While there are urgent health-related demands surrounding dementia, there are sociopolitical dimensions to this issue that ought not to be neglected, concerning the ways in which institutions and individuals treat people living with dementia. Key among these concerns, for dementia self-advocate Christine Bryden, is the dominant narrative of dementia as a process that irreversibly sets those that live with it on a path to the destruction of their personal identities and personhood. In this paper, I bolster Bryden’s arguments against the (...) loss narrative and develop a novel conception of personhood as a first step towards challenging it. (shrink)

Across care settings, the practice of lying to or withholding the truth from people living with dementia is common, yet it is objected to by many. Contrary to this common discomfort, I have argued in previous work that respecting members of this group as moral equals sometimes requires deceiving them. In this paper, I test my proposed practice against complex, controversial cases, demonstrating both its theoretical strength and its practical value for those working in social care.

Carers often interfere with the choices of people living with dementia. On neorepublican and (most) relational egalitarian views, interference can be justified if it tracks a person's interests: if it does not lead to a relationship of domination. However, the kind of environment-shaping interventions carers often pursue would be considered infantilising or objectionably paternalistic in other cases. In this paper, I defend this indirect approach and argue that it offers the best prospects of dementia care without domination.

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person's own home or in an institutional setting, ought always to be a last resort. In this paper, however, I suggest that this common (...) intuition gets things the wrong way around. Adopting a relational egalitarian framework, I argue that the most serious injustices engendered by present‐day dementia care services are contingent on broader societal structures—they can thus be ameliorated relatively easily (if resource intensively) by changing those structures. Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present‐day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart. Though we may be far from achieving just care arrangements in most of our societies, we must never lose sight of the fact that, when we engage in morally permitted informal dementia care, we are exercising our last resort. (shrink)

This article, prompted by an extended essay published in theJournal of Medical Ethicsby Charles Foster, and the current controversy surrounding the case of Vincent Lambert, analyses the legal and ethical arguments in relation to the withdrawal of life-sustaining treatment from patients with prolonged disorders of consciousness. The article analyses the legal framework through the prism of domestic law, case-law of the European Court of Human Rights and the Convention on the Rights of Persons with Disabilities, and examines the challenge to (...) the ethical consensus made by Foster. It concludes that the right approach remains a version of the approach that has prevailed for the last 25 years since the decision inAiredale NHS Trust v Bland[1993] AC 789, refined to reflect that that there is now, and rightly, a much more limited place for judgments made about the ‘burden’ of treatment or the quality of life enjoyed by the person made on the basis of assumptions about that person as a category as opposed to investigation of that person as an individual human being. (shrink)

Many caregivers feel that they need to lie or withhold the truth from people living with dementia, but worry that, in doing so, they are violating a duty to tell the truth. In this article, I argue that withholding the truth from and, in limited circumstances, lying to people living with dementia is not only morally permissible, but morally required by a more general requirement that we treat each other as persons worthy of respect. I do so through an analysis (...) of the groundings of the duty to tell the truth, and a critical reflection on its cognitively ableist construction. (shrink)

By emphasising the role of concepts like social status, power and respect, all relational egalitarians seek to demonstrate that there is more to the political concept of equality than the distribution of goods. While there is a broad consensus on the nature of equality, however, the nature of justice is a matter of internal dispute. The aim of this paper is to disentangle these argumentative threads, building on work in early relational egalitarian scholarship to develop a relational approach to justice, (...) both distinct from the distributive approach to justice and isolated from the relational approach to equality. In doing so, I reveal possible and sometimes surprising alliances between relational egalitarians and other scholars on the nature of justice. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 32-41, January/February 2022.

Matilda Mroz argues that cinema provides an ideal opportunity to engage with ideas of temporal flow and change. Temporality, however, remains an underexplored area of film analysis, which frequently discusses images as though they were still rather than moving. This book traces the operation of duration in cinema, and argues that temporality should be a central concern of film scholarship. In close readings of Michelangelo Antonioni’s L’Avventura, Andrei Tarkovsky’s Mirror, and the ten short films that make up Krzysztof Kielowski’s (...) Decalogue series, Mroz highlights how film analysis must consider both particular moments in cinema which are critically significant, and the way in which such moments interrelate in temporal flux. She explores the concepts of duration and rhythm, resonance and uncertainty, affect, sense and texture, to bring a fresh perspective to film analysis and criticism. Essential reading for students and scholars in Film Studies, this engaging study will also be a valuable resource for critical theorists. (shrink)

