Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

We add texture to the conclusion of Duchon and Drake (Journal of Business Ethics, 85, 2009, 301) that extreme narcissism is associated with unethical conduct. We argue that the special features possessed by financial accounting facilitate extreme narcissism in susceptible CEOs. In particular, we propose that extremely narcissistic CEOs are key players in a recurring discourse cycle facilitated by financial accounting language and measures. Such CEOs project themselves as the corporation they lead, construct a narrative about the corporation and themselves (...) using financial accounting measures, and then reflect on how their accounting-constructed performance is perceived by stakeholders. We do not present empirical evidence about whether the use of accounting language and measures leads to unethical behaviour by extreme narcissistic CEOs — although the conclusions of Duchon and Drake (2009) suggest empirical support is probable. Rather, we focus on developing alertness to the potential for accounting, when engaged by an extremely narcissistic CEO, to be a precursor or implement of unethical behaviour. (shrink)

New social movements of the post-war era have brought to prominence the idea that identity can be a crucial focus for political struggle. Linked to an increasing recognition that social theory itself must put the politics of identity on center stage, this volume impels social theorists not only to make sense of the "world out there", but also to make sense of differences within the discourse of theory.

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, (...) digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. (shrink)

This chapter unfolds a central philosophical problem of statistical mechanics. This problem lies in a clash between the Static Probabilities offered by statistical mechanics and the Dynamic Probabilities provided by classical or quantum mechanics. The chapter looks at the Boltzmann and Gibbs approaches in statistical mechanics and construes some of the great controversies in the field — for instance the Reversibility Paradox — as instances of this conflict. It furthermore argues that a response to this conflict is a critical choice (...) that shapes one's understanding of statistical mechanics itself, namely, whether it is to be conceived as a special or fundamental science. The chapter details some of the pitfalls of the latter ‘globalist’ position and seeks defensible ground for a kind of ‘localist’ alternative. (shrink)

Are the generalizations of classical equilibrium thermodynamics true of self-gravitating systems? This question has not been addressed from a foundational perspective, but here I tackle it through a study of the “paradoxes” commonly said to afflict such systems. My goals are twofold: (a) to show that the “paradoxes” raise many questions rarely discussed in the philosophical foundations literature, and (b) to counter the idea that these “paradoxes” spell the end for gravitational equilibrium thermodynamics.

In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an ‘At-Risk Mental State’ (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk–benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns about the unnecessary harm (...) associated with such ‘false-positive’ results. These harms are especially pertinent when identifying psychosis risk individuals due to potential stigma and discrimination in a young clinical population. A dearth of high-quality evidence supporting interventions for ARMS patients raises further doubts about the benefit accompanying an ARMS disclosure. Despite ongoing discussion in the bioethical literature, these concerns over the ethical justification of disclosure to ARMS patients are not directly addressed in clinical guidelines. In this paper, we aim to provide a unified disclosure strategy grounded in principle-based analysis for ARMS clinicians. After considering the ethical values at stake in ARMS disclosure, and their normative significance, we argue that full disclosure of the ARMS label is favoured in the vast majority of clinical situations due to the strong normative significance of enhancing patients' understanding. We then compare our framework with other approaches to ARMS disclosure and outline its limitations. (shrink)

Despite the promise of international collaboration and sharing by bringing together bioethicists from throughout the world at the 2024 IAB conference in Qatar, I will not be attending. The authors...

Many believe that quantum mechanics makes the world hospitable to the tensed theory of time. Quantum mechanics is said to rescue the significance of the present moment, the mutability of the future and possibly even the whoosh of time’s flow. It allegedly does so in two different ways: by making a preferred foliation of spacetime into space and time scientifically respectable, and by wavefunction collapse injecting temporal ‘becoming’ into the world. The aim of this paper is to show that the (...) reasoning underlying these claims is wishful thinking. Against the first claim I develop what I call the “coordination problem” for tensers. The upshot of this problem is that if tensers escape the threat of relativity, they do so only by embracing conflict with the branch of physics they believed saved them, quantum mechanics. I then step back from the fray and examine some methodological issues, concluding that scientific methodology will always be “against” tenses as they are currently conceived. The Appendix deals with the confused tangle of issues linking wavefunction collapse to an open future. (shrink)

(1996). The self, the other, and linguistic identity in francophone Africa. The European Legacy: Vol. 1, Fourth International Conference of the International Society for the study of European Ideas, pp. 439-444.

The doctrine of the Father’s begetting the Son in his divine nature, despite its credal affirmation, enjoys no clear scriptural support and threatens to introduce an objectionable ontological subordinationism into the doctrine of the Trinity. We should therefore think of Christ’s sonship as a function of his incarnation, even if that role is assumed beginninglessly.

