Huang and colleagues provide some intriguing insights into the attitudes about end of life care of practising Taiwanese neonatal doctors and nurses.1 There are some similarities with surveys from other parts of the world. Most Taiwanese neonatologists and nurses agreed that it was potentially appropriate to withhold or limit treatment for infants who were dying. A very high proportion was opposed to active euthanasia of such infants. But there were also some striking differences. Only 21% of Taiwanese doctors ‘agreed’ with (...) withdrawal of mechanical ventilation for dying newborn infants. This proportion is lower than reported in any European country.2 More than 90% of neonatologists surveyed in the UK, the USA, The Netherlands and Sweden found withdrawal of mechanical ventilation acceptable.2 ,3 Taiwanese doctors also seemed reluctant to give analgesia or sedatives to such infants, with almost 60% disagreeing with their use in dying infants where there was a risk of hastening death.1 In contrast, two-thirds or more of European neonatologists thought this was acceptable .2The results of the survey of Huang et al highlight three beliefs about end-of-life care that are widespread, but all of which are seriously mistaken1. None are new, but …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ends of the Divine:David Bentley Hart and Jordan Daniel Wood on GraceJames Dominic Rooney O.P.David Bentley Hart and Jordan Daniel Wood stand alongside some modern theologians in their diagnosis that there is a problem in an overly transcendent account of the divine nature. If God were unable to be affected by what happens in the world, many think, then God cannot really be responsive to or care about (...) us. Unlike "radical kenotic" theologians who hold that God is affected by the world and deny the classical doctrine of divine impassibility, however, Hart and Wood argue that we can get an intimate God–world relation without denying impassibility. If it were true that God was so free and unlimited as to express himself without hindrance in creating this world and guiding its history (they argue), then the world would necessarily express God's own inner life perfectly. There would be a non-contingent and mutual relation between the world and God's inner life.The Hart/Wood strategy appears to have all the right upshots of the radical kenotic views without sacrificing the metaphysics. However, this strategy rests upon a seriously fraught modal claim: that God could not have done otherwise than what he did (in creation, the Incarnation, redemption, etc.). This modal claim supports their inferences about the ways in which creation and its history will necessarily reflect who or what God is. Phrases about God being unable to do otherwise or acting "necessarily" lend themselves to equivocation, as it is easy to slip between de re and de dicto uses of "necessary." We need to distinguish: [End Page 811]1. Necessarily, if God creates, then God creates (and does so from eternity).2. If God creates, then God necessarily creates.To affirm 1 is true is only to say (de dicto) that, necessarily, whenever it is true God creates, then it is true he creates. This first proposition poses no serious metaphysical or theological puzzle. The necessity here concerns a relation among propositions. On reading 1, the "necessity" qualifies over not God's creating, but the conditional; there thus could be other logically possible situations where God does not create. That is, if "God creates" is true, then "God creates eternally" is also true, simply on account of God's actions necessarily being eternal in duration. The mere fact that God has a relation to the universe which is "necessarily eternal" in that way does not by itself entail that God cannot do otherwise than create.To affirm 2, by contrast, would be to switch to the claim that God creates necessarily, with the necessity concerning God's creating itself. Thus, 2 involves a relation of metaphysical necessity (de re). If God cannot not do or cause x, then x is metaphysically necessary insofar as x "could not not exist" or "could not not be otherwise." What I will show is that Hart and Wood both hold that, given God's character, his choices and actions simply could not be otherwise. That is, both hold reading 2. Since Hart and Wood appeal to God's character, they do not appeal to a relation among propositions or the relation among facts such that, necessarily, given God chose to create, God chooses to create. Their views involve a strong modal thesis about God's actions that goes beyond traditional claims that God's actions befit his wisdom, since, on those traditional claims, many possible courses of action could equally befit God's wisdom. Both Hart and Wood deny that God could have done anything else apart from what he (actually) did in creation and salvation that would befit his wisdom or character.I will show that, if such a modal claim is to support the implications that Hart and Wood (and others) draw from it, God would bear a relation to the world that is constitutive of his divine identity. I group these two together since Hart and Wood represent what appear to be the fundamentally logically exhaustive ways of pursuing this strategy in terms of either the divine nature or the persons. And their strategy is embraced by a family of theoretically similar contemporary proposals... (shrink)

We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...) of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease. We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …. (shrink)

End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...) agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions – that of ‘professional dissensus’. In the final part of the article we address the role of agreement in end-of-life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Báñez with Love:A Response to a Response by Taylor Patrick O'NeillJames Dominic Rooney O.P.From where I stand, the traditional options of Molinism and Báñezianism seem logically exhaustive possible accounts of the way in which God can cause people to love him, under the influence of grace, while at the same time being able to affirm that those people remain free. Either God's giving efficacious grace to an individual (...) is such as to cause that individual to act a certain way, merely in virtue of giving that grace to that individual, or it is not. If that grace is not intrinsically efficacious, then you need to explain the way in which God can cause an action by giving grace which does not require grace to be intrinsically efficacious. On the latter front, Molinists aim to affirm that human beings are free even while acting under the influence of God's grace, and hold that God's grace is not such as to make it that one could not have done otherwise. They explain this by appeal to counterfactual truths about what human beings would do, metaphysically prior to and independent of God's subsequent decisions to give or withhold grace. These "counterfactuals of freedom" are central to Molinist accounts of freedom, since the truth of these counterfactuals alone secures the fact that human beings are acting freely even when God gives them grace and causes them to perform certain actions. Those human beings could have acted otherwise. Conversely, since God knows these truths, he can use them in order to give grace to an individual at those times when he knows it will be efficacious.To me, the Molinist view is a non-starter. What these truths consist in, what grounds them, how God uses them—I find the critiques compelling [End Page 675] and Molinist answers to these questions metaphysically problematic.1 I am committed to finding a Báñezian solution, therefore, to the riddle. From my perspective, the mystery of predestination invites confusion ultimately because the issue is a subtle philosophical, not a theological, problem. The resolution to the riddle of grace and free will can come only through an adequate account of the nature of human freedom. And I remain unsatisfied by a lack of philosophical clarity among Báñezian authors on the nature of freedom. In a recent paper, I therefore posed a problem for Báñezianism that resembles what is called the "grounding problem" for Molinism: where do the truths about alternative possibilities come from? And I illustrated the problem in the context of the account of grace given by one famous defender of the view, Fr. Réginald Garrigou-Lagrange, whose work in turn was recently promoted by Taylor Patrick O'Neill.In short, Garrigou-Lagrange appears to accept that there need to be alternative possibilities if human action is to be free. He gives an accounting of those possibilities as follows. On one side, when I sin, Garrigou-Lagrange argues that God's denial of efficacious grace, even though this denial occurs prior to anything I do or could have done, does not necessitate my sin because I performed the sin by means of my normally operating volitional and intellectual capacities (which God merely refrained from interfering in), and I had alternative possibilities provided by the possibility of God providing efficacious grace. Then, on the other, when I do good, he appeals at many points to non-culpable "defects" regarding my intellectual or volitional capacities as grounding those alternative possibilities that I could have sinned even when acting under efficacious grace. In both cases, my acts are still metaphysically contingent. However, neither case provides a sufficient grounding for alternative possibilities (I argued), because I had no relevant control over God's decision to deny efficacious grace, nor were those "defects" in light of which I could have sinned under my control. Instead, I argued that Garrigou-Lagrange's account of humans having alternative possibilities for action would be successful only if there were facts about what I would have done under sufficient grace, truths prior to and independent of God's decision to give efficacious... (shrink)

Virtue ethics interprets human action as pursuing good ends through practices that develop qualities internal to those final goals. The philosophical approach has been identified as critical of economics, leading in turn to the innovative response that by viewing the market as mutually beneficial exchange, economic practice is in fact defendable on virtue ethics grounds. This defends economics using arguments drawn from virtue ethics, but there is a need also to explore space for virtue ethics within economic theory. Examining key (...) contributions of Kenneth J. Arrow, Amartya Sen and Elinor Ostrom, the article notes that virtue ethics’ appreciation of persons’ communicability of ends is increasingly being relied upon within economics, though sometimes under different names. Its strength to interdisciplinary work between economics and philosophy lies in presenting a methodology able to capture how human beings are capable of, though not fixated on, cooperation. (shrink)

I have argued elsewhere that the overall method that is required in liberal political philosophy is that of reflective equilibrium and that this method can be best understood in processual terms. In the present article I try to show how neoclassical (and other) theists can bring their convictions to bear in a politically liberal society, within the confines of this method, in a rational (rather than irrational or mad) manner.