Not least among the many enigmas attending the origins and development of the first vernacular lyric in the European Middle Ages is the existence of at least twenty women poets who lived in southern France from about the mid-twelfth to the mid-thirteenth century and who participated in the highly conventionalized poetic system created by the troubadours, those humble poetlovers who sang to their beloved as domna, the superior lady. In periods when the tides of feminism are high these women's voices (...) have insistently claimed our attention, as we try to understand their songs and puzzle over their very existence. Their poetic inventions require us in particular to pay close attention to the subtle, even elusive, concept of voice—its relation to the identity of the poet and the poem's speaker, the elements that characterize its expression, the multiplicity of images created by different voices, and so on. If we are willing to listen and analyze carefully, the trobairitz have much to teach us about the way women poets enter into and find their place in a traditional poetic system created by male poets. Their songs demonstrate with intricate complexity the way poetic fictions play with cultural, literary, and social definitions of man and woman, masculine and feminine; their poems offer valuable warnings about the pitfalls involved in generalizing women into woman. (shrink)

In this article we argue that our present-day mode of looking at bodies expresses a cosmetic gaze, that is, a gaze already informed by the techniques, expectations and strategies of bodily modification and a way of looking at bodies as awaiting an improvement. The cosmetic gaze, as we see it epitomized in contemporary media phenomena like reality makeover shows on television, is also a physiognomic gaze in that it creates a short-circuit between inside and outside beauty. Our article traces some (...) of the history of the present short-circuit between an inside and an outside and analyzes how different visual media have informed and shaped the gaze in historically specific ways, but also how aspects of that history inhere in media practices today. More specifically, we will analyze John Caspar Lavater’s hand-drawn portraits, Francis Galton’s photographical composites, the anthropometrically defined but still intuitively discovered ideals of the ‘Aryan body’ in Nazi Germany, and today’s reality television makeover shows in order to understand some of the continuities and discontinuities of the cosmetic gaze. (shrink)

At the intersection of literature and history, three “antique romances” initiated a new genre in the mid-twelfth century by transposing into French the great stories of Greek and Latin epic: the fratricidal war of Oedipus's sons in the Roman de Thèbes, the founding of Rome in the Eneas, and the Roman de Troie's Trojan War based on Dares and Dictys. Rejecting Homer's version for these “eyewitness” accounts, Benoît de Sainte-Maure translated the full history of the Trojan War from its beginning (...) in the tale of Jason and the Argonauts to the annihilation of Troy and the victors’ unhappy homecomings. The myth of Trojan descent claimed by many European rulers, including the British and Normans, gives Benoît's translation more than entertainment value for his first public, the Plantagenêt court of Henry II and Eleanor of Aquitaine. Indeed, while repeatedly assuring his readers that this great estoire, story and history, will provide pleasurable enjoyment, Benoît also signals a more serious intent by invoking Solomon and the seven liberal arts: we would be like beasts if not for learning from the past that allows us to distinguish between wisdom and folly. The author/narrator's school training is on full display as he highlights the importance of remembering and the dangers of forgetting. Obliged to share his knowledge, Benoît will put into romanz matter that is at once old and new, lost and refound, so that lay readers without access to his Latin sources can “remember” their past as he shapes it in romance. The success of his enterprise can be gauged by the number of extant manuscripts as well as the romance's subsequent influence on multiple versions of Trojan history, from the Histoire ancienne jusqu’à César to Chaucer's Troilus and Criseyde. But can we pinpoint more specifically what and how Benoît's public might remember? (shrink)

Elizabeth Barnes has recently developed an account of disability that is sensitive to the role of self-evaluation. To have a physical disability is, according to Barnes, to have a body that is merely different from the norm. Yet, as Barnes notes, some disabilities will genuinely frustrate some life plans. It may be the case, therefore, that a disability is instrumentally bad for a person and that acquiring one may be a genuine loss. Equally, however, a person may genuinely value a (...) disability such that it is instrumentally good for them and that they experience the acquiring of it as a gain. Notably, Barnes explicitly restricts this analysis to physical disabilities, leaving open the status of mental disabilities. Nevertheless, Barnes does not rule out the extension of her model to this category, and she expresses a desire to see future work on other disabilities built upon it. This article takes up this challenge, making the case that to possess a mental disability is merely to possess a minority mind. (shrink)

