This study considers freedom of speech and the rules of engagement in the public sphere; good government, civic responsibility, and public education; and the foundations of religion and society, as seen through the eyes of seventeenth-century Dutch philosopher, Spinoza.

Disorders of Consciousness (DoCs) raise difficult and complex questions about the value of life for persons with impaired consciousness, the rights of persons unable to make medical decisions, and our social, medical, and ethical obligations to patients whose personhood has frequently been challenged and neglected. Recent neuroscientific discoveries have led to enhanced understanding of the heterogeneity of these disorders, and focused renewed attention on the medical and ethical problem of misdiagnosis. -/- This book examines the entanglement of epistemic and ethical (...) uncertainty in DoCs and other medical contexts, and how they interact to create both epistemic and ethical risks. Philosopher and bioethicist L. Syd M Johnson pulls together multiple threads in this work: the ontological mysteries of consciousness, medical uncertainty about unconsciousness, ableist bias, withdrawal of treatment in neurointensive care, and the rarely questioned view that consciousness is essential to personhood and moral status. Johnson challenges longstanding bioethical dogmas about DoC patients, and argues for an ethics of uncertainty for contexts where there is a need for decisive action in the presence of unavoidable uncertainty. The ethics of uncertainty refocuses ethical inquiry concerning persons with DoCs, placing less emphasis on their contested personhood, and more on inductive risk and uncertainty, on respect for autonomy, and especially on epistemic justice. With applications to various decisional contexts where uncertainty and ethical risk interact, this ethical approach enables surrogate decision makers facing fraught and risky choices to fulfill their obligations as moral and epistemic agents. (shrink)

The central role played by Darwin's analogy between selection under domestication and that under nature has been adequately appreciated, but I have indicated how important the domesticated organisms also were to other elements of Darwin's theory of evolution-his recognition of “the constant principle of change,” for instance, of the imperfection of adaptation, and of the extent of variation in nature. The further development of his theory and its presentation to the public likewise hinged on frequent reference to domesticates.We have seen (...) that Darwin's reliance on the analogy between domesticated varieties and wild species was a bold and original step, in light of contemporary views on the nature of domesticates. However, as Darwin undoubtedly foresaw, his reliance on the analogy created difficulties as well as solving problems, and these began with his Malthusian codiscoverer of the principle of natural selection, Alfred Russel Wallace. Wallace's paper “On the Tendency of Varieties to Depart Indefinitely from the Original Type,” presented to the Linnean Scoiety along with the first public unveiling of Darwin's theory, states: We see, then, that no inferences as to varieties in a state of nature can be deduced from the observation of those occurring among domestic animals. The two are so much opposed to each other in every circumstance of their existence, that what applies to the one is almost sure not to apply to the other. Domestic animals are abnormal, irregular, artificial; they are subject to varieties which never occur and never can occur in a state of nature.62Much has been made of the similarity of views of Darwin and Wallace, but this quotation surely reveals how utterly different their views were on what to Darwin was an important matter. Several critics of the Origin saw Darwin's reliance on the domesticates as his Achilles heel. As Young has pointed out, Samuel Wilberforce included the following passage in his attack on the Origin: Nor must we pass over unnoticed the transference of the argument from the domesticated to the untamed animals. Assuming that man as the selector can do much in a limited time, Mr. Darwin argues that Nature, a more powerful, a more continuous power, working over vastly extended ranges of time, can do more. But why should Nature, so uniform and persistent in all her operations, tend in this instance to change? Why should she become a selector of varieties?63Another critic, Fleeming Jenkin, found the analogy a weakness in Darwin's theory because of the limited extent of variation in any one direction in domestic animals and plants.64 We have already seen that Darwin had confided a similar view to his notebook thirty years earlier, but changed his mind as a result of his profound study of domesticates. De Beer's reference to “an English country gentleman's knowledge of domestic plants and animals and their breeding”65 fails totally to recognize the originality and depth of Darwin's knowledge of domesticates.Why did Darwin, against the currents of his time, rely so heavily on mankind's experience with domesticated organisms to shape his theory about species in nature? On reason is that only with domesticates was an approach that came close to experimental verification possible. Darwin fully realized the inadequacies of the experiment, as is emphasized by his repeated contrasting of selection under nature and selection by man. Yet the extensive experience and data of plant and animal breeders offered the only reliable base against which Darwin could continually challenge his views. As he wrote in the introduction to Variation, with domestication, “man ... may be said to have been trying an experiment on a gigantic scale.”66 Given Darwin's high opinion of the quantitative work of Malthus and Quetelet (as emphasized by Schweber),67 and his unremitting efforts to secure data by which to test his theories, it was inevitable that he should attach high significance to domesticated varieties. John Tyndall, in his Belfast address of 1874, said: “The strength of the doctrine of Evolution consists, not in experimental demonstration (for the subject is hardly accessible to this mode of proof), but in its general harmony with scientific thought.”68 Darwin would have agreed with the latter thought, but I think he would have challenged the preceding one on the grounds that long experience with domesticated varieties did provide an element of experimental demonstration. It gave him confidence in his theory, and he used his vast knowledge of artificial selection boldly and creatively. (shrink)

