Patients with borderline personality disorder (BPD) 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: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses contracts as (...) a defence of the authentic self, and (5) 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)

IntroductionBorderline personality disorder patients are often subjected to inpatient compulsory care due to suicidal behaviour. However, inpatient care is usually advised against as it can have detrimental effects, including increased suicidality.AimTo investigate what motives psychiatrists have for treating borderline personality disorder patients under compulsory care.Materials and MethodsA questionnaire survey was distributed to all psychiatrists and registrars in psychiatry working at mental health emergency units or inpatient wards in Sweden. The questionnaire contained questions with fixed response alternatives, with room for comments, (...) about the respondents’ motives for practising compulsory care of borderline personality disorder patients. The responses were analysed quantitatively with descriptive statistics, and comments were analysed with qualitative descriptive content analysis.ResultsThe psychiatrists’ views were divided on when it was justified to treat borderline personality disorder patients under compulsory care, as were their views on borderline personality disorder patients’ decision competence. When there was an assessed risk of harm, 53% were positive to compulsory care of decision-competent borderline personality disorder patients and another 31% because they considered the patients to be decision incompetent in such situations. Adding the risk of harm caused many respondents to alter their assessment of the patient from decision competent to decision incompetent.ConclusionThe large variations in doctors’ opinions indicate that the care of borderline personality disorder patients is arbitrary. Further, the assessed risk of harm increases the use of compulsory care, even though such care is advised against in clinical guidelines, has questionable legal support, and could lead to an increased suicide risk over time. (shrink)

Two related aspects of the present ‘knowledge capitalism’ stage of globalisation are discussed in this article: the transformation of education to make it more directly supportive of educational growth and competition, and the growing demands on educational research to provide scientific evidence for education policy and practice, using narrowly defined methods and techniques. It is argued that both developments have profound consequences for the construction and use of educational theory, and the vital need for critical discussion and communication in this (...) respect is emphasised. (shrink)

The most influential egalitarian perspective is undoubtedly Rawls's (1971, 1993), which assigns absolute priority to the least advantaged in society (the difference principle). However, many have claimed that even though an egalitarian perspective should imply some priority to the worst off, the Rawlsian perspective is too demanding. One response to this criticism is to argue in favour of an egalitarian perspective that never assigns absolute priority to the worse off, but which still includes limited priority to those members of society (...) in distributive conflicts. A different response to the demandingness criticism is to agree that the worse off should not always be given absolute priority, but to argue that there are some cases where they should be. In this paper, we elaborate on this view, and look at the possibility of deviating from the leximin approach within this category of egalitarian principles. (shrink)

Over the years, egalitarian philosophers have made some challenging claims about the nature of egalitarianism. They have argued that egalitarian reasoning should make us reject the Pareto principle; that the Rawlsian leximin principle is not an egalitarian idea; that the Pigou–Dalton principle needs modification; that the intersection approach faces deep problems; that the numbers should not count within an egalitarian framework, and that egalitarianism should make us reject the property of transitivity in normative reasoning. In this paper, taking the recent (...) philosophical debate on equality versus priority as the starting point, I review these claims from the point of view of an economist. (shrink)

School-based Physical Education is important, especially to students with disabilities whose participation in physical activities out of school is limited. The development over time of participation-related constructs in relation to students’ perceived functioning and achievement is explored. Students in mainstream inclusive secondary school self-rated their PE-specific self-efficacy, general school self-efficacy, aptitude to participate in PE, and perceived physical and socio-cognitive functional skills at two timepoints, year 7 and year 9. Results were compared between three groups of students with: disabilities, high (...) grades, or low grades in PE. Over time, perceived physical skills of students with disabilities became strongly associated with self-efficacy and aptitude to participate. Perceived socio-cognitive skills in the study sample improved and had a positive effect on PE-specific self-efficacy. Efforts should be made to limit the accelerated negative impact of perceived restricted functioning of students with disabilities. Grading criteria need to be developed to comply with standards adapted to fit abilities of students with disabilities. Meaningful learning experiences appear to be created when participation is promoted and capacity beliefs are boosted. Allocating resources to support the development of students’ socio-cognitive skills seem to have potential for overall positive school outcome. (shrink)