Assembling a series of voices from across the field, this book demonstrates how posthuman theory can be employed to better understand and tackle some of the challenges faced by contemporary international law. With the vast environmental devastation being caused by climate change, the increasing use of artificial intelligence by international legal actors, and the need for international law to face up to its colonial past, international law needs to change. But in regulating and preserving a stable global order in which (...) states act as its main subjects, the traditional sources of international law - international legal statutes, customary international law, historical precedents and general principles of law - create a framework that slows down its capacity to act on contemporary challenges, and to imagine futures yet to come. In response, this collection maintains that posthuman theory can be used to better address the challenges faced by contemporary international law. Covering a wide array of contemporary topics - including environmental law, the law of the sea, colonialism, human rights, conflict, and the impact of science and technology - it is the first book to bring new and emerging research on posthuman theory and international law together into one volume. This book's posthuman engagement with central international legal debates, prefaced by the leading scholar in the field of posthuman theory, provides a perfect resource for students and scholars in international law, as well as critical and socio-legal theorists, and others with interests in posthuman thought, technology, colonialism and ecology. (shrink)

The dispute between the transgender-rights movement and “gender-critical” activists represents a stark division in British public discourse. Although the issues of contention are numerous and require their own philosophical treatment, a core metaphysical concern underlies them. Gender-critical activists, such as Kathleen Stock, tend to argue that recognizing trans women as women requires erasing the category of biological sex. This implies that all trans women are male, and thus recognizing them as women rips female biology from the root of the category (...) “woman.” In this article, I argue that this view is mistaken. As exogenously produced sex characteristics should count toward a person's sex classification, all trans women are female. (shrink)

The transition from university to working life appears a critical period impacting human service workers’ long-term health. More research is needed on how psychological factors affect the risk. We aimed to investigate how subgroups, based on self-efficacy, psychological flexibility, and basic psychological needs satisfaction ratings, differed on self-rated health, wellbeing, and intention to leave. A postal survey was sent to 1,077 recently graduated psychologists in Sweden, response rate 57.5%, and final sample 532. A hierarchical cluster analysis resulted in a satisfactory (...) eight-cluster solution. We identified two at-risk subgroups, displaying the lowest scores on health and wellbeing, and one potential low-risk subgroup with the highest ratings on said variables. The “Low risk?” group rated high on all three psychological constructs, a positive transition to working life, a work environment where resources balanced relatively high emotional demands, good health, and wellbeing. Almost the complete opposite ratings characterized the potential risk groups. “Quitting?” scored significantly higher than “Getting sick?” on self-efficacy and psychological flexibility as well as actively seeking new employment and reporting daily thoughts on leaving the profession. We suggest that a combination of low self-efficacy and psychological flexibility could increase the risk of individuals staying despite suboptimal working conditions. With combined higher self-efficacy and psychological flexibility, individuals in similar circumstances appear more inclined to quit. We conclude that the ways recently graduated psychologists rate their self-efficacy, psychological flexibility, and basic needs satisfaction appear to be reflected in their self-rated health and wellbeing. (shrink)

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the interaction between (...) ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient. (shrink)

We provide a complete axiomatization of modal inclusion logic—team-based modal logic extended with inclusion atoms. We review and refine an expressive completeness and normal form theorem for the logic, define a natural deduction proof system, and use the normal form to prove completeness of the axiomatization. Complete axiomatizations are also provided for two other extensions of modal logic with the same expressive power as modal inclusion logic: one augmented with a might operator and the other with a single-world variant of (...) the might operator. (shrink)

This article discusses the key existential stakes of implementing biometrics in human lifeworlds. In this pursuit, we offer a problematization and reinvention of central values often taken for granted within the “ethical turn” of AI development and discourse, such as autonomy, agency, privacy and integrity, as we revisit basic questions about what it means to be human and embodied. Within a framework of existential media studies, we introduce an existential ethics of care—through a conversation between existentialism, virtue ethics, a feminist (...) ethics of care and post-humanist ethics—aiming to deepen and nuance our understanding of the human behind “human-centered” AI directives. The key argument is that biometrics implicates humans through unprecedented forms of objectification, through which the existential body—the relational, intimate and frail human being—is at risk. We interrogate these risks as they become visible at three sites where embodied humans are challenged by biometrics, and thus where the existential body is challenged by the biometric body. This occurs through reductionism (biometric passports nailing bodies to identities, removing human judgment and compromising agency at the AI border), enforced transparency (smart home assistants surveying human intimacies and invading intimate spaces in the bedroom) and the breaching of bodily integrity (chipping bodies to capture sensory data, challenging the very concept of bodily integrity through self-invasive biohacking). Our existential ethics of care is importantly not a solutionist list of principles or suggestions, but a manifesto for a way of thinking about the ethical challenges of living with biometrics in today’s world, by raising the right questions. We argue that a revitalized discussion of the basic existential stakes within human lived experience is needed and should serve as the foundation on which comprehensive frameworks can be built to address the complexities and prospects for ethical machines, responsible biometrics and AI. (shrink)