Throughout much of the critique of poetry in Republic X, Socrates exploits a parallel between painting and poetry. I argue there are two distinct methods at work here, the ‘similarity’ and ‘heuristic’ methods. The first uses painting to discover the general definition of mimesis, which is then swiftly applied to poetry. The second describes certain features of painting before using independent arguments to show that these also apply to poetry. That Socrates sometimes uses the parallel in this heuristic way is (...) not new in the literature. My purpose is to be more precise about what these two methods are, when Socrates uses one or the other, and why. At the end of the paper, I argue that the painting–poetry parallel is methodologically very similar to the state–soul parallel used earlier in the work. This allows us to view the arguments of Republic X in a more sympathetic light. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Establishment Hypothesis:Toward a More Integrated Theology of Holy OrdersDominic CerratoPreliminary ConsiderationsUnderstanding the ProblemThough the Sacrament of Holy Orders is a single sacrament consisting of three degrees, throughout its theological development, much of the focus has been on that of the priesthood. By priesthood I mean the two degrees that are sacerdotal in nature, the episcopate and the presbyterate. Given the growing understanding of the Eucharist in the Tradition, (...) and its intrinsic connection to the priesthood as its exclusive agent, this sacerdotal emphasis was a natural and organic development.1 Nonetheless, while revealing much, this sacerdocentrism, along with the adoption of the cursus honorum,2 had the unintended effect of obscuring the third level of the hierarchy, the diaconate.3 While the diaconate as an ancient order (Acts 6:1–6) would eventually be numbered among the major orders, being ordained non ad sacerdotium sed ad ministerium episcopi4 meant that deacons were not, in the same sense, related to the Eucharist as were priests. Consequently, much of [End Page 1275] what passed for diaconal theology is its liturgical role and charitable work among the poor. As observed by the Benedictine theologian Dom Augustinus Kerkvoorde just prior to the restoration of the diaconate, "there is, as far as we know, no independent theology of the diaconate. The number of authors and works should not delude us. None of them deals with the diaconate exclusively, say, to help deacons correctly understand and exercise their function in the Church."5 He goes on to characterize diaconal theology as fragments strewn throughout the various writings on orders in general, the priesthood, and the sacraments.6As later noted by the 2002 International Theological Commission on the Diaconate, this lack can be clearly observed in both the conciliar and post-conciliar documents on the diaconate. Of these, the commission wrote, "with reference to the pastoral priorities and in what concerns objective doctrinal difficulties, the Council texts show diversity of theological nuances which it is quite hard to harmonize."7 In a similar manner, with regard to the 1983 revision of the Code of Canon Law, the American canonist James Provost commented that there is:still no coherent treatment of the permanent deacons as a "proper and permanent rank in the hierarchy" comparable to the treatment given presbyters and bishops in the code; rather they are treated as exceptions to the norms for presbyters.8As a result, both before and after the Second Vatican Council, theological consideration of Holy Orders focused almost exclusively on the episcopate and presbyterate.9The recognition of a deficient theological development in the diaconate does not mean that there has been no progress over the centuries. There are, as Kerkvoorde observes, fragments throughout the Tradition up to and beyond the Vatican II. Moreover, there are some who have proposed new [End Page 1276] ways of envisioning the diaconate grounded in these very same fragments.10 While these have advanced our understanding of the diaconate as an order, missing is precisely how the three degrees relate to one another and how this unity is grounded.As the Catechism of the Catholic Church (CCC) points out, Holy Orders is a single sacrament consisting of three degrees. If one degree, say the diaconate, is theologically impoverished, then the unity of Holy Orders suffers from this same deficiency. Put another way, the triune nature of this sacrament means that its unity is dependent upon the three degrees and their relationship to one another. Commenting on this dependency, the English Dominican scholar Aidan Nichols observes: "The priesthood cannot be approached in isolation from the episcopate and the diaconate."11 To better illustrate the relationship of the three degrees to the intelligibility of Holy Orders, he goes on to observe:To the ordinary Catholic Christian, the priesthood is the order with which he or she is most familiar, and understandably so.... In this sense, it is the central image of the triptych: yet the central panel cannot be appreciated without those which flank it. We need the whole picture. 12The image of the triptych to describe the unity and diversity of Holy Orders is quite useful. As a work... (shrink)

In Gaudium et Spes and Dignitatis Humanae the Second Vatican Council not only presents the dignity of the human person as the parting point for its moral teaching but also grounds human dignity in natural teleology. Natural teleology is the view that the good of any thing corresponds to, and so can be discerned from, the ends to which it is directed by its nature, both that end which is proper to it and those ends that it has as part (...) of a wider order. As official Church teachings, these documents refrain from providing a philosophical justification of their account of human dignity. The existence of natural teleology, however, is generally contested in modern philosophy. For this reason, grounding human dignity in natural teleology constitutes a questionable approach to the issue. Of all major Catholic theologians, Thomas Aquinas is arguably the one who provides the most developed philosophical resources for articulating these views on natural teleology and its connection with human dignity. This paper examines and assesses the way in which he grounds human dignity in natural teleology. In his view, we see that human beings are the principle part of the universe and that the other parts of the universe are ordered towards the good of human beings. After surveying his general justification of how a thing is ordered to particular ends in virtue of its nature, the paper considers his explanation of how each part of the universe assumes further ends within the universe as a whole, and his main set of arguments on how we perceive human dignity against the backdrop of the natural teleology of the universe. (shrink)

David Bentley Hart and Jordan Daniel Wood are part of a movement aiming to overcome any separation between divine and human nature, avoiding what they see as a problematic account of grace. As opposed to radical kenoticism which holds that God only exists or has a given character in relation to creation, Hart and Wood appeal to facts about God such that He could not act otherwise towards human beings, given His character. They thereby ground conclusions that God could not (...) fail to create and that human beings could not be otherwise than divinized. Even though they differ on what it is in virtue of the fact that God could not act otherwise, both authors rest their views on such claims. I will argue such views involve serious theological and metaphysical problems, because this strategy entails – as much as radical kenoticism – that God is constituted by His relation to creation. (shrink)

Intense public interest in scientific claims about COVID-19, concerning its origins, modes of spread, evolution, and preventive and therapeutic strategies, has focused attention on the values to which scientists are assumed to be committed and the relationship between science and other public discourses. A much discussed claim, which has stimulated several inquiries and generated far-reaching political and economic consequences, has been that SARS-CoV-2 was deliberately engineered at the Wuhan Institute of Virology and then, either inadvertently or otherwise, released to the (...) public by a laboratory worker. This has been pursued despite a clear refutation, through comprehensive genomic analysis, of the hypothesis that the virus was deliberately engineered and the failure of detailed investigations to identify any evidence in support of a laboratory leak. At the same time a substantial, established body of knowledge about the many factors underlying the emergence of novel zoonotic diseases has been largely ignored—including climate change and other mechanisms of environmental destruction, tourism, patterns of trade, and cultural influences. The existence and conduct of these debates have raised questions about the vulnerability of science to manipulation for political purposes. Scientific discourses are vulnerable because: (i) claims can be made with no more than probabilistic force; (ii) alleged “facts” are always subject to interpretation, which depends on social, ethical, and epistemological assumptions; and (iii) science and scientists are not inherently committed to any single set of values and historically have served diverse, and sometimes perverse, social and political interests. In the face of this complexity, the COVID-19 experience highlights the need for processes of ethical scrutiny of the scientific enterprise and its strategic deployment. To ensure reliability of truth claims and protection from corrupting influences robust ethical discourses are required that are independent of, and at times even contrary to, those of science itself. (shrink)