Recent work in the ontology of music suggests that we will avoid confusion if we distinguish between two kinds of question that are typically posed in music ontology. Thus, a distinction has been made between fundamental ontology and higher-order ontology. The former addresses questions about the basic metaphysical options from which ontologists choose. For instance, are musical works types, indicated types, classes of particulars, or some other kind of entity? Higher-order ontology addresses the question of what lies ‘at the centre’ (...) of a specific form of music, such as rock or jazz—or perhaps classical music. The argument of this essay is, first, that a close examination of the best efforts in two of these territories shows that they have the effect of pressing the music in each sphere into implausible Procrustean beds. Second, it is argued that the general question that higher-order ontologies pose, that is, ‘What work-kind is it that lies at the centre of a given kind of music, F?’ is a question based on a mistaken but seductive assumption, namely that the concept of the work of F has actual application. In fact, these concepts—upon which higher-order ontology depends—are mere artefacts of philosophy. The question is also addressed why the assumption is so seductive. Finally, the question finally is posed about what, if anything, is implied from the foregoing about the traditional ontology of classical music. (shrink)

Legal decision-support systems have the potential to improve access to justice, administrative efficiency, and judicial consistency, but broad adoption of such systems is contingent on development of technologies with low knowledge-engineering, validation, and maintenance costs. This paper describes two approaches to an important form of legal decision support—explainable outcome prediction—that obviate both annotation of an entire decision corpus and manual processing of new cases. The first approach, which uses an attention network for prediction and attention weights to highlight salient case (...) text, was shown to be capable of predicting decisions, but attention-weight-based text highlighting did not demonstrably improve human decision speed or accuracy in an evaluation with 61 human subjects. The second approach, termed semi-supervised case annotation for legal explanations, exploits structural and semantic regularities in case corpora to identify textual patterns that have both predictable relationships to case decisions and explanatory value. (shrink)

There is no subject at the interface of law, psychiatry and medical ethics which is more controversial than psychosurgery. The divergent views of the treatment begin with its definition. The World Health Organisation1 and others2 define psychosurgery as the selective surgical removal or destruction of nerve pathways or normal brain tissue with a view to influencing behaviour. However, proponents of psychosurgery demur on the basis that the `modern' treatment is concerned predominantly with emotional illness, without any specific effect upon behaviour. (...) The alternative definition offered is `the surgical treatment of certain psychiatric illnesses by means of localised lesions placed in specific cerebral sites.3It is difficult entirely to accept this definition because, as examined below, scientific psychiatry is not yet in a position to directly treat psychiatric illness solely through surgical intervention. There is no reliable theoretical relationship between particular cerebral sites (which are normal and healthy) and an identifiable psychiatric illness or symptomatology. Given this state of psychiatric understanding, it is misleading to suggest fine distinctions between generalised alteration of behaviour or mood and treatment of an illness. Highly divergent practices and theories (relating to the multiplicity of conditions treated, surgical methods adopted and areas of the brain operated upon) further undermine exaggerated claims that psychosurgery can scientifically `treat' specific illness through precise surgical intervention. Nonetheless, contemporary psychosurgery does not contain quite the same `broadbrush' approach of its ancestors and it can lay some legitimate claim as an effective empirical treatment in narrowly limited circumstances. Major ethical problems still, however, arise and these will be discussed in this article. (shrink)

Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a (...) need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

The research presented in this volume demonstrates that it is no longer reasonable to ask whether or not synesthesia is real--we must now ask how we can account ...

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations warrant (...) research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

This paper is the result of a contribution between ethics and law, which will be used as thought-process tools, to address the complex issue of legal and ethical statuses of GM fish. To find answers, we propose to consider this issue from a wider angle, looking at the relations between the human, animal, and living worlds. We show that it is possible to construct other forms of intellectual logic that, without setting these worlds in opposition, do not lapse into relativism (...) where boundaries are blurred. In this sense, we submit the hypothesis that ordered pluralism should help us to move past a mere Man–Animal relationship to reveal the entire complexity of relationships within mankind and between mankind and other (non-human) worlds alongside it and to which it belongs: the animal and living worlds. With this new logic, “animal ethics” and “animal law” are re-embedded into a set of relationships. This logic emerges from a new consideration: the nature of the contemporary objects we are dealing with. We shall call objects like genetically modified fish “relational objects” in the sense that in order to be apprehended, they utilize a set of relationships of which there are just as many as the dimensions forming them, not as predicates but as primary constituents. Experimentally, in the case of GM fish, we translate this by proposing to typologize legal and ethical considerations induced by multiple relations connected to this object. According to the type of relationship in question, the GM fish will not have the same status; it is a changing object that must be suitably apprehended. (shrink)