This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the law—indicates that there is more than one ethically defensible way to proceed. The question posed is whether the courts can be viewed as an appropriate vehicle to settle clinical unease by providing a ruling that clarifies the legal and ethical issues arising in the case, even in situations where there is (...) no dispute between the patient (or her proxies) and the healthcare team. The concept of ‘clinical unease’ is framed with reference to the broader experience of clinical decision-making, and distinguished from other widely discussed phenomena in the healthcare literature like moral distress and conscientious objection. A number of reported cases are briefly examined where the courts were invited to rule in circumstances of apparent ‘unease’. The respective responsibilities of clinicians and courts are discussed: in particular, their capability and readiness to respond to matters of ethical concern. Four imagined clinical scenarios are outlined where a clinical team might welcome a court adjudication, under current rules. Consideration is given to the likelihood of such cases being heard, and to whether there may be better remedies than the courts. There are final reflections on what clinicians may actually wish for in seeking court involvement, and on whether a willingness to engage with the experience of clinical unease may lead to greater sensitivity towards the value perspectives of others. (shrink)

Taken together, Sections 145 and 63 of the Mental Health Act 1983 provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and that it should be applied. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancillary treatment of physical illness, the assistance (...) of a court may be sought. In so doing, the law may justify compulsion but never prescribes it; the clinician is presented with authority that he or she could use but is left to decide whether it should be employed. This paper explores how the clinical question is set before the court, and whether the distinction between symptom, manifestation and consequence is sufficiently understood. This has important consequences in the context of self-neglect and its close cousin self-harm: the question whether the relevant ailment was attributable to or exacerbated by neglect or self- inflicted harm will determine whether compulsion under the MHA is applicable; and furthermore, whether or not compulsion is clinically acceptable. No data are available. Not applicable. (shrink)

In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case (...) to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William’s position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William’s position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

This article takes as its starting point the moral requirement to include persons with serious cognitive impairments in democratic decision‐making. That said, including such persons poses particular practical challenges to effective democratic participation. Nussbaum has set out the most extensive proposals for inclusion based on a model of guardianship, but we find they fall short due to not suitably respecting and facilitating the subjective decision‐making of impaired persons. Instead, we argue for a model of co‐constitution, whereby aides work within a (...) supported decision‐making paradigm to arrive at political choices in collaboration with impaired persons. To flesh out this model, we propose collaboration be based on three ideal types of interaction – expert, Socratic, and deliberative – designed to accommodate differing degrees and types of cognitive impairments. We further argue that the aide should have a relationship of detached professionalism with the impaired person and therefore should not be the person’s carer. Finally, we conclude that this separation be combined with transparent and regular invigilation of the aide’s decision‐making process to best safeguard the process from abuse or error. (shrink)

Global challenge-led research seeks to contribute to solution-generation for complex problems. Multicultural, multidisciplinary, and multisectoral teams must be capable of operating in highly demanding contexts. This brings with it a swathe of ethical conflicts that require quick and effective solutions that respect both international conventions and cultural diversity. The objective of this article is to describe the process of creating a toolkit designed to support global researchers in navigating these ethical challenges. The process of creating the toolkit embodied the model (...) of ethical research practice that it advocates. Specifically, at the heart of ethical decision-making is consideration of the following: Place, solutions must be relevant to the context in which they are to be used; People, those impacted by the outcomes must be partners in co-creation; Principles, ethical projects must be guided by clear values; and Precedent, the existing evidence-base should guide the project and, in turn, the project should extend the evidence-base. It is the thesis underlying the toolkit that consideration of these 4Ps provides a strong basis for understanding ethical conflicts and allows for the generation of potential solutions. This toolkit has been designed in two phases of collaborative work. More than 200 researchers participated from more than 30 countries and more than 60 different disciplines. This allowed us to develop a model for contextual, dynamic analysis of ethical conflicts in global research that is complementary to traditional codes of ethics. It emphasizes the need to consider ethical analysis as an iterative, reflective, process relevant at all stages of the research journey, including, ultimately, in evaluating the legacy of a project. The toolkit is presented as an open access website to promote universal access. A downloadable “pocket guide” version is also now available in 11 languages. (shrink)

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...) the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public. Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (shrink)

The overwhelming weight of legal authority in the USA and Canada holds that consent is not required for brain death testing. The situation in England and Wales is similar but different. While clinicians in England and Wales may have a prima facie duty to obtain consent, lack of consent has not barred testing. In three recent cases where consent for brain death testing was formally presented to the court, lack of consent was not determinative, and in one case the court (...) questioned whether the clinicians were even required to seek consent from the parents of a child at all. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