My investigation reveals that Heidegger’s account of affectivity – though his programmatical determination included an ontical dimension or otherwise lived, personal experiences – is overshadowed by a dense ontology that cannot enable real phenomenal experience. This is why he could not account for other affective states such as emotions, feelings and the role of the body in affectivity. Besides, in that account we are lost when we seek to answer the question of whether moods are “one” or “many”. My aim (...) is to point out how these deficiencies in Heidegger’s account of mood could be overcome in Richir’s account of affectivity, where indeterminate background feelings (affections) could give rise to a determinate and occurrent emotion (affects). The advantage of this move is a rich ontic account of affectivity where not only the body but also sense/meaning of affective episodes play a robust role in an encounter of world events. If Richir reproached Heidegger for existential solipsism, one could now reproach the former for existentiell/phenomenal solipsism. In the end I suggest that these two core but opposite aspects of affectivity (the ontological and the ontic) belong to the same reality: Dasein is not just in the world (ontology), but also the world is in Dasein (ontic/phenomenological). (shrink)

Chapter Overview: This chapter looks at the foundations of modern psychiatry, with its stress on neurological malfunction, and asks about its strengths and limitations. We start by tracing some of the historical development of the ideas that have found their way into modern psychiatry from their roots in 19th-century medicine and neuroscience. Turning to the present day, we briefly look at competing conceptions of mental illness, before we discuss the philosophy of science that forms some of the theoretical foundations of (...) modern psychiatry. We suggest that modern psychiatry makes a number of commitments that are quite familiar to philosophers of psychology, employing mechanistic explanations to address disorders that are seen as natural kinds. We end with an example that seems to fit this picture, specific phobia, and one that seems not to, addiction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Section on Psychedelics Research and TreatmentDominic SistiAgainst a backdrop of post-pandemic malaise, diseases of despair, and a fragmented mental health care system, psychedelics have enjoyed a resurgence of interest as powerful psychotherapeutic agents and as catalysts of personal growth. The true power of these substances—some of which are considered sacramental by Indigenous peoples—has been shrouded for half a century by cultural mythology, political propaganda, and (...) misuse. From about 1940 to 1970, psychedelics including psilocybin and LSD were studied and used by clinicians to treat a range of psychiatric disorders from alcoholism and depression in adults to "autistic schizophrenia" in children.In June 1971, the Nixon administration's racist and illiberal War on Drugs inaugurated what was essentially a total ban on psychedelics. Society was robbed of half a century of scientific progress, and one can only speculate how differently our society might now function, and how many people might have been spared the trauma of mental illness and incarceration. Thankfully, it appears the time has arrived for psychedelic medicines to be decriminalized and included again in the pharmacopeia.In June 2023, a group of psychedelic researchers, therapists, bioethicists, Indigenous scholars, and advocates met at the Banbury Conference Center at Cold Spring Harbor Laboratory. There, this interdisciplinary group discussed several pressing ethical issues in psychedelics research and treatment that continue to [End Page 114] challenge the field. The aim of this meeting was to develop a bioethical framework for the use of psychedelics in mainstream medical settings. That is, how should psychedelics be employed responsibly by everyday clinicians, including psychiatrists, psychologists, social workers, and other behavioral health-care providers? This special section offers a sampling of three topics in psychedelic bioethics raised by the Banbury group, several of whom appear as coauthors.In our first paper, Logan Neitzke-Spruill and colleagues offer an overview of explanatory models describing the therapeutic mechanisms of psychedelic substances and how each of these models generates unique ethical quandaries. Starting from molecular biology and moving to neural circuitry and networks, neurobiological models now propel contemporary scientific research into psychedelics. Knowing how these substances work on a molecular level may offer promising ways forward in the development of new molecules designed to treat serious mental illnesses and other neurologic conditions. Perhaps neuroplastic mechanisms will be harnessed to develop new therapies without necessitating a psychedelic trip—a controversial premise discussed in our third paper, by Katherine Cheung, Brian Earp, and David Yaden.Such "neuroreductionism" risks ignoring the subjective psychological and spiritual experiences of patients that appear to be pivotal in psychedelic-assisted therapy, often described as mystical and utterly transformative. At the psychological level, these substances engender a kind of vulnerability and suggestibility requiring clear ethical standards to ensure patients' psychological and physical safety. And so too, practitioners will need structural and cultural competency to recognize the spiritual or moral values that inspire patient reactions during and after their psychedelic experiences. Ethically informed psychedelic practitioners will have to navigate between disciplinary silos and explanatory models. One practical upshot is the open question of how best to train psychedelic practitioners who hold this broad set of competencies.To that end, well-trained practitioners will need to be able to disclose in some way the transformative properties of psychedelics to prepare patients for their experiences. But how does one describe the ineffable? This raises the question of how or if it is possible for patients to truly consent to the transformative experience elicited by psychedelics, often described as one of the most important experiences of a person's life. The experience might stimulate significant emotional healing, or it might be horrifying. This sounds like a problem uniquely attached to psychedelics: after all, most pharmaceuticals don't trigger changes in one's fundamental moral values, life choices, and commitments, nor are they intended to. Yet, Brent Kious, Andrew Peterson, and Amy McGuire challenge the view that the psychedelic experience is uniquely transformative and impervious to the disclosure requirements of informed consent, a bedrock of bioethics. Ultimately, the writers show how consent is possible even if the experiences are dramatically different from most medical interventions, endorsing a practical view of consent [End... (shrink)

The sorites paradox is the name given to a class of paradoxical arguments, also known as little by little arguments, which arise as a result of the indeterminacy surrounding limits of application of the predicates involved. For example, the concept of a heap appears to lack sharp boundaries and, as a consequence of the subsequent indeterminacy surrounding the extension of the predicate ‘is a heap’, no one grain of wheat can be identified as making the difference between being a heap (...) and not being a heap. Given then that one grain of wheat does not make a heap, it would seem to follow that two do not, thus three do not, and so on. In the end it would appear that no amount of wheat can make a heap. We are faced with paradox since from apparently true premises by seemingly uncontroversial reasoning we arrive at an apparently false conclusion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Is Psychiatry About?Dominic Murphy, PhD (bio)There are no such things as minds, but there are animate objects who behave differently from other types of natural entity. They move around under their own power, and some of their activity seems to be very different from that of other natural objects. Furthermore, some of our predictions about these objects are disproved in interesting ways; if we make a false prediction (...) we do not revise our best theory about how such things generally behave, but we instead conclude that there is something wrong with the object of the prediction. These intelligent unpredictable things need a special vocabulary, and mental talk has arisen to serve as that vocabulary. But since a mind is not a thing in nature we face the problem of saying what the sciences of the mind are actually about.There are, then, intelligent systems that can be judged pathological, and some of them are our conspecifics. It is fair to say that there is no agreement about how such judgments are made or should be made. The question of what a mental illness is part of this larger picture, and it raises several different issues.First, how should we think about our practices of judging deviance? It would be contrary to accepted practice to wear a swimsuit to a state funeral, but what sort of norms would it violate and what state of mind would we ascribe to somebody who did it? Second, what is the difference between a judgment of deviance and a judgment of pathology? We have many ways of distinguishing between types of deviance, and the lines between criminality, immorality and pathology, to take three examples, are not always easy to discern. Third, what makes an illness a mental illness? This is Gough's topic, and I will get to it in a moment, but it worth situating it within this broader framework which asks what we are doing when we make these judgments of norm-violation.Gough begins by quite correctly pointing out that if we look at the domain of psychiatry as currently understood, we would have a hard time seeing what it is supposed to be the science of. It is customary to see psychiatry as dealing with the mental but, as Gough notes, there are some mental processes that psychiatry does not deal with, and some processes that psychiatry deals with that are not mental. Gough's response to this problem is a very interesting one, which starts from the idea that the point of psychiatry is to help those who need it; how different do things look if we start from this position? Conley and Glackin (2021) argues that the practical and therapeutic aspirations of psychiatry should constrain our understanding of mental illness. Glackin argues that we should [End Page 41] see this 'norms-first' view, as I will call it, as part of a broader liberal-democratic conversation about the ways in which we should live togetherA view that starts with norms is typically opposed to the 'naturalist' position. A naturalist begins with positive facts as the basis for diagnostic concepts, on the grounds that our concepts of disease and health are supposed to answer to facts about the physical and mental constitution of human beings. Gough's view is neither a norms-first view or a naturalist's view. We could call it an institutionalist view, or, if we were being a bit less kind, an ostensive one—"these things here, that's mental illness."David Hull (1988) taught us that every science (indeed, every intellectual formation or tradition) needs to be understood in two ways. First, we have the theoretical commitments that are taken to define it. Second, there are the practices and institutions that separate its practitioners off from others. Contemporary evolutionary biology, for instance, is built on the twin foundations of the modern synthesis—Darwinian natural selection and Mendelian genetics. These two theoretical commitments have been transformed and adapted and supplemented in diverse ways so that their modern forms no longer resemble their originals very closely. Still, they continue as the central undertakings about the nature of the living world that modern... (shrink)

