Obtaining a valid informed consent from an elderly person, especially when frail or with possible dementia, will initially involve the practical problem of assessing the ability to communicate. Only then can the assessment of decisionmaking capacities and the obtaining of informed consent for participation in research be progressed. Normal ageing does not impair communication or decision-making, but pathological status does, this may, or may not, be associated with the ageing process. Perceptual impairment may, in particular, interfere with the communication. Once (...) the subject appreciates and understands that he/she has the right to make a choice then it is important to ensure that he/she fully understands the decision he/she is being asked to make and can communicate and explain in his/her own words why a particular decision was made. In this paper suggestions, based upon existing guidelines or texts, will be made as to how to improve communication with the elderly and the capabilities that the subject must demonstrate to show his capacity to make a decision will be discussed. (shrink)

Consideration of a paradox originally discovered by John Buridan provides a springboard for a general solution to paradoxes within the Liar family. The solution rests on a philosophical defence of truth-value-gaps and is consistent (non-dialetheist), avoids ‘revenge’ problems, imports no ad hoc assumptions, is not applicable to only a proper subset of the semantic paradoxes and implies no restriction of the expressive capacities of language.

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about (...) the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

Two kinds of sources are available to the historian to reconstruct the first centuries of the history of Mithradates' antidote: biographical information on Mithradates' interests in medicine, and a series of recipes. In this paper I argue that we cannot reconstruct the original recipe of Mithridatium from our existing sources. Instead, I examine how the Romans remodelled the history of the King's death and used the royal name to create a "Roman" drug. This drug enjoyed a huge popularity in the (...) first centuries of the Roman Empire. An Emperor, Marcus Aurelius, consumed it as well as members of the upper class; and many highly literate physicians recommended it notwithstanding the medical sect they were belonging to. With all its expensive ingredients, and its claim to work as a panacea, Mithridatium responded to a real demand in a Roman Empire at its commercial and political apogee. (shrink)

Volume 20, Issue 3, March 2020, Page 65-68.

The concept of medicine as a profession in the English-language literature of medical ethics is of recent vintage, invented by the Scottish physician and medical ethicist, John Gregory (1724-1773). Gregory wrote the first secular, philosophical, clinical, and feminine medical ethics and bioethics in the English language and did so on the basis of Hume's principle of sympathy. This paper provides a brief account of Gregory's invention and the role that Humean sympathy plays in that invention, with reference to key texts (...) in Gregory's work. The paper also considers two interesting and perhaps provocative ways in which Hume can be read through Gregory: first, sympathy as a principle of scientific discovery in Hume's science of man and moral physiology; and sympathy as gendered feminine in Hume's moral philosophy. Hume's principle of sympathy is at the core of Gregory's medical ethics and the histories of Western medical ethics and bioethics pivot on Gregory - and, therefore, on Hume - as it does on few other figures. (shrink)

outrageous remarks about contradictions. Perhaps the most striking remark he makes is that they are not false. This claim first appears in his early notebooks (Wittgenstein 1960, p.108). In the Tractatus, Wittgenstein argued that contradictions (like tautologies) are not statements (Sätze) and hence are not false (or true). This is a consequence of his theory that genuine statements are pictures.

The reception of child immunization in Iran today can be explained by the conjunction of several factors. Firstly, the Pasteur Institute of Teheran (established in 1921) initiated the vaccine transfer, while the successive public health policies developed and systematised it. Since the Islamic Revolution, the application of the Expanded Program of Immunization has allowed the Islamic Republic of Iran to reach the fourth world-wide rank for immunisation of child populations. The socio-cultural appropriation of the technique can also be explained by (...) its integration into the popular preventive practices (such as magic and religious rituals) as well as a specific treatment of the collective/individual question. This paper describes some results of a qualitative anthropological research conducted in Teheran and the rural district of Hassanâbâd (near Isfahân) between 1991 and 1992. (shrink)

Some problems that arise in the account given by Thomasma and Pellegrino [6] of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. As a consequence, the (...) project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety. (shrink)

Too many patients are injured in the course of medical care. This truth is as distressing now as it was four years ago when it began an article in this journal’s last similar symposium. Many or most injuries seem preventable. Yet today’s systems of care and of oversight of care too often fail to prevent them, despite generations of increasing legal intervention. Few injuries are litigated, even fewer addressed through medical peer review or state disciplinary authorities. The Institute of Medicine’s (...) landmark report To Err Is Human brought patient safety to national attention when released in late 1999. Half a decade later, significant reduction of injury remains a distant prospect, despite some apparent progress. (shrink)

