Some people will confront Alzheimer's with a measure of resignation, a determination to struggle against the progressive debilitation and to extract whatever comforts and benefits they can from their remaining existence. They are entitled to pursue that resolute path. For other people, like myself, protracted maintenance during progressive cognitive dysfunction and helplessness is an intolerably degrading prospect. The critical question for those of us seeking to avoid protracted dementia is how best to accomplish that objective.One strategy is to engineer one's (...) own death while still mentally competent to do so (even in the stage of mild dementia). If I were to use a preemptive strategy in the face of a dementia diagnosis, I would probably choose to stop eating and drinking, a process known as voluntarily stopping eating and drinking. An alternative tactic for avoiding prolonged dementia would be to allow oneself to decline into moderate dementia—thus losing capacity to perform self‐deliverance or even to make serious medical decisions—but before getting to that point to provide advance instructions rejecting prospective life‐sustaining medical interventions. These advance instructions would authorize palliative but not curative measures. My current personal instructions define the point of intolerable cognitive decline triggering medical nonintervention as “mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.” These instructions dictate allowing my demise at a point of moderate dementia when I may not be perceptibly suffering, when I may still be getting some rudimentary satisfaction from my debilitated life, and when I no longer recall the preoccupation with personally intolerable indignity that motivated my instructions. Can I expect that my advance instructions will be implemented in those circumstances? Is it lawful, and is it moral for a surrogate decision‐maker and associated caregivers to allow an uncomprehending, ostensibly content but demented individual to die? My analysis herein contends that it is not only lawful and moral but also legally required to implement clear, considered advance instructions even at a stage of moderate dementia. (shrink)

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

The collapse of Communism in the regimes in Eastern Europe and the former Soviet Union has brought forth a plethora of alternative political and economic models for the reorganization of those societies. The vacuum that has been left could be regarded as an ideal laboratory for the testing of competing theories, and the temptations to experiment with the more benign forms of constructivist rationalism are likely to prove irresistible. If liberal capitalism is to be successfully created, it will clearly not (...) have the same biography as it has had in the Western European and Anglo-American countries, where its emergence was the result of slow evolution: often its appearance and survival were due to a quite fortuitous combination of circumstances. In those countries it was not the result of any deliberate democratic choice but the outcome of a happy confluence of traditional rules and customary practices, and the participants in them had little idea of the form of the system that they were creating. Indeed, ideological sanctification was almost an afterthought, and democratic approval was belated and in most cases not enthusiastic. Britain was a liberal capitalist society, and possessed the necessary body of private law, some time before the franchise was significantly democratized . It is, of course, recent theoretical and empirical research which has revealed that the political choice mechanisms that developed haphazardly after the success of the market are a potential threat to it. (shrink)

Index to the Dhammasangani. Compiled by Tetsuya Tabata, Satoshi Nonome and Shoko Bando. Pali Text Society, London 1987. vii, 128 pp. £8.75.

Over-enthusiastic newborn screening has often caused substantial harm and has been imposed on the public without adequate information on benefits and risks and without parental consent. This problem will become worse when genomic screening is implemented. For the past 40 years, there has been broad agreement about the criteria for ethically responsible screening, but the criteria have been systematically ignored by policy makers and practitioners. Claims of high benefit and low risk are common, but they require precise definition and documentation, (...) which has often not occurred, undermining claims that involuntary testing is justified. Even when the benefits and risks are well established, it does not automatically follow that involuntary testing is justified, a position supported by the widespread tolerance for parental refusal of immunizations and newborn screening. (shrink)

In his book on Liberalism against Populism , William Riker argued that Lincoln's success in the 1860 election was the culmination of a long progression of strategic attempts by the Whig coalition of commercial interests to defeat the `Jeffersonian-Jacksonian' Democratic coalition of agrarian populism. Riker adduced Lincoln's success to his `heresthetic' maneuver to force his competitor, Douglas, in the 1858 Illinois Senate race, to appear anti-slavery, thus splitting the Democratic Party in 1860. Riker also suggested that electoral preferences in 1860 (...) exhibited an underlying `chaotic' preference cycle. However, these accounts do not explain why the slavery question became paramount in 1858-60. I suggest here that US politics, from 1800 to 1858, can be interpreted in terms of a single land-capital axis that sustained the pre-eminence of an agrarian coalition, first created by Jefferson, of both slave interests and free labor. Lincoln's strategy in 1858-60 was to persuade free labor in the northern and western states that they were threatened by the consequences of the Dred Scott decision by the Supreme Court in 1857. Lincoln argued that although the decision applied to the territories, it was indicative of the intention of the South to extend slavery to the free states. Lincoln's speeches in 1858-60 made this threat credible to the North, and initiated a belief cascade among the electorate. For southern voters, the North consequently appeared to be a `tyrannical' majority, whose creation violated the constitutional logic of Union, and legitimated secession. I argue that this second `civil rights dimension, created in the election of 1860, is necessary for understanding critical elections that have occurred at irregular intervals in US political history. Key Words: constitutional transformation • belief cascade • contingency. (shrink)