Paraconsistent responses to vagueness are often thought to represent a revision of logical theory that is too radical to be defensible. The paracomplete logic of supervaluationism, SpV, is not only taken to be more conservative but is also commonly said to 'preserve classical logic'. This chapter argues that this is wrong on both counts. The paraconsistent logic SbV, or subvaluationism, is no less conservative than SpV nor more so. In the end both logics offer equally compelling theoretical approaches to vagueness. (...) Each approach is also equally objectionable, with neither providing an adequate account of vagueness, but this criticism arises from a feature shared by each approach that is independent of their paracompleteness or paraconsistency per se. For all that has been said, a paraconsistent approach, and the associated recourse to truth-value gluts, remains a contender in accounting for vagueness. (shrink)

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...) more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

One of the most commonly referenced ethical principles when it comes to the management of dying patients is the doctrine of double effect (DDE). The DDE affirms that it is acceptable to cause side effects (e.g. respiratory depression) as a consequence of symptom‐focused treatment. Much discussion of the ethics of end of life care focuses on the question of whether actions (or omissions) would hasten (or cause) death, and whether that is permissible. However, there is a separate question about the (...) permissibility of hastening or causing unconsciousness in dying patients. Some authors have argued that the DDE would not permit end of life care that directly aims to render the patient unconscious. The claim is that consciousness is an objective human good and therefore doctors should not intentionally (and permanently) suppress it. Three types of end of life care (EOLC) practices will be explored in this article. The first is symptom‐based management (e.g. analgesia); the second is proportional terminal sedation as a means of relieving suffering (also referred to as palliative sedation or continuous deep sedation); and finally, deliberate and rapid sedation to unconsciousness until death (a practice we call terminal anaesthesia in this paper). After examining the common arguments for the various types of symptom‐based management and sedation, we apply the DDE to the latter two types of EOLC practices. We argue that aiming at unconsciousness, contrary to some claims, can be morally good or at least morally neutral in some dying patients. (shrink)

Reflection on natural law reaches a highpoint during the Middle Ages. Not only do Christian thinkers work out the first systematic accounts of natural law and articulate the framework for subsequent reflection, the Jewish and Islamic traditions also develop their own canonical statements on the moral authority of reason vis-à-vis divine law. In the view of some, they thereby articulate their own theories of natural law. These various traditions of medieval reflection on natural law, and their interrelation, merit further study, (...) particularly since they touch upon many current philosophical concerns. They grapple with the problem of ethical and religious pluralism. They consider whether universally valid standards of action and social life are accessible to those who rely on reason rather than divine law. In so doing, they develop sophisticated accounts of many central issues in metaethics, action theory, jurisprudence, and the philosophy of religion. However, do they reach a consensus about natural law, or do they end up defending incommensurable ethical frameworks? Do they confirm the value of arguments based on natural law or do they cast doubt on it? This collection brings together contributions from various expert scholars to explore these issues and the pluralism that exists within medieval reflection on natural law. It is the first one to study the relation between the natural law theories of these various traditions of medieval philosophy: Jewish, Islamic, Byzantine, and Latin. Each of the first four essays surveys the 'natural law theory' of one of the religious traditions of medieval philosophy-Jewish, Islamic, Byzantine, and Latin-and its relation to the others. The next four essays explore some of the alternative accounts of natural law that arise within the Latin tradition. They range over St. Bonaventure, Peter of Tarentaise, Matthew of Aquasparta, John Duns Scotus, and Marsilius of Padua. (shrink)