Connaissons-nous l'enfant? Au sortir du " siècle de l'enfant ", la différence de l'enfance ne cesse de nous interroger. Si l'exigence de penser l'enfance à nouveau est aujourd'hui partagée, les voies de cette entreprise, et plus précisément les problématiques au sein desquelles elle s'impose, sont diverses et mouvantes, à l'image du monde dont héritent ceux que Hannah Arendt appelait " les nouveaux-venus ". Emergent toutefois du foisonnement des pensées de l'enfance quelques paradigmes que l'ouvrage se propose de rendre visibles. Le (...) paradigme démocratique inscrit la question de l'enfance dans la dynamique égalitaire des sociétés démocratiques, et dans l'inéluctable effacement de la différence enfant/adulte auquel les conduit leur " passion de l'égalité ". Le développement de la " philosophie pour enfants " relève-t-il de cette passion de l'égalité? La figure de " l'enfant philosophe " participe-t-elle de cet effacement? Assurément son émergence au cours des vingt dernières années constitue l'un des faits marquants d'une histoire commune à l'enfance et à la philosophie. Que dire alors de la figure de l'enfant artiste, de l'enfance saisie dans sa proximité avec l'artiste? Elle participe d'une tentative de penser l'enfance autrement, d'une pensée esthétique de l'enfance alliant l'héritage schillérien des Lettres sur l'éducation esthétique de l'humanité aux tentations d'une pensée poétique de l'enfance. Que devient alors, dans cette pensée de l'enfance bousculée, cette autre figure qui ne cesse d'accompagner l'enfance, du moins depuis qu'on la pense comme éducable, la figure du pédagogue? Voilà peut-être l'un des points de résistance aux bouleversements postmodernes : l'impossibilité d'une connaissance de l'enfance qui n'en passe pas par l'éducation de l'enfance. Le point de vue paradigmatique n'épuise toutefois pas la question. Par-delà les paradigmes qui tentent de la saisir, quelque chose de l'enfance ne cesse de se dérober. (shrink)

De nouvelles théories, pragmatistes en particulier, de l’action collective et de l’expérimentation sociale insistent sur le rôle joué par les résistances locales dans les processus d’innovation politique. Toutefois, cette insistance ne se traduit pas nécessairement, dans les réformes de la démocratie, par une réflexion approfondie sur la manière de faire évoluer en conséquence les mécanismes d’apprentissage institutionnel. Or une telle évolution est une condition pour que le rôle joué par les résistances locales puisse dépasser le stade d’alibi ou de faire-valoir (...) de manière à transformer leur propre rapport au pouvoir et à déstabiliser les contre-résistances institutionnelles au changement. (shrink)

The compilers of the Hippocratic gynaecological treatises often recommend sexual intercourse as part of treatments for women’s diseases. In addition, they often prescribe the use of ingredients that are obvious phallic symbols. This paper argues that the use of sexual therapy in the Hippocratic gynaecological treatises was more extended than previously considered. The Hippocratic sexual therapies involve a series of vegetable ingredients that were sexually connoted in antiquity, but have since lost their sexual connotations. In order to understand the sexual (...) signification of products such as myrtle and barley, one must turn to other ancient texts, and most particularly to Attic comedies. These comedies serve here as a semiotic guide in decoding the Hippocratic gynaecological recipes. However, the sexual connotations attached to animal and vegetable ingredients in these two genres have deeper cultural and religious roots; both genres exploited the cultural material at their disposal. (shrink)

La présente contribution propose une étude de la périphérie gauche au sein d’un corpus oral multigenres, représentant douze activités de communication orale, annoté syntaxiquement et prosodiquement. La segmentation discursive du corpus en unités de base du discours (BDU) résulte d’une coïncidence entre unités syntaxiques et prosodiques, correspondant à des encodages linguistiques distincts mais complémentaires. Partant du postulat selon lequel ces unités discursives remplissent une fonction cognitive dans la planification et l’interprétation du discours, nous nous intéressons à l’étude de leur périphérie (...) gauche. Ce lieu, qui constitue le point d’ancrage du message, joue en effet un rôle important dans la négociation de la structure discursive. Dans l’objectif d’étudier les stratégies discursives à l’œuvre dans les différents genres du corpus, nous faisons l’inventaire des types formels observés et étudions finalement les fonctions discursives que ces éléments périphériques peuvent revêtir. (shrink)