Nursing has improved over the centuries from the physician's handmaiden to a recognised profession. Yet, the image of a nurse is often associated with notions of caring and nurturing‐ attributes considered feminine. Indeed, cultural, and societal biases exist that can deter men from entering the nursing profession where their sense of masculinity is questioned. Several studies have highlighted the existence of gender‐based stereotypes, stigma, rejection, loneliness and discrimination which impact the retention of men in the nursing profession. Despite the established (...) evidence regarding negative experiences, it appears limited attention has been paid to the men who decide to stay in nursing: how do they thrive in a profession wherein biases are evident within and in the wider societal context? Undoubtedly, several factors such as job security and financial incentives may contribute to men remaining in nursing. Beyond these, we borrow the notion of ‘constructive resistance’ to underscore that though the biases may be apparent, male nurses are able to construct alternatives that accommodate the image of a man in the nursing profession. Strategies such as developing the image as a ‘super nurse’ can create opportunities for male nurses to be preferred by other healthcare providers as well as female nurses. Thus, although resistance may usually appear as a negative phenomenon, constructive resistance represents hidden advantages which offers an opportunity to retain male nurses. These need to be highlighted and explored more as they can offer deeper insight into strategies that can be employed to improve retention and representation of men in nursing particularly at a time when the impact of nursing shortage remains a global issue. (shrink)

The annual Kronos Philosophical Journal was established in Warsaw in 2012. The papers presented in the annual might be of interest to the readers from outside Poland, allowing them to familiarize themselves with the dynamic thought of contemporary Polish authors, as well as entirely new topics, rarely discussed by English speaking authors. Volume V/2016 comprises articles problematizing Russian phlosophy and literature as well as Ancient Greek philosophy and culture.

All contemporary frameworks of mental capacity stipulate that we must begin from the presumption that an adult has capacity. This presumption is crucial, as it manifests respect for autonomy and guards against prejudice and paternalism on the part of the evaluator. Given its ubiquity, we might presume that we all understand the presumption’s meaning and application in the same way. Evidence demonstrates that this is not the case and that this has led to harm in vulnerable persons. There is thus (...) strong reason to question our presumptions about the presumption of capacity. We distinguish between two main ways of understanding and applying the presumption of capacity, and advocate for the one that we argue mitigates risk of harm. Our proposed interpretation offers many advantages in that it is consonant with actual practice of capacity evaluations, precludes confused and abusive avoidance of needed evaluations, and preserves the respect for autonomy motivating the presumption in the first place. (shrink)

In psychological research, ressentiment is alluded to as a negative emotional response directed at social groups that are mostly marked as ‘inferior others’. However, conceptual work on this notion is sorely missing. In our conceptual proposal, we use the notion of ‘moral emotions’ as a starting point: typically referred to as “other-condemning” moral emotions (Haidt), psychologists have loosely conceptualised anger, contempt and disgust as a set of negative emotions that have distinct elicitors and involve affective responses to sanction moral misconduct (...) of ‘others’. Though this conglomerate of different other-condemning emotions might describe emotions of ressentiment, we argue that the phenomenon itself is a more complex sentiment. Therefore, we apply Withy’s concept of ‘disclosive posture’ to account for the different psychological processes underlying ressentiment. Disclosing refers to a specific openness to the world, which in the case of ressentiment implies a specific awareness of and sensibility for instances of inequality, grudge, or disfavour. Ressentiment thus becomes a perceptual tool in morally relevant everyday situations. The term ‘posture’ refers to a habitualised, embodied comportment or action tendency that leads to the adoption of a negative attitude and stance towards others. Drawing on Withy, we discuss ressentiment’s similarities (and differences) to the closely related concept of hatred (Szanto, Vendrell Ferran) to embed the analysis of ressentiment in a broader social framework. (shrink)

Healthcare rationing during pandemics has been widely discussed in global bioethics literature. However, existing scenarios and analyses have focused on high income countries, except for very few disease areas such as HIV treatment where some analyses related to African countries exist. We argue that the lack of scholastic discourse, and by extension, professional and democratic engagement on the subject constitute an unacceptable ethical omission. Not only have African governments failed to develop robust ethical plans for pandemics, ethicists in this region (...) have been unable to ignite public discourse on rationing. Therefore, we aim to initiate a debate on how rationing health and social goods could be done ethically in Ghana during the current and future pandemics. The paper discusses and critiques some moral considerations (utilitarian, equity, equal worth, urgent need, and the prioritarian principles) for rationing and their relevance in the Ghanaian context. This contribution may facilitate ethical decision-making during the current (COVID-19) pandemic - in Ghana and other African settings where hardly any rationing guidelines exist. (shrink)