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Exclusivity and ParticularityJohn Dominic CrossanSeveral of the authors spoke of the imperial exclusivity so characteristic of Christianity. For José Ignacio Cabezón, “What Buddhists find objectionable is (a) the Christian characterization of the deity whose manifestation Jesus is said to be, and (b) the claim that Jesus is unique in being such a manifestation” (p. 56). For Bokin Kim, “most Christians hold to an exclusive view of Christ that claims (...) his uniqueness” (p. 76). For Rita Gross, “the exclusive claims made on behalf of Jesus by Christians appalled me even as a teenager, and my repugnance for exclusive truth claims on the part of religions—any religion—has not diminished since. Thus, part of my journey is working out both a theory and a praxis of religious pluralism that is neither relativistic nor universalistic, that encourages both commitment to one tradition and appreciation of other traditions” (p. 64). I myself find such exclusivistic claims for Christianity, or any other religion, insulting in theory and lethal in practice, objectionable in history and obscene in theology. They are implicitly genocidal even if political impotence limits the divine ethnic cleansing they imagine. But how, as Gross repeats, does one establish “a position that is neither relativistic nor exclusivistic”? (p. 65). My own answer is particularity, but I must explain that in terms of my understanding of Trinity, divinity, and particularity.Trinity seems a particularly and peculiarly Christian understanding of God, but my proposal is that the structure of the Holy is Trinitarian in all religions that I know about and even in all those I can imagine. I speak very deliberately about the Holy (not about God) as the infinite mystery that surrounds and supports, fascinates and terrifies us. It is that against which we interact as meaning-seeking beings. Be it absolute open meaninglessness or absolute univocal meaning, our interaction with it does not seem to be an option but a necessity. And my point is that the Holy is Trinitarian in structure. It is not just on the one hand that religion is Trinitarian in structure. But it is not on the other hand that the Holy in itself and apart from us is Trinitarian in structure. It is, I propose, that the Holy in itself as seen by us across the spectrum of world religious experience is Trinitarian in structure. That Trinity [End Page 97] involves, first, ultimate metaphor, that foundational image that imagines the Holy as, for example, power, person, state, or order, as nature, god/goddess, nirvana, or mandate of heaven. It involves, second, material manifestation, some physical object in which that metaphorical vision is peculiarly, specially, or even uniquely incarnated, some person, place, or thing, some individual or collectivity, some cave or shrine or temple, some clearing in the forest or tree in the desert where that ultimate referent is encountered and experienced. It involves, finally, preliminary preparation, for there must be at least one believer to begin with and eventually more to end with. But, as there are always nonbelievers as well, some prior affinity must exist, as it were, between this metaphor rather than that, this manifestation rather than that, and this believer rather than that. For me, therefore, all faith and all religion, not just my own Christianity, is Trinitarian in structure and that structure seems to inhere in the Holy itself, at least insofar as we can see it. For me, therefore, Christianity and Buddhism differ most profoundly on their ultimate metaphor for the Holy: it is person (God) for the former but state (nirvana) for the latter. In Christianity, of course, our ultimate metaphor is rather overinvested: it is person; and that person is parent; and that parent is father. But I leave those specifications aside for the moment.Divinity is the term I use for any material manifestation. By calling such manifestations divine I mean precisely that a religion’s ultimate metaphor is experienced by believers as peculiarly, specially, or even uniquely present in that physical phenomenon. In that sense I understand both Christ and the Buddha to be divine in exactly the same way—that is, as incarnations of the Holy but within different ultimate metaphors. Christ did... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Integralism and Justice for AllJames Dominic Rooney O.P.Catholic integralism has received a lot of attention recently, promoted by pundits and scholars alike.1 Much ink has been spilled in scholarly venues discussing historical evidence marshaled by defenders of integralism who argue that the Catholic Church has rights to the coercive power of the state in service of its religious mission, notably Thomas Pink.2 My interest in this piece is different. (...) I aim simply to show that integralism is unjust. To prove this, I propose two problems that illustrate the integralist position entails violations of distributive justice concerning the rights of non-Catholics. It is important to highlight that my argument that integralism is unjust will not require denying Pink's controversial views about the power of the Church to direct state policy. In other words, I presume the truth of Catholicism and Pink's controversial readings of Church documents, but show that these readings do not allow us to arrive at the view that integralism is true. What my argument attacks is not that the Church has such powers, but that there is any identifiable "ideal" political arrangement in which these powers are exercised.Pink has attempted to show that—contrary to popular perception—the [End Page 1059] Second Vatican Council's declaration on religious freedom, Dignitatis humanae (DH), is compatible with integralist positions. Appealing to arguments given by Francisco Suarez, Pink argues that the Church has rights to the coercive power or authority of the state. On this reading, "the authority to direct and coerce in matters religious...belongs to the Church. It no more belongs to the state than it belongs to private individuals."3 Instead, the Church is a coercive authority which can impose "temporal penalties" on its members.4 Further, the baptized acquire obligations to lend the Church their temporal authority in service of its mission; thus, "rulers and officials of Christian states—[fulfill] their baptismal obligations to the Church in lending her their power and resources to hold other baptized Christians to their baptismal obligations."5 Consequently, the Church has a right, given its coercive authority to impose temporal penalties on its members, to the temporal power which baptized rulers hold, in service of its mission.6Pink's interpretation of what was called the Church's "indirect power" over government therefore involves a strong thesis that the Church has God-given rights to utilize civic coercion for its own supernatural ends. I will refer to this controversial thesis about "indirect power" as the "Suarezian thesis" (but will not be concerned with whether his view accurately represents Suarez). Pink and other integralists claim that this strong thesis about a native or intrinsic right of the Church to the coercive power of the state is doctrinally binding on Catholics.7 But Pink's view of that indirect power is controversial among Catholic theologians. Theologians as noteworthy as Avery Dulles, Joseph Ratzinger, and John Henry Newman explicitly reject this interpretation that the Church has native or intrinsic rights to civil coercive authority.8 For my purposes, I will concede the Suarezian thesis and [End Page 1060] illustrate that it is theoretically independent of integralism. Indeed, I will argue that integralism is false even if the Church did have a claim to temporal coercive power of the state. Integralism is more than the Suarezian thesis, does not follow from it, and does not strictly require it.The essay will be structured as follows. I will begin by providing clarifications on the meaning and nature of the integralist thesis. Then I will propose two arguments to show that, even if the Suarezian thesis were true, it would not entail that integralist states are the ideal political arrangement. What I will show is that there is no good sense in which integralist states are politically ideal. This is not to say integralist states are always impermissible. There are constraints that integralists themselves accept on when integralist states are permissible, and only when these constraints are met is an integralist state supposed to be politically ideal. I will construe the constraints charitably. Then I will show both that integralism lacks any good justification for the claim that... (shrink)

Colonialism’s legacy in South Africa includes persistent economic inequality which, since the country’s universities charge fees, bars many from higher education, perpetuating the marginalisation of those previously disadvantaged by the apartheid regime. In 2015-6, country-wide unrest raged across university campuses, as students protested the yearly cycle of tuition increases under the slogan #FeesMustFall, demanding “free, decolonised education”. Protests ended in December 2017 when the government announced a sliding-scale payment policy alleviating the economic burden for poorer students. This paper sets the (...) #FMF movement and its twin demands within the context of decoloniality, and argues that while free education has been achieved, imagining and implementing decolonised education for South Africa in an increasingly globalised world is a more challenging, elusive goal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Experience, and TherapyDominic Murphy (bio)The contemporary philosophical idea of autonomy has a psychological implication, to wit, that there exists a comprehensive set of ideal competences, realized in our mind/brain, that enable a person to be self-governing. Autonomy is normally accorded individuals who enjoy a certain kind of psychological functioning and, perhaps, a certain sort of psychological history (Christman 1991). We think that autonomous individuals critically evaluate their life (...) and actions, endorse them as self-determined rather than imposed from without, and guide their own lives in accordance with the plans and values they have worked out for themselves. Such self-government has to depend on some psychological structures, but philosophers have tended to theorize about what these structures might be at a considerable distance from what the behavioral sciences can tell us. Anderson and Lux's paper is a welcome contribution to the growing literature that tries to connect issues in ethics with empirical considerations. This sort of methodological, as opposed to merely metaphysical, naturalism, is only just coming into vogue in ethics, even in moral psychology.1 Anderson and Lux are, as far as I am aware, the first people to reflect seriously on what we can learn about autonomy from clinical experience. Theirs is a very suggestive and fruitful paper that looks at real-life cases of loss of autonomy and tries to reach conclusions about what the deficits in performance tell us about the psychological preconditions of autonomy. Their paper also opens the way for an investigation into the precise neurologic and computational underpinnings of these capacities, which is essential if we are to get a serious moral psychology underway.I find little to quarrel with in the story that Anderson and Lux tell, but I will try to modify it slightly to bring out what I think is the important psychological point they make and explore some ramifications. I begin by claiming that they have scored a decisive point in favor of an external conception of autonomy. Second, I suggest that what Anderson and Lux have really put their finger on is less a requirement of accurate self-assessment than a requirement of sensitivity to feedback from the environment. I conclude by raising some of these issues about the relations between autonomy and assessments of psychological function when the deficit responsible is less amenable to clear cut neurologic identification.The External Perspective on AutonomyOne way of taking the paper (although this goes beyond anything that Anderson and Lux suggest) is that there is a smooth naturalistic picture of the cognitive basis of autonomy. When people have a normally functioning neurocomputational setup in their heads, we should assume that they are autonomous, and vice versa. However, autonomy cannot simply be identifiable with a mind that is working as some scientific theory says it should, because a mind that is [End Page 303] in that sense working correctly could, nonetheless, be directed by forces other than the agent. Servile or deluded individuals might endorse their lives even if those lives are the product of indoctrination, self-deception, or internalized oppression (Mackinnon 1997; Mele 1995). Normal mechanisms of belief fixation, for example, may not foster one's autonomy if the only context in which they are exercised is one in which many possible ways of life are simply unavailable for consideration, having been excluded from consideration by the dominant forces around one. We might, then, think of full autonomy as depending on relational rather than intrinsic properties. Perhaps autonomy requires a subject to have both normal psychological capacities and the right sort of environment in which to exercise them. I do not follow-up on this suggestion, but I mention it because it introduces two dimensions, within the subject and around the subject, where the externalist perspective on autonomy can get a grip. I discuss the former, but I do not mean to suggest that the latter is not important. A full account must deal with both. But even the psychological structures that foster autonomy cannot be identified with a mind working according to some scientific theory, as we shall see.Many writers on autonomy argue that we must recognize appropriate, objective constraints... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Matter and Mathematics: An Essentialist Account of the Laws of Nature by Andrew YOUNANDominic V. CassellaYOUNAN, Andrew. Matter and Mathematics: An Essentialist Account of the Laws of Nature. Washington, D.C.: The Catholic University of America Press, 2023. xii + 228 pp. Cloth, $75.00Andrew Younan’s work situates itself between two opposing philosophical accounts of the laws of nature. In one corner, there are the Humeans (or Nominalists); in the (...) other, the Anti-Humeans (or Platonists). The goal of the book is to find an explanation for the orderliness of the natural world that avoids falling into the difficulties of the two opposing philosophies. For example, the Humeans treat “events” as fundamental, and the laws of nature follow from these “events.” For the Humeans, reality is essentially random, with any order being something of our own contrivance. Whereas for the Anti-Humeans, the laws of nature are fundamental and are treated as causing events, turning the effect of necessity into the cause of material [End Page 166] characteristics. Looking to Aristotle and Thomas Aquinas, Younan proposes the recovery of a third option, the Essentialist position. This Essentialist position understands substances, that is, individual beings, as fundamental and all else (for example, events and laws of nature) follow from these individual beings. The thesis of the book, generally understood, is that Essentialism evades the critiques that the Humeans and Anti-Humeans put against one another while retaining what is right in each approach.The book is divided into two parts. The book’s first part deals with general objections and replies and is divided into three chapters. Chapters 1 and 2 address the two opposing accounts of nature mentioned, while chapter 3 argues for the benefits of recovering an Essentialist position. Chapter 1 examines the objection that Aristotelian natural philosophy is incompatible with modern science, an objection raised by Descartes. Chapter 2 addresses the objections of the Humeans, namely, that natural philosophy and, with it, causality and induction have been debunked. Chapter 3 looks at the fathers of quantum theory, specifically Heisenberg, and argues that a return to Aristotle’s understanding of nature would benefit the modern scientific project. The book’s second part is an argument for the Essentialist position and is divided into three chapters. Chapters 4 and 5 are the foundation for chapter 6. Chapter 4 is an abstractive account of mathematics, differing from Descartes and his conceptions, which draws on the texts of Aristotle and Aquinas’s Division and Methods. Chapter 5 situates necessity and its role in Aristotelian natural philosophy. Chapter 6 is the author’s attempt at defining what it is to be a law of nature.Younan argues that adopting an essentialist understanding of nature in a system where all knowledge begins in the senses has three significant “payoffs.” The first is that it avoids governance language, that is, it avoids making laws themselves causes of necessity; the second is that it avoids the assertion of a priori knowledge; the third is that it understands individual things as the fundamental primitives in nature, restoring the substance to its proper place as the thing that “stands under” accidental being.The book is concluded with an appendix that explores and rearticulates Thomas Aquinas’s fifth way under the consideration of everything the author had argued for in the book’s main text. Taking as established by the rest of the book that necessity and teleology go hand in hand, Younan argues for a creator God who establishes a universe freely but within certain parameters that follow upon being itself. Younan concludes, with Thomas Aquinas, that laws of nature are “ordinances of reason” that must come from a rational mind. To be as consistent as they are, the laws of nature must be promulgated by God, and they are discoverable within the nature of matter itself.Younan’s book often engages its interlocutors on the big-picture scale, frequently giving generalizations and not going into details to avoid getting bogged down in the weeds. The author is very aware of what he is doing. [End Page 167] It is appropriate since engaging the multiheaded hydra of the schools of thought that Younan... (shrink)

