Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...) these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment. (shrink)

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics (...) consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside. (shrink)

In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that (...) impulsivity can serve to undermine an agent’s autonomy. I then explain that we are already able to reduce impulsivity through the use of pharmacological interventions, as is evidenced by the use of Methylphenidate in the treatment of ADHD. (shrink)

_Beyond Solidarity_ is an impassioned argument for a sharable morality in a world increasingly fractured along lines of difference. Giles Gunn asks how human solidarity can be reconceived when its expressions have become increasingly exceptionalist and outmoded, and when the pressures of globalization divide as much as they unify. He finds the terms for answering these questions in a more inclusive, cosmopolitan pragmatism—one willing to explore fundamental values without recourse to absolutist arguments. Drawing on the work of William and (...) Henry James, John Dewey, Primo Levi, Richard Rorty, and many others, as well as postcolonial writing, Jewish literature of the Holocaust, and the cultural and religious experience of African Americans in slavery, Gunn points pragmatism in a transnational direction and shows how it can better account for the consequences of diversity. _Beyond Solidarity_, then, is a study of the difference that difference makes in a globalized world. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

The ideas of mindfulness and no-self are intimately connected in Buddhist philosophy. This is because, in Buddhist Philosophy, the practice of mindfulness leads to the realization that there is no self. In contemporary mindfulness in psychology, the no-self theory has not played such a basic role. An outline of Buddhist philosophy is given showing how the ‘root delusion’ of having a self lies at the base of human suffering and how mindfulness, when appropriately deployed, enables one to free oneself from (...) this delusion and thus achieve psychological well-being. This is not to say that mindfulness based interventions do not help to alleviate suffering. Nor is it to say that people working in these areas should not use mindfulness in their own way. It is only to say that by ignoring the no-self experience, teachers and practioners are falling short of achieving what mindfulness was originally employed to achieve. (shrink)

“Bioconservatives” in the human enhancement debate endorse the conservative claim that we should reject the use of biotechnologies that enhance natural human capacities. However, they often ground their objections to enhancement with contestable claims about human nature that are also in tension with other common tenets of conservatism. We argue that bioconservatives could raise a more plausible objection to enhancement by invoking a strain of conservative thought developed by G.A. Cohen. Although Cohen’s conservatism is not sufficient to fully revive the (...) bioconservative objection, we argue that it can be supplemented by an account of reasonable partiality for humanity in a way that provides further support to the bioconservative position in a manner congruous with broader conservatism. We propose that the idea of partiality to humanity can buttress the bioconservative objection into its strongest possible form. However, we conclude by arguing that, even in this form, the objection cannot do all the work that bioconservatives expect of it. (shrink)

Body as Sanctuary for Soul reminds us about "that primordial seed of memory" planted within, which once retrieved and nurtured becomes the inner intelligence of the soul. As Plato affirmed, we all move through "the river of forgetfulness" upon being born, and for some it can take a lifetime to retrieve what we have forgotten. Roberta Pughe teaches an embodied methodology to move this process along more quickly; to help call the soul home to live integrated within the container of (...) the body. There is a specific skill set required to understand conceptually exactly what is going on and to learn how to nurture this in daily life. Pughe draws from gestalt theory, shamanism, Platonic philosophy, and elemental breath work in a practical and easily accessible manner. Her audio tracks complement the text, providing a daily opportunity for experiential spiritual practice. Once you have applied the book's information, you begin to experience your soul's intelligence informing the daily activities of your life. Each enlightened soul seeks embodiment - simultaneously traversing both earth and sky realms - so that it can unveil its mythical knowledge in practical ways to create a life of greater purpose and fulfillment of destiny. (shrink)

Background: There is a lack of empirical data on lay attitudes toward different sorts of deception in medicine. However, lay attitudes toward deception should be taken into account when we consider whether deception is ever permissible in a medical context. The objective of this study was to examine lay attitudes of U.S. citizens toward different sorts of deception across different medical contexts. Methods: A one-time online survey was administered to U.S. users of the Amazon “Mechanical Turk” website. Participants were asked (...) to answer questions regarding a series of vignettes depicting different sorts of deception in medical care, as well as a question regarding their general attitudes toward truth-telling. Results: Of the 200 respondents, the majority found the use of placebos in different contexts to be acceptable following partial disclosure but found it to be unacceptable if it involved outright lying. Also, 55.5% of respondents supported the use of sham surgery in clinical research, although 55% claimed that it would be unacceptable to deceive patients in this research, even if this would improve the quality of the data from the study. Respondents supported fully informing patients about distressing medical information in different contexts, especially when the patient is suffering from a chronic condition. In addition, 42.5% of respondents believed that it is worse to deceive someone by providing the person with false information than it is to do so by giving the person true information that is likely to lead them to form a false belief, without telling them other important information that shows it to be false. However, 41.5% believed that the two methods of deception were morally equivalent. Conclusions: Respondents believed that some forms of deception were acceptable in some circumstances. While the majority of our respondents opposed outright lying in medical contexts, they were prepared to support partial disclosure and the use of placebos when it is in the patient's interests or when it is what the person would want. These results support the position that physicians should be allowed a greater degree of authority to make a professional judgment about whether deception might be morally warranted by the circumstances, provided that it doesn't involve outright lying. (shrink)