Ethical egoism and Kantian ethics constitute radically different and incompatible moral traditions. Speaking rather broadly, one might go so far as to say that each tradition is a source of inspiration for criticisms of the other, each tradition reminding us of the limitations of the other. For Kantian ethics, with its extreme other-regarding and abstract approach to morality, would sometimes seem to lose sight of the self, leaving a self that seems somewhat eviscerated. Ethical egosim, by contrast, with its extreme (...) self-centered conception, would seem to lose sight of the importance of others, positing a self that can only give instrumental value to others. Though both traditions have been criticized, these criticisms have travelled independently of one another—no line of argument being at once a criticism of both. Perhaps no such argument is to be had. However, when two traditions trade off of one another this suggests an underlying text or theme. That theme, I suggest, is about the metaphysics of the moral self—that is, the way in which the self is morally constituted. I want to offer an account of the way in which the self is morally constituted which is at once a criticism of both ethical egoism and Kantian ethics. (shrink)

In this commentary on Carse and Rushton’s call for reorientation of moral distress, we state agreement with the authors that the discourse of moral distress should refocus on the moral components of integrity. We then explain how our philosophical taxonomy of moral distress, mentioned by the authors, appeals to moral integrity. In this process, we clarify our taxonomy’s appeal to Aristotle’s concept of akrasia. We conclude by offering support of Carse and Rushton’s challenge to organizations to strengthen moral integrity by (...) fostering resilience. (shrink)

Since Paul and Zipf, it has become evident that lexical choice and meaning change are largely guided by pragmatic principles. Two central interacting principles are, first, the least-effort tendency to reduce expression and, second, the communicative requirements on sufficiency of information. Descendants of this opposition include Grice’s bipartite Maxim of Quantity grounded within a general theory of rationality and cooperation, the Q and R Principles, and the interplay of effort and effect within Relevance Theory. This chapter motivates a constraint on (...) lexicalization, surveys the role of the R principle in motivating the Division of Pragmatic Labour, syntagmatic reduction, narrowing of meaning, euphemism, and negative strengthening, and provides pragmatic motivation for the lexical clone, un-noun, and un-verb constructions, and for the complementary Avoid Synonymy and Avoid Homonymy principles. (shrink)

Although there are many variations on the theme, so much is made of the good of moral autonomy that it is difficult not to suppose that there is everything to be said for being morally autonomous and nothing at all to be said for being morally nonautonomous. However, this view of moral autonomy cannot be made to square with the well-received fact that most people are morally nonautonomous — not, at any rate, unless one is prepared to maintain that most (...) people are irrational in this respect. I am not. Thus, I reject what I take to be the prevailing view of moral autonomy. I argue that it is false that (1) moral autonomy is such that it is rational for every person to prefer being morally autonomous to being morally nonautonomous, but true that (2) moral autonomy is such that if anyone is morally autonomous, then it is rational for him to prefer being morally autonomous to being morally nonautonomous. (shrink)

While I agree with Punzo's central thesis that virtue ethics is superior to Kantian ethics, the aims of my comments are twofold. On the one hand, I draw attention to some ways in which Punzo overstates the case against Kantian ethics, noting that unattainable ideals as such are no mark against a moral theory. On the other, I build upon Punzo's insights in order to bring into sharper focus the superiority of virtue ethics. Accordingly, I distinguish between inter-species (Kantian ethics) (...) and intra-species (virtue ethics) morality, maintaining that the former, unlike the latter, invariably proves too wide of the mark. (shrink)

Nietzsche’s challenge to philosophy has two main prongs. The first is the challenge intrinsic to philosophy, the theoretical challenge to discover the truth; in Nietzsche this ultimately became the challenge to understand the perhaps deadly truth that to be is to be will to power and nothing besides—what Strauss called the “fundamental fact.” The second is the chief derivative challenge of philosophy proper, the practical challenge compelling philosophy to translate truth or an approximation of truth into a culturally livable form—what (...) Strauss recognized in Nietzsche as the challenge for philosophy to rule religion. The two parts of my paper deal with these two challenges. Besides his theoretical and practical challenges, Nietzsche makes a subsidiary, tactical challenge especially relevant to Strauss, a challenge regarding truth-telling or esotericism, namely, telling the truth about philosophy. I will deal with that challenge as an interlude. (shrink)