I have argued elsewhere that the overall method that is required in liberal political philosophy is that of reflective equilibrium and that this method can be best understood in processual terms. In the present article I try to show how neoclassical (and other) theists can bring their convictions to bear in a politically liberal society, within the confines of this method, in a rational (rather than irrational or mad) manner.

In lieu of an abstract, here is a brief excerpt of the content:Saving Honor:The Ideology of Equal Esteem and the Good of Honor, Friendship, and Glory according to St. ThomasDominic Verner O.P.In his book Natural Law and Human Rights, Pierre Manent assesses and critiques a practical ideology that he finds pervasive within the European academy and sees increasingly informing the practical sensibilities of much of the Western world. "Our governing doctrine," as Manent calls it, is chiefly characterized by the primacy (...) of right over law and the rejection of any objective principle by which actions and persons might be judged.1 It is "the plasticity of the human form" itself which demands respect.2 The only non-constructed and thus normative characteristic of equal human nature is the power of being an "individval-conatus," the power to be one's own rule and reason for acting.3 And the only generally recognized purpose of this "individual-conatus" is to satisfy the desire for power, which is the sole universal motive of human action.4 Such an individual can be legitimately ruled and governed only by himself, a claim reflected in the ideal of the autonomous subject and representative government.5 In sum, Manent characterizes this ideology in terms of a thoroughgoing [End Page 335] rejection of any objective rule, "any law of God or of nature," according to which man is defined and judged.6Manent warns that this ideology is opposed to the very wellsprings of action, since an operation is rightly called an action only when it is performed according to some deliberate choice, which requires some rule and reason. If all rules and reasons are entirely self-generated, then there is no principle according to which deliberation might occur. Such a so-called autonomous subject purports to command himself, but in fact he is more patient than agent: the subject is moved by desires and preferences which cannot be weighed according to any discriminatory rule or principle, since the desires and preferences themselves are the only rule the subject acknowledges. Aside from submitting to the movement of the inexplicably strongest preference, the only positive reason for acting that remains is to destroy any vestiges of objective rules or reasons for acting—that is, the law—that might hinder the realization of individual preference: "The acting animal is now the prisoner of the very audacious and ingenious arrangement that he once devised to escape the urgency and to avoid the difficulty of the practical question. Caught in the realm of inaction, he seeks out, in a kind of terminal fever, the last corners of social existence that still escape the laissez-faire idea and where the very idea of the law might suffer its final defeat."7What is a Christian to make of this practical ideology? What natural inclinations does it privilege and how might the goods it seeks be sought rightly? Manent argues that the sole universal motive for action explicitly recognized by this practical ideology is a certain kind of power: the power of self-determination. According to the governing doctrine, this power is the only universal human motive that can be relied upon to construct common life and political order. Manent's response to this ideology is therefore to propose a recovery of a natural law account of the heterogeneity of universal human motivations to include useful, pleasing, and honorable goods. In this article, I will argue that Manent's own account of the ideology he critiques suggests a more fundamental motive driving the ideology, namely, a desire for an unassailable esteem. And since it is a desire for esteem that best explains the attractiveness of the ideology of modern freedom, an alternative vision of practical life will need to address the desire for esteem and articulate its proper bases. In advancing this argument, I will first show that Manent's own analysis highlights the importance of the desire for esteem in motivating the ideology of modern freedom. I will then turn to the anthropology of Thomas [End Page 336] Aquinas to show that the desire for esteem is manifested in the desire for honor and for friendship and is rooted in a fundamental inclination to have certain knowledge of one's... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Collective Violence and Birthday PartiesA Girardian Analysis of the PiñataDominic Pigneri (bio)The piñata is a tradition most commonly associated with Latin America, but this party game has a mysterious origin. Some suppose that the origin of the practice was brought to the Americas by the Spanish, who received the custom from the Italians.1 Some say that the Italians, through Marco Polo, appropriated the ritual from the Chinese.2 Others see (...) the Mexican piñata as originating locally in an Aztec religious ritual.3 But looking at this festival activity through a Girardian lens we can see that wherever a custom came into being, it seems that its origins lie in the lethal practice of collective violence. The following description may serve as an exemplar of the tradition:In Mexico, a plain, round clay cooking pot called an olla is decorated and finally almost entirely concealed by ruffles and streamer coverings shaped into animals, stars, etc. It is filled with nuts, sugar cane, fruits and small toys and is hung overhead from a rope. One participant in the game is blindfolded and given a long stick with which he or she tries to hit the pot. Several people (usually children) take turns at being blindfolded and swinging the stick, and finally when someone hits the pot [End Page 209] hard enough to break it, the other players scramble on the ground for the scattered prizes. It is a kind of noisy and happy version of a grab-bag, and the game goes on for quite a few minutes, since a controlling cord is used to swing the pot out of reach of the batters. There are several sing-song chants which the children say as the game goes on with each new target.4While the clay pot is the most traditional, piñatas are also made from other materials, including papier-mâché and cane plants.5 Furthermore, the piñata has a place in many different festivals; it is especially associated with Christmas, Easter, and birthday parties all over the Americas where there is a Latin influence.While the ritual of the piñata contains no explicit violence, the ritual itself contains many of the elements of the scapegoat mechanism René Girard describes in Violence and the Sacred. What Girard describes here is the banding together of society as they focus their internal animosity onto an arbitrary third-party victim. The peace that arrives after this violence is so profound that it is instinctually associated with the divine. This peace inspires a reenactment of this violence as a religious ritual. Therefore, religion functions as the force that keeps internal violence from turning all members of a society against one another. This controlled violence is the safety valve that releases the violence that would otherwise rend the social fabric of a community.6 Religion also veils the violence, which grants peace. It is important that the violence be expressed, but also hidden. Girard says, "Men cannot confront the naked truth of their own violence without the risk of abandoning themselves to it entirely. They have never had a very clear idea of this violence, and it is possible that the survival of all human societies of the past was dependent on this fundamental lack of understanding."7 This is the significance of the ritualism of cultic sacrifice.This relates to our current question of the piñata in the sense that the practice is reminiscent of a sacrificial ritual, especially when the piñata takes the shape of a being like an animal or human person. First, destruction is the initial aim of the activity. The piñata, like the oblation, must be destroyed in some way. This is what grants the ritual its efficacy. Second, there is a need for rubrics, a carefully followed procedure for the desired effect to come about. In cultic sacrifice, this can take place in a variety of ways, from ritualistic washing of the priest and the victim to the exact procedure and order for dissecting the victim. Similarly, as we saw in the description of the piñata above, there is a procedure. The piñata is... (shrink)

Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? (...) Is it problematic if narratives, arguments or perspectives appear to favour stopping over continuing life-sustaining treatment? Similar questions might arise with written materials about decisions for adults, or for other ethically contentious decisions. This paper explores the meaning of ‘balance’ in information provision, focusing particularly on written information about life-sustaining treatment for children. We contrast the norm of non-directiveness in genetic counselling with the shared decision-making model often endorsed in end-of-life care. We review evidence that parents do not find neutrality from medical professionals helpful in discussions. We argue that balance in written information must be understood in the light of the aim of the document, the most common situation in which it will be used, and any existing biases. We conclude with four important strategies for ensuring that non-neutral information is nevertheless ethically appropriate. (shrink)

Gathers medical and legal documents, opinions from various perspectives, and a timeline of events in the Terri Shiavo case to provide a resource for examining the moral and ethical issues surrounding end-of-life decisions.

By applying both traditional source analysis and archeological research this paper examines two questions related to the Gothic War in Picenum and Ager Gallicus: First, it deals with the credibility of Procopius’ reporting; second, it looks at the scope of the destructions caused by the 20-year-long conflict in the region and, hence, sheds light on the problem of whether the changes this war brought about – especially in contrast with the following invasion of the Lombards – justify the claim that (...) its end clearly marked the transition from antiquity to the Middle Ages. (shrink)

Background In the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage. Methods Two surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended (...) format to provide features they thought should and should not be considered in allocating ventilators for COVID-19 patients when not enough ventilators are available. In the second survey, 505 participants were presented with 30 features identified from the first study, and were asked if these features should count in favour of a patient with the feature getting a ventilator, count against the patient, or neither. Statistical tests were conducted to determine if a feature was generally considered by participants as morally relevant and whether its mean was non-neutral. Results In Survey 1, the features of a patient most frequently cited as being morally relevant to determining who would receive access to ventilators were age, general health, prospect of recovery, having dependents, and the severity of COVID symptoms. The features most frequently cited as being morally irrelevant to determining who would receive access to ventilators are race, gender, economic status, religion, social status, age, sexual orientation, and career. In Survey 2, the top three features that participants thought should count in favour of receiving a ventilator were pregnancy, having a chance of dying soon, and having waited for a long time. The top three features that participants thought should count against a patient receiving a ventilator were having committed violent crimes in the past, having unnecessarily engaged in activities with a high risk of COVID-19 infection, and a low chance of survival. Conclusions The public generally agreed with existing UK guidelines that allocate ventilators according to medical benefits and that aim to avoid discrimination based on demographic features such as race and gender. However, many participants expressed potentially non-utilitarian concerns, such as inclining to deprioritise ventilator allocation to those who had a criminal history or who contracted the virus by needlessly engaging in high-risk activities. (shrink)

This paper describes a structured approach to the selection of an analytic strategy for cross-case analysis and a method for data display. To this end, criteria will be developed addressing both, aspects of scientific rigor as well as the practicability of application and the application of the decision process will be demonstrated.

Objections to the orthodox doctrine of an eternal hell often rely on arguments that it cannot be a person’s own fault that she ends up in hell. The paper summarizes and addresses three significant arguments which aim to show that it could not be any individual’s fault that they end up in hell. I respond to these objections by showing that those who affirm a classical picture of sin have Moorean reasons to reject these objections. That classical perspective holds that (...) all (serious) sin involves choosing eternal destiny apart from God and that no sin could possibly be caused by God. Consequently, it is necessary for ending up in hell that someone commit a serious sin, and it is sufficient for ending up damned that one persists forever in sin. Since the objections conflict with Moorean commitments central to the classical perspective, those who hold to such a classical perspective on sin would have good reason to reject all these arguments, which involve assumptions that would entail that such a perspective is false. (shrink)

It is a reasonable worry that God would not truly love us and want our salvation if He fixed a definite point after which He will no longer offer us the graces to repent of our sins. I propose that Thomas Aquinas succeeds in showing us that God would not be cruel or arbitrary in setting up a world where embodied agents end up after death in a state where they will inevitably fail to repent of their sins. Aquinas proposes (...) that being disembodied is to be in a state where a person cannot be mistaken about what they want, given that they know themselves perfectly. If the disembodied state were like this, it would not be surprising that being in that state makes repentance impossible, since a soul would become fully integrated around whatever one desired, without any conflicting desires that could prompt repentance. Thus, humans would persist in whatever desires they had at the moment of death and disembodiment. I conclude by arguing that, while this scenario stands in need of fuller theodicy, Aquinas’ scenario is helpful in defending a view that God is not cruel or arbitrary for creating a world in which post-mortem repentance is impossible. (shrink)

Background: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students’ experiences during the first (...) semester of an undergraduate problem-based learning medical program at an African medical school. Method: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Results: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Conclusions: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem based learning process. (shrink)

When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical. Our enormous scientific and medical progress already outstrips our capability to provide treatment. Life can be prolonged at enormous cost, sometimes far beyond the point that the individual appears to be gaining a net benefit from that life. Science (...) can tell us how to achieve something, but it cannot tell us whether we should achieve that end—whether it is good. For that, we need ethics. Ethics grows in importance as our technology creates new possibilities. Where there are no options, there are no ethical questions. However, once there are options, there arise pressing questions about whether to pursue them. We require values and principles to decide how to use medicine and science. During the last 7 years, issues like the creation of brain organoids, human non-human chimeras, mitochondrial transfer, gene editing of embryos and in vitro gametogenesis have grown in prominence. These raise deep questions about moral status and how it should be determined, the limits of modification of humans, and what is good in life. As editors of the JME, we are proud of our small contribution to thinking about these challenges. We are grateful to the hard work of our associate editors and administrative staff, but there is still much more to do. During our term as editors, we have published papers from diverse perspectives, on a wide range of topics. We have seen vigorous debate within the pages of the journal and have often sought to deliberately encourage that debate …. (shrink)