This is my commentary on Jonathan Schaffer's paper "Evidence for Fundamentality?”; both the paper and comments were presented at the Pacific APA, San Francisco, March 2001. Schaffer argues against the view that there is an ultimate fundamental level to the world. Seeing that quarks and leptons may have an infinite hierarchy of constituents, he claims, “empowers and dignifies the whole of nature” (15). Like Kant he holds that there are as good reasons for believing matter infinitely divisible as composed of (...) fundamental simples. I’m afraid that Schaffer’s provocative arguments have not convinced me. In the paper, I criticize the idea that fundamentalism 'weakens' and 'denigrates' the whole of nature and try to show that an infinite hierarchy can not do the work Schaffer needs it to. I then argue that we should not in fact be agnostic between the two rival hypotheses. (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities (...) content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

Hierarchy has been a central concern of work on the modern political imaginary. The need to elucidate hierarchy’s deeper sources and its legitimations were some of the motivations behind Cornelius Castoriadis’ development of the notion of the imaginary. The work of Claude Lefort on the political imaginary similarly commences from a critical analysis of the hierarchical form of bureaucracy and its place in the constitution of totalitarian political regimes. In a different vein, Charles Taylor’s conception of the imaginary details a (...) long-term process of the erosion of preceding forms of hierarchy and their justifications. In the contemporary period, the opposition to hierarchy has penetrated organisations and institutions that had previously been shaped by it, like the family, the capitalist firm, the school, and the political movement. Despite the potentials that these initiatives suggest of a change in the political imaginary, it will be argued that forms of hierarchy have, to varying degrees, been reconstituted and that the problem of hierarchy appears in new ideological forms, both with respect to institutionalised power and the legitimating justifications for how things are organised. The critique of hierarchy was once associated with the radical democratic imaginary, however, there have recently been perverse mobilisations. (shrink)

It has long been a commonly held belief among classicists that traditional Romans frowned upon male homosexuality and associated it with the influence of Greek culture. There have always been exceptions to this belief, but when Paul Veyne published the following remarks in his 1978 article ‘La famille et l'amour sous le hautempire romain’, his views were quite heterodox: Il est faux que l'amour ‘grec’ soit, à Rome, d'origine grecque: comme plus d'une société méditerranéenne de nos jours encore, Rome n'a (...) jamais opposé l'amour des femmes à celui des garçons: elle a opposé l'activité à la passivité; être actif, c'est être un mâle, quel que soit le sexe du partenaire passif. (shrink)

Ordinary equational logic is a connective-free fragment of first-order logic which is concerned with total functions under the relation of ordinary equality. In [AN] (see also [AN1]) and in [Cr] it has been extended in two equivalent ways into a near-equational system of logic for partial functions. The extension given in [Cr] deals with partial functions under two relationships: a relationship of existence-dependent existence and one of existence-dependent Kleene equality. For the language that involves both relationships a set of rules (...) was given that is complete. Those rules in the set that involve only existence-dependent existence turned out to be complete for the sublanguage that involves this relationship only. In the present paper we give a set of rules that is complete for the other sublanguage, namely the language of partial functions under existence-dependent Kleene equality.This language lacks a certain, often needed, power of expressing existence and fails, in particular, to be an extension of the language that underlies ordinary equational logic. That it possesses a fairly simple complete set of rules is therefore perhaps more of theoretical than of practical interest. The present paper is thus intended to serve as a supplement to [Cr] and, less directly, to [AN]. The subject is further rounded out, and some contrast is provided, by [Rob]. The systems of logic treated there are based on the weaker language in which partial functions are considered under the more basic relation of Kleene equality. (shrink)

The practice of psychology in rural areas offers unique challenges for psychologists as they try to provide optimal care, often with a minimum of resources. Psychologists are frequently required to be creative and flexible in order to provide effective services to a wide range of clients. However, these unique challenges often confront psychologists with ethical dilemmas and problems for which their urban-based training has not prepared them. The author examines how certain characteristics of rural communities may lead to specific ethical (...) dilemmas. By being a part of a small community, psychologists will inevitably face multiple relationship dilemmas. Confidentiality is harder to maintain in a small town, particularly with its informal information-sharing network. To provide services to meet community needs, with a limited number of referral options, psychologists typically need to be generalists. This may lead to concerns about scope of practice, training, and experience with diverse populations. Psychologists also face other competency issues, such as a lack of supervision and consultation resources. Other concerns addressed include the psychologist's visibility in the community, having clients know about the psychologist's personal life, and the blurring of professional and personal roles. Suggestions are made for coping with each of these ethical issues, although more quantitative research and discussion are needed on the practice of psychology in rural areas. (shrink)

Rurality in the modern United States (US) is characterized as a small population spread over a wide area of land. Only approximately 21% of the population lives in rural areas, which is defined as...

