the goal of emotion theory—an emotion's social meaning, personal significance, pragmatic function, and narrative context get stripped out. All that makes it what it is! Even in doggedly empirical anthropology, detailed emotional episodes are rare (Jean Briggs's Utku ethnography Never in Anger, published in 1970, is still unsurpassed). Instead we get recollections and summary examples, lacking the constitutive detail, real-time evolutions, and consequences of the real thing. Yet these must serve for comparison, fodder for countless theoretical speculations. Are we at risk of analyzing faux emotions and building theories on cardboard constructions?An empty Arctic stage, a handful of characters, life simplified to survival: Briggs is a hard act to follow. Bare life does not make for basic emotions. On the white set, emotions prove hard to parse. That gruff hesitation, that flashing glint—are they tokens of anger? Empathy will not suffice. As Briggs shows, narrative context is all. And in our more cluttered emotional worlds, the value of backstory, interwoven biographies, and emotional plots is all the greater. Flanagan is right; we must do emotions better. (shrink)

Williams’s well-known critique of the ‘moralism’ of liberal political philosophy—its disconnect from political reality—holds special significance for the theory and practice of constitutional adjudication, where calls for ‘realism’ increasingly resound. Is constitutional discourse also guilty of moralism—as Williams himself thought—or might it succeed where political philosophy has failed? This paper reconstructs Williams’s critique of political moralism as one that decries the empty idealism of the philosophical project of abstraction: the quest for general, timeless, and universal principles drains theory of its (...) prescriptive force. It then argues that legal-constitutional reasoning, even in its most ambitious ‘forum of principle’ conception, is not a flight to abstraction but precisely a pragmatist negotiation of the concreteness-abstraction tension through acts of justification. But constitutional discourse in its current form remains moralistic in another distinct sense: it idealizes the political, thereby failing to account for the social and political pressures on courts and the proper normative significance of institutional considerations. Constitutional discourse could only offer a solution to the ailments of political philosophy if it cures its own chronic idealization. (shrink)

Abstract:Since Homeric times, psychotherapy has been an essential part of the medical act. Initially, the word of physicians had a magical character. Plato rationalizes this in many of his dialogues. In "Charmides," he dives deeper into this matter and proposes to apply it to every disease. Analysing this dialogue has fundamental consequences for psychotherapy: 1) Remedy and epodé (charm) must be applied in every doctor–patient relationship. 2) The body can only be healed if the soul is cured first by a (...) charm. Patients must "offer" their souls to the physician, which implies the need for confidence and the unavoidable asymmetry which characterize doctor–patient relationships. 3) The openness of the patient's soul to the physician and the physician's "beautiful speech" to the patient will enable the latter to reach the state of sophrosyne (temperance), the condition of the possibility of true health. In the discussion of the meaning of sophrosyne, Socrates questions every one of the disciples' propositions and concludes that the only thing one can be sure of is that sophrosyne is a way of searching for virtue (areté). Later, in Theaetetus, Plato adds another element: temperance is a homoiosis theó, that is, the assimilation of patient with God. With this, Plato seals the ethical character of psychotherapy forever. (shrink)

In the last two decades Information and Computer Technology has come to play an increasingly important role in medicine and health care. Many medical practitioners and scholars wonder: will e-health cause a paradigm shift in health care? To answer this question we provide a philosophical analysis of the concept of the 'paradigm shift' through the work of Michel Foucault, Thomas Kuhn and Larry Laudan. Their work offers key insights to a comprehensive understanding of major evolutions in medicine. Nowadays the long-standing (...) curative paradigm in medicine is facing important challenges due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm in medicine with an emphasis on preventive, predictive and personalized care. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. On the other hand the characteristics of e-health will be strongly determined by this new paradigm. 'Will e-health cause a paradigm shift in medicine?' might not be the right question to pose. Rather, we should ask how the underlying paradigm shift, from discovery and cure to prevention and prediction, acts as a facilitator to embrace ICT in health care. This analysis is of crucial importance in understanding the impact of digital health care applications and provides a necessary framework for the emerging, dynamic system of e-health. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Even though he generally agrees with Chrysippus on the matter of the ontology of passions, Seneca differentiates mainly in his emphasis that passions are the reason why man leads an inauthentic, unhappy and undignified life. Although Seneca is a very orthodox Stoic, in most of the cases where his stoic credibility is challenged, he resorts to a therapy plan that exceeds the usual stoic strictness on the absoluteness of the status of the sage. In this scheme, the Roman philosopher employs (...) practical techniques that refer to the ordinary man, the man who rationally desires to change his merely-being into well-being. This shift of focus is partially explained through the social orientation of the moral context: man is not alone while achieving his perfection of character; there are others who need to be helped, so that the pursuit of wisdom becomes a pananthropic effort, not an act of alienation. Since moral success is connected with the other person in such a manner, it is not a paradox that it needs to start from within, from the nucleus of personhood. The role of individuality is particularly stressed, especially on the premises that man first ought to make this constant and conscious effort to help himself, to cure his own soul, often with the aid of others who share the same path, before he attempts to be engaged in the therapy of the passions of others. Under this prism, the senecan proposal for the therapy of passions leads to a practical culmination where man is not only bound to achieve his ontological excellence but also to relieve his soul from the traumas of passions and to connect himself with the moral and existential safety that the presence of “recta ratio” guarantees. (shrink)