A model of metaphysics associated with EJ Lowe and Tuomas Tahko sees metaphysics as involving a priori knowledge of possible essences, or at least modal facts, and delimiting the actual ‘ontological categories,’ the ultimate and essential divisions of what exists, based on the results of a posteriori scientific investigation. Their approach to metaphysics has been criticized by those who argue that such metaphysics is unsuitably a priori, disconnected with empirical research in natural science, and ends up failing to provide meaningful (...) constraints on metaphysical theorization. I present different epistemological and semantic worries about these accounts to motivate an alternative perspective on which metaphysics centers on form, rather than possibility. This scholastic perspective is shown to incorporate the skeptical insights as constitutive of its approach to existence, by way of the position that ‘being’ is not a genus. Rather, ‘being’ is a determinable. The scholastic approach can thus provide responses to the skeptics, since it denies that ontological categories – in the Lowe/Tahko sense – are what metaphysicians investigate and proposes a different view of ontological categories as classes of forms. (shrink)

Sandbach, who has given us a very useful introduction to early Stoicism, examines here a problem of more interest to specialists, that concerning the possible influence of Aristotle on the first Stoic philosophers. It is his view that Aristotle's influence, if any, was of little importance, and that if the development of Stoic philosophy is to be understood, it should be seen in relation rather to ideas to be found in Plato, in the Academy and in other thinkers such as (...) Diodorus. However it is not Sandbach's purpose to explore this second, positive thesis here. The negative critique of the supposed links between Aristotle and the Stoics is the focus of the book. Sandbach starts with a survey of what was known of Aristotle's works in the third century B.C. to philosophers and non-philosophical writers. A theme is introduced here that will be emphasized throughout the book: little of Aristotle was read outside his school, and neither he nor his school were held in high regard at that time. The next chapter strengthens this position and is followed by chapters organized according to each of the parts of Stoic philosophy, in which the claims of a variety of scholars for Aristotelian influence in particular areas of Stoicism are examined and rejected. Reading these chapters is rather like going through a set of file cards containing references and brief remarks. The critique ends with a short section on what the Stoics disregarded in Aristotle's philosophy, a Conclusion, and Appendices on some later Stoics and on Ocellus Lucanus. (shrink)

This paper investigates a series of normative principles that are used to justify different aspects of executive compensation within business firms, as well as the remuneration of lower-ranking employees. We look at how businesses perform pay benchmarking; employees’ engagement, fidelity and loyalty ; and the acceptability of what we call both-ends-dipping, that is, receiving both ex ante and ex post benefits for the same work. We make two observations. First, either different or incoherent principles are used to justify the pay (...) of executives compared to employees, or the same principles are applied differently. Second, these differences or inconsistencies tend to be to the benefit of executives and/or to the detriment of employees. We conclude by asking whether there is any reason for thinking differently about executive pay than we do about employee pay. Our analysis leads us to question the principles justifying current executive compensation and to wonder if these principles are potentially being instrumentalized to serve other ends. (shrink)

[Encyclopedia entry] Born in Italy in 1225, and despite a relatively short career that ended around 50 years later in 1274, Thomas Aquinas went on to become one of the most influential medieval thinkers on political and legal questions. Aquinas was educated at both Cologne and Paris, later taking up (after some controversy) a chair as regent master in theology at the University of Paris, where he taught during two separate periods (1256-1259, 1269-1272). In the intermediate period he helped establish (...) a studium for his Order in Rome, beginning work on the Summa Theologiae, the masterwork for which he is still well-known. Subsequent to an experience (traditionally, a vision) Aquinas had on the feast of St. Nicholas in 1273, Aquinas intentionally refrained from further work on that text, so that it remained incomplete at the time of his death a year later in 1274. Apart from his own contributions, the Thomistic school – including followers within and without the Dominican Order to which Aquinas belonged – has had profound and far-reaching influence upon the history of legal thought in the West. Many of the classical developments of Thomistic thought are written as commentaries on the Summa Theologiae (hereafter, ST), including the works of Tomasso de Vio (Cajetan) and those of Domingo Banez, Francisco de Vitoria, Bartholome de las Casas, and the other highly influential members of the School of Salamanca who are noteworthy for developing Aquinas’ political and legal thought in the 16th century. Specifically, the ways in which Aquinas synthesized classical political and legal themes around the law, morality, and the common good provided a touchstone for what has come to be called ‘natural law jurisprudence.’ Natural law thinkers, in short, appeal to objective facts about what is good for human beings, and the social or political nature of the kind of creatures that we are, as a standard against which we measure the legal and social institutions created by human institutions. What is crucial here is that facts about human beings as social animals constitute reasons for individuals and groups to act or be structured in certain ways, such that ‘nature’ is the proper source for jurisprudential and political principles. (shrink)

Background: Although inclusive education is widely discussed, its implementation has not, arguably, been far-reaching. There remains a lack of specific, targeted approaches towards fully including learners with physical and mental impairments in the educational space. Objectives: This study investigated the extent of the inclusion of learners with autism spectrum disorder (ASD) in three schools in Johannesburg. Method: A qualitative interpretivist design was adopted. Teachers who work with learners with ASD were interviewed using open-ended questions. The sampled data were analysed using (...) thematic analysis, making use of both a priori codes and emergent codes that arose from the open-ended questions. Results: The findings reveal numerous pedagogic strategies such as differentiation, scaffolding, use of visual cues, group work and collaboration that can include learners with ASD in the classroom space. Conclusion: Teacher collaboration and teacher training are vital in ensuring that learners with ASD are fully included in the classroom space. (shrink)

John Henry Newman's theory of heresiology evolved over the course of his life, accentuating certain Christological characteristics of heresy. He began with the study of the Arian heresy, progressing through the Sabellian and Apolloniarian, and ending with the Monophysite. The theory of heresy and orthodoxy finally developed in the Development of Doctrine reflects this struggle to find common features of orthodoxy corresponding to principles governing Christology in the early Church Fathers. As a consequence, Newman's heresiology, in its final stage, holds (...) that faith is inherently Christological, as it depends on the doctrine of the Incarnation to secure the authority of the divine voice of Christ to which one submits in faith. (shrink)

The rapid development of vaccines against COVID‐19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID‐19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the (...) view that those who are most vulnerable to COVID‐19 should get the vaccine first. While this is intuitively attractive, we argue that there are other possible values and criteria that need to be considered. These include both intrinsic and instrumental values. The former are numbers of lives saved, years of life saved, quality of the lives saved, quality‐adjusted life‐years (QALYs), and possibly others including age. Instrumental values include protecting healthcare systems and other broader societal interests, which might require prioritizing key worker status and having dependants. The challenge from an ethical point of view is to strike the right balance among these values. It also depends on effectiveness of different vaccines on different population groups and on modelling around cost‐effectiveness of different strategies. It is a mistake to simply assume that prioritizing the most vulnerable is the best strategy. Although that could end up being the best approach, whether it is or not requires careful ethical and empirical analysis. (shrink)

It is frequently claimed that an all-loving and good God cannot permit anyone to end up in hell. In this book, the author shows that this issue of God’s permission of hell has an intimate connection with age-old questions regarding why God would permit sin. Indeed, focus on why an all-loving and good God would permit hell is the best lens through which to explain sin. -/- Many arguments against the possibility of hell require affirming that God permits sin because (...) God could not achieve goods for us without allowing sin. The author argues that we have independent philosophical reasons to reject that sin is necessary for us in any way, and, further, we have similar reasons to hold that hell is necessarily possible if the God of classical theism exists. In the end, understanding why an all-loving and good God would permit hell reveals that there is always hope for us, even when things appear most hopeless. -/- The book will appeal to those working in metaphysics, theology, philosophy of religion, and medieval philosophy. (shrink)