Whilst this paper was initially part of a larger project tracing the development of Anglo-American thought from the colonial through to the post-colonial era, below it stands alone as reflection on the colonialism of John Stuart Mill read from a post-colonial perspective. It aims to show that Mill's views on colonial rule were largely informed by his principle of liberty which, in turn, was based on his qualitative utilitarianism. The driving force behind his colonialism, as with his work in general, (...) was his unwavering belief in the importance of human progress and development. Mill never believed, as did many of his contemporaries, that the ‘backward’ societies of the colonies were inherently inferior, but rather that they needed paternal intervention from more civilised, progressive societies in order to stimulate growth in that spontaneous human development was not inevitable. When read in this light Mill's views on colonial rule, while culturally bigoted and ethnocentric, appear less contradictory to his liberalism as a whole. (shrink)

This symposium provides five case studies of the ways that John Dewey's philosophy and practice were influenced by women or "weirdoes" (our choices include F. M. Alexander, Albert Barnes, Helen Bradford Thompson, Elsie Ripley Clapp, and Jane Addams) and presents some conclusions about the value of dialoging across difference for philosophers and other scholars.

This paper argues that there is a relationship between the structure of live theater and the question of whether human beings have free will, and that the practice of live theater and the pursuit of philosophical certitude regarding free will are both constructive human experiences coalesced around roughly the same set of sensations.

This collection situates Deleuze's work and several of his most important concepts in the context of his post-Kantian predecessors, further illuminating both the breadth of his philosophical heritage and the manner in which he moves beyond it. Through a series of studies by leading scholars in the field, At the Edges of Thought sheds new light on key philosophical encounters with thinkers such as Maimon, Kleist, Hölderlin, Fichte, Hegel, Schopenhauer and Feuerbach in Deleuze's texts. Readers are invited to join with (...) Deleuze as he traverses and transforms post-Kantian philosophy, taking it towards the very edges of thought. (shrink)

The first three chapters of Eleonore Stump’s Atonement are devoted to a critique of atonement theories she styles “Anselmian,” including penal substitutionary theories. I focus on her critique of the latter. She presents three groups of objections labeled “internal problems,” “external problems,” and “further problems,” before presenting what she takes to be “the central and irremediable problem” facing such accounts. The external and further problems are seen to be irrelevant to penal substitutionary theories once they are properly understood. Her four (...) internal problems are shown to be far from conclusive. Finally, her identified central problem is seen to be spurious because given Stump’s definitions of love and forgiveness, it is not true that God, as characterized by penal substitutionary theories, fails to be perfectly loving and forgiving, and Stump’s entire approach to the doctrine of the atonement is mistakenly predicated on construing God as a private party involved in a personal dispute rather than as a Judge and Ruler. (shrink)

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided (...) less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. (shrink)

To their dismay, children look like their parents. They are not perfect copies, and over many generations some features evaporate; but even over fifty generations features relevant to an anthropologist persist. Children perhaps can find some comfort in the fact that we are not alone: organisms in general maintain remarkably stable structures through time. In What is Life? Erwin Schrödinger famously predicted the existence of the gene, but he also asked how life manages such stability in the face of thermodynamics’ (...) prescription that systems spontaneously move to increase their entropy. How does life escape the randomizing effects of the Second Law? Schrödinger of course recognized that there is no genuine conflict between life and thermodynamics. The Second Law applies only to closed, i.e., approximately energetically isolated, systems, yet living organisms are open systems. Although living creatures are not plugged into electrical sockets like your refrigerator, Schrödinger noted that organisms are dependent on the high quality energy of their environment. They maintain their structures at the expense of increased contributions of entropy (waste) to their environment. Life arises in the balance between the low entropy found in the environment and the entropy the organism itself throws off. Writing in the 1940’s, Schrödinger could see the general form of the answer to his question, but he lacked the resources to explain why these stable structures arose in the first place. (shrink)

Table of Contents: Politics, morality, and pluralism -- Liberal morality and political legitimacy -- Political legitimacy and social justice -- Williams's concept of the political -- Legitimacy, stability, and morality -- The politics of morality -- A moral point of view -- Manners and morality -- Morality and conflict -- Moral conflict and political theory -- The morality of politics -- Feminism and multiculturalism -- A defense of culture -- Politics and normative conflict -- The political as moral viewpoint -- (...) Morality and politics: a review -- Political unity and pluralism -- The liberal archipelago -- Loose linkage and political legitimacy -- Political unity and the body politic -- Social justice and political unity -- The bonds of civility -- Nationhood and the liberal polity -- The nature of nationhood -- Pluralism and nationalism -- Nationalism and social justice -- Deliberative democracy and the liberal polity -- Liberalism and democracy -- Democracy and deliberative discourse -- The terms of deliberative discourse -- Normative discourse and political legitimacy -- Deliberative democracy and intragroup politics -- Group autonomy and intergroup discourse -- Politics, history, and reason -- Principle and justice in the liberal polity -- Liberal institutions and liberal ideals -- Stopping history -- Rationalism and politics. (shrink)

This work contains newly translated excerpts from Samuel Pufendor's two major works in political and moral thought, Elements of Universal Jurisprudence and The Law of Nature and Nations. The editor and translator have worked to present a readable and comprehensive introduction to Pufendorf's political philosophy. The new English translation far exceeds what is currently available in terms of sophistication and clarity. A substantive introduction is included to acquaint readers with Pufendorf's ideas.