In his discussion of in vitrogametogenesis, Rob Sparrow claims that an ethical barrier to development of this technology is that many jurisdictions currently prohibit the practice of creating embryos solely for the purpose of research. However, he suggests that this ethical barrier will soon be eroded, in view of the fact that in vitro gametogenesis could serve as a powerful new technology to overcome infertility. In this commentary, I argue that Sparrow is being overly optimistic in his analysis here. I (...) claim that the debate over so-called compromise positions in the human embryonic stem cell debate suggests that the purpose of the research for which a research embryo is created is unlikely to be considered as having any significant bearing on the moral permissibility of the practice for those who oppose it. Even though in vitro gametogenesis could serve as a powerful new technology to overcome infertility, I argue that opponents of the practice of creating embryos solely for research purposes would still view the creation of research embryos that the development of in vitro gametogenesis would require, as being incompatible with affording the embryo proper moral respect. I conclude by suggesting that Sparrow's analysis of the potential benefits of in vitro gametogenesis provides us with further reasons to scrutinise the unconvincing arguments that are often cited in favour of prohibiting the practice of creating embryos solely for research purposes. (shrink)

The writer responds to the essay “Developing, Administering, and Scoring the Healthcare Ethics Consultant Certification Examination,” by Courtenay R. Bruce et al., in the September‐October 2019 issue of the Hastings Center Report.

Best known for having declared the death of God, Nietzsche was a thinker thoroughly absorbed in the Christian tradition in which he was born and raised. Yet while the atheist Nietzsche is well known, the pious Nietzsche is seldom recognised and rarely understood. Redeeming Nietzsche examines the residual theologian in the most vociferous of atheists. Fraser demonstrates that although Nietzsche rejected God, he remained obsessed with the question of human salvation. Examining his accounts of art, truth, morality and eternity, Nietzsche's (...) thought is revealed to be a series of experiments in redemption. (shrink)

Abstract‘Dogwhistles’ and microtargeted political advertisements are objects of widespread moral and political concern. With a few notable exceptions in the case of dogwhistles (and none in the case of microtargeting) moral criticism of these speech act types generally focuses on problematiccontent—that a dogwhistle is, for instance, racist, or a microtargeted advertisement misleading. I argue that these practices areadditionallymorally wrongful on content-neutral grounds—regardless of their content. My argument proceeds from a deliberative conception of democracy according to which only a vote which (...) follows from anadequate deliberative processconfers democratic legitimacy on its results. I claim that both dogwhistles and microtargeting threaten to prevent adequate democratic deliberation from taking place, and therefore that these practices are anti-democratic and, additionally, morally impermissible. I then discuss potential objections and how my argument relates to existing work. (shrink)

In a recent article, Steinkamp, Gordijn, and ten Have discussed a new way of thinking about the ethics consultant's ethical expertise. After critiquing their model of ethical expertise, along with the notion that discourse can and will enable ethicists to consult without over-reaching, this essay suggests that the debate about ethical expertise is intractable because it constitutes a 'tragic choice'.

First published in 1889. This re-issues the second, revised edition of 1926. Chuang Tzu was to Lao Tzu, the author of Tao Tê Ching, as Hui-neng, the sixth Patriarch of Zen Buddhism, was to Bodhidharma, and in some respects St.Paul to Jesus; he expanded the original teaching into a system and was thus the founder of Tao-ism. Whereas Lao Tzu was a contemporary of Confucius in the sixth century B.C, Chuang Tzu lived over two hundred years later. He was one (...) of the greatest minds produced by China; philosopher, metaphysician, moralist and poet. It is impossible to understand the spiritual depth of the Tao Tê Ching without the aid of Chuang Tzu. (shrink)

Whether ethics is too important to be left to the experts or so important that it must be is an age-old question. The emergence of clinical ethicists raises it again, as a question about professionalism. What role clinical ethicists should play in healthcare decision making – teacher, mediator, or consultant – is a question that has generated considerable debate but no consensus.

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and (...) Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. (shrink)

Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three (...) themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question. (shrink)

We develop and test a trickle-down model of how authentic leadership at the department level flows down the organizational hierarchy to encourage team leader authentic leadership and consequently, promotes team and individual-level supervisor-directed helping behavior. Analyses of multi-level and multi-source data collected from a total of 487 employees comprising 122 teams, 47 departments, and 4 different working areas of a major public sector organization in Taiwan show that team leaders’ authentic leadership mediates the relationship between departmental authentic leadership and individual-level (...) leader–member exchange. We also found that intra-team trust completely mediates the influence of team authentic leadership on both team helping behavior and individual-level supervisor-directed helping behavior. Finally, the results reveal that self-concordance mediates the influence of team authentic leadership on individual-level supervisor helping behavior as well as the influence of individual-level LMX on individual-level supervisor-directed helping behavior. Theoretical and practical implications of these findings are discussed. (shrink)

A growing number of bioethics papers endorse the harm threshold when judging whether to override parental decisions. Among other claims, these papers argue that the harm threshold is easily understood by lay and professional audiences and correctly conforms to societal expectations of parents in regard to their children. English law contains a harm threshold which mediates the use of the best interests test in cases where a child may be removed from her parents. Using Diekema9s seminal paper as an example, (...) this paper explores the proposed workings of the harm threshold. I use examples from the practical use of the harm threshold in English law to argue that the harm threshold is an inadequate answer to the indeterminacy of the best interests test. I detail two criticisms: First, the harm standard has evaluative overtones and judges are loath to employ it where parental behaviour is misguided but they wish to treat parents sympathetically. Thus, by focusing only on ‘substandard’ parenting, harm is problematic where the parental attempts to benefit their child are misguided or wrong, such as in disputes about withdrawal of medical treatment. Second, when harm is used in genuine dilemmas, court judgments offer different answers to similar cases. This level of indeterminacy suggests that, in practice, the operation of the harm threshold would be indistinguishable from best interests. Since indeterminacy appears to be the greatest problem in elucidating what is best, bioethicists should concentrate on discovering the values that inform best interests. (shrink)

1. Prolegomena -- 2. [Without special title] -- 3. Opera theologica.