Where there is a fixed population (i.e., who exists does not depend on what choice an agent makes), the deontic version of anonymous Paretian egalitarianism holds that an option is just if and only if (1) it is anonymously Pareto optimal (i.e., no feasible alternative has a permutation that is Pareto superior), and (2) it is no less equal than any other anonymously Pareto optimal option. We shall develop and discuss a version of this approach for the variable population case (...) (i.e., where who exists does depend on what choice an agent makes). More specifically, we shall develop and discuss it in the context of a person-affecting framework—in which an option is just if and only if it wrongs no one according to certain plausible conditions on wronging. (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)

Luce once declared that his and Jessop’s interpretation of Berkeley is “reflected in our edition of the Works.” The appearance of a recent article by Stephen Daniel draws attention to two examples of the implications of this interpretive model of editing. One is Luce’s and Jessop’s rejection of Alciphron as a reliable source for Berkeley’s philosophy, because we have access to his true philosophy elsewhere , and “it is idle to turn to Alciphron for Berkeleianism,” for he does not rest (...) his case there “on his own philosophy” . The other is the “correction” of Alciphron by incorporating an anonymous letter to Peter Browne “as a supplement” to Berkeley’s work—something that Daniel criticizes for circularity and lack of scholarly accuracy. The question arises as to whether Alciphron is the only example of a text in the Worksthat is biased in favor of the editors’ private interpretation. (shrink)

Did George Berkeley, as I argued long ago in Belfrage (1986), defend a theory of "emotive meaning" in his Manuscript Introduction (an early version of the introduction to the Principles)? This question has raised a broad spectrum of different issues, which I think it is important to keep apart, such as rhetorical, psychological, semantic, ethical, metaphysical, and theological aspects. In the present paper, I hope to clear the ground of ambiguities, which have led to serious misunderstandings on this interesting point (...) in Berkeley's unpublished philosophy. I open with a summary account of the historical context. (shrink)

Utopian rationalism names the belief that science has made utopia a practical possibility. Its characteristics include determinism, collectivism, distrust of individual initiative and belief in the superiority of collective planning in securing human happiness. The first section traces the utopian and dystopian tradition into modern science fiction. The ideas collected here are systematized in the next section, which on all points dismisses the tenets and claims of utopian rationalism as false, and in a final section, which discusses utopian thinking and (...) its dangers in general. Utopian thinking is traced to three traits of human nature, namely, the quests for happiness, perfection, and submergence. (shrink)

Körner's notion of vagueness, its relation to ostension and the alledged gulf between logic and experience are examined. Ostension is seen not to cause vagueness ~ there are precise concepts of mathematics which can be ostensively introduced. A distinction is drawn between classical logic not applying to the vague world and not applying to the vague language. The claims about logic and the vague world are unverifiable claims about existence. Körner's attempt to elimmate the seeming incompatibility between vague language and (...) logic leads to a Protagorean relativism which is rejected. It is denied that the incompatibility between vagueness and classical logic causes a gulf between two sublanguages; instead, ordinary language is held to contain both and so to be inconsistent. (shrink)

Fairness preferences fundamentally affect individual behavior and play an important role in shaping social and political institutions. However, people differ both with respect to what they view as fair and with respect to how much weight they attach to fairness considerations. In this article, we study the role of family background in explaining these heterogeneities in fairness preferences. In particular, we examine how socioeconomic background relates to fairness views and to how people make trade-offs between fairness and self-interest. To study (...) this, we conducted an economic experiment with a representative sample of 14- to 15-year-old and matched the experimental data to administrative data on parental income and education. The participants made two distributive choices in the experiment. The first choice was to distribute money between themselves and another participant in a situation where there was no difference in merit. The second choice was to distribute money between two other participants with unequal merits. Our main finding is that there is a systematic difference in fairness view between children from low-socioceconomic status families and the rest of the participants; more than 50 percent of the participants from low-SES families are egalitarians, whereas only about 20 percent in the rest of the sample hold this fairness view. In contrast, we find no significant difference in the weight attached to fairness between children from different socioeconomic groups. (shrink)

Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected (...) benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide. (shrink)

Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to guide clinicians when deciding on (...) compulsory care for BPD patients and reduce the use of potentially harmful care. The arguments analysed are (a) the patients lack decision competence, (b) the patients lack authenticity, (c) compulsory care saves the patient from suicide, (d) compulsory care safeguards against litigation, complaints, or doctor's anxiety, (e) compulsory care is a practical solution in emergencies, and (f) it is better for the caregiver to ‘err on the safe side’. We conclude that compulsory care is not ethically justified in most cases unless the clinician has probable reason to believe that the patient lacks decision capacity by suffering from a severe mental co-morbidity and stands to benefit from such care. (shrink)