It is well-recognized that uncertainty is an endemic feature and limitation of clinical judgment and practice that cannot be eliminated in many cases. Among the tasks of clinical ethics is the responsible management of uncertainties, first articulated in E. Haavi Morreim’s very nice concept of the "moral management of medical uncertainty." The papers in the 2012 Clinical Ethics issue of the Journal provide philosophically innovative and clinically applicable accounts of the varieties of uncertainty in clinical medicine and therefore in clinical (...) ethics: epistemic uncertainty, metaphysical uncertainty, and relational uncertainty. (shrink)

Central concepts and consensus views in clinical ethics are marked by instability. The papers in this number of the Journal take up two such central concepts, quality of life and moral status, and two such consensus views, that germ-line gene transfer should not be undertaken for the purposes of enhancement of human traits and that the ethical obligation of physicians to treat HIV infected patients rests on consent of the physician. One outcome of these philosophical investigations is that these two (...) concepts and consensus views are less stable than one might have thought. I explore the possibility of generalizing this outcome in a reflection on clinical ethics as the management of instability and incompleteness, including the instability and incompleteness of clinical ethics itself. In the course of this reflection I liken clinical ethics to abstract expressionism in mid-twentieth century Western art. (shrink)

Thailand has a rich history of using aesthetics as a means of communication. This is seen not only in the communication of basic ideas, but aesthetics are also used to communicate the cultural values of the nation. Aesthetical images in Thailand have the tendency to dwell both in the realm of the mundane and the supernatural, in the daily and the esoteric. Historically, many faith traditions have used aesthetics as an effective form of communication, including Buddhism, Brahmanism, as well as (...) other local expressions of deities across the country. Art plays a large role in the daily communication of religious values and concepts. -/- While Christianity has a rather long history in Thailand, the large-scale impact that Christianity, and specifically Protestantism, has had is rather minimal. There can be a myriad of reasons for this, but one potential possibility is Christianity’s lack of an aesthetical engagement upon and within Thai culture. This potentially is not an issue of only the Protestant church in Thailand but also stems from some of the western Christian roots throughout its faith tradition. One finds a chasm between aesthetical practices and faith from the Heidelberg Confession, in which Christians became so worried about the ramifications of idol worship, that they threw out the proverbial ‘baby with the bathwater’ and basically condemned the use of icons and other forms of art in western Protestantism. -/- Therefore, this paper will examine the relationship between Thai culture and Christianity, trying to remove the western biases in Christianity and will attempt to suggest new ways that the Thai Christian Church may develop organic, indigenous Thai art, that can be used as a more effective means of communication. If Christianity wants to effectively convey its concepts into Thai culture, it must value aesthetics as a means of communication. Is it possible that Christianity could not only communicate a more effective message in Thailand, but also that Christianity could experience a more robust self-analyzation of its core concepts through Thai aesthetics? Therefore, one needs to explore the ways that Christianity may be able to better understand itself through current Thai aesthetical practices. These concepts will be explored to develop a more robust and organic way of communicating the Christian concepts through a Thai paradigm. (shrink)

I. Singminji sigi p'yŏn -- II. Chŏnhwan'gi ŭi iron oe.

In this essay we discuss a class of apparently metaphorical idioms, exemplified by “fine as frog's hair,” that do not afford any obvious interpretation, and appear to have originated, at least in part, in language play. We review recent trends in both play theory and metaphor theory, and show that a playful approach to language is often an important element in the use and understanding of metaphors (and idioms generally), even when metaphors can be readily interpreted by means of a (...) vehicle-to-topic mapping. Based on this evidence we call for a more deliberate inclusion of language play in metaphor theory and analysis. (shrink)

My comment makes a point out ofRousseau's original insight: that education forsocial participation ought to start within thestudent's lifeworld, and not, as in our days, with the immediatedemands of modern, time-ridden consumerculture. When time is turned into a commodityand place is turned into a transit point forpeople constantly on the move, presence in acommon lifeworld is lost. I take issue with thedominant thinking of education in terms of timeand efficiency, and suggest that we startthinking of education more in terms of (...) placeand presence. I propose that modern thinkers ofeducation – of which I mention a few here –contributed significantly to the pedagogy ofplace or presence. I don't see time as a stringmade up of past-present-future, but rather asan expanding mental and pragmatic universe ofhere-and-nows. The term kairos catchesthis presence as the capacity for doing theright thing at the right moment, that is, themoment when the past has prepared the ground sothat the future can come as a gift. Thisconception is, I think, an important ground forthe idea of an education for citizenship. (shrink)

This paper sketches some developments in the discussion of liberal nationalism since the early 1990s and proposes a generic understanding of nationalism according to which its main feature is the act of sorting people into members and non-members of the nation with a view to regulating access to political goods linked to the state. One discussion of liberal nationalism that has recently received renewed attention is the relation between nationalism and multiculturalism. Liberal nationalism sees nationalism as a response to increased (...) diversity and involves normative demands on nationalism for accommodating this diversity. In light of the proposed generic understanding of nationalism, the question arises whether such a liberal nationalism is coherent. This question requires us to distinguish between a substantive and a performative perspective on nationalism, raising the possibility that liberal nationalism can be substantively coherent but performatively incoherent. (shrink)