A study of the tradition of ethical socialism, its successes, its failures, and its relevance to contemporary Britain. It focuses on a group of writers who, although separated by time, all promoted this brand of socialism. It chronicles their thoughts and theories, and examines their intentions.

We describe a patient LS, profoundly deaf in both ears from birth, with underdeveloped superior temporal gyri. Without hearing aids, LS displays no ability to detect sounds below a fixed threshold of 60 dBs, which classifies him as clinically deaf. Under these no-hearing-aid conditions, when presented with a forced-choice paradigm in which he is asked to consciously respond, he is unable to make above-chance judgments about the presence or location of sounds. However, he is able to make above-chance judgments about (...) the content of sounds presented to him under forced-choice conditions. We demonstrated that LS has faint sensations from auditory stimuli, but questionable awareness of auditory content. LS thus has a form of type-2 deaf hearing with respect to auditory content. As in the case of a subject with acquired deafness and deaf hearing reported on a previous occasion, LS’s condition of deaf hearing is akin in some respects to type-2 blindsight. As for the case of type 2 blindsight the case indicates that a form of conscious hearing can arise in the absence of a fully developed auditory cortex. (shrink)

First published in 1987. Towards the end of the twentieth century there was a resurgence of thinking about politics, economics and society referred to variously as the 'New Right', the radical right, neo-conservatism, economic liberalism or libertarianism. Although the New Right is not a single coherent movement it represented a clear alternative to the prevailing social-democratic consensus and had had considerable influence on government policy in both America and Britain. This book presents an introductory survey of the New Right worldwide. (...) It examines the varieties of free-market and 'monetarist' economic thought and introduces the reader to the public-choice critique of public policy. In political philosophy the book analyses American and British conservative thought and compares conservatism with neo-liberalism. The author pays particular attention to the New Right's analysis of constitutionalism and its critique of the dominance of 'politics' over 'economics' during the high-point of the consensus period. The author assesses the success which the different schools of the New Right have had in influencing public opinion and in the formation of government policy. He does not argue for or against the New Right but presents a dispassionate survey from which the reader can draw his or her own conclusions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:CONRAD'S REPLY TO KIERKEGAARD by Jerry S. Clegg Varied answers to a fixed question have often guided interpretations of Conrad's novella, Heart ofDarkness. Who, that question has been, was Conrad's model for the enigmatic colonial official he calls Kurtz? Hannah Arendt has speculated that it was Carl Peters, an early explorer of east Africa.1 Norman Sherry has picked Arthur Hodister, a Belgian officer, as his candidate.2 Ian Watt (...) has likewise suggested historical figures: Henry M. Stanley and King Leopold of Belgium.3 Since all these men had a reputation for cruelty, those thinking that Conrad had them in mind when describing Kurtz have stressed the political message of his story; for them it is basically an indictment of colonialism. Stephen Reid has argued for a mythic model. Kurtz, he holds, was meant to be seen as one of the man-gods of Frazer's Golden Bough—a primitive king who is obliged to maintain his political position by engaging in certain bestial rites.4 Kenneth Bruffee has recendy cast Kurtz as Conrad's version of Byron's Childe Harold, arguing that the eventualjudgment on him by the character Marlow represents the effort of a squire-narrator to free himself from the pernicious influence of his knight-hero.5 For Bruffee Heart of Darkness is the prototype of a genre oftwentieth-century literature thatrejects the values ofaristocratic romance in favor of democratic norms. There may be truth in all these associations of Kurtz with known colonizers, mythical kings, and fictional knights, but they share a pair of deficiencies. They do not clarify the argument of Heart ofDarkness and so do not dojustice to its copious philosophical content. They also 280 Jerrys. Clegg281 fail to note those features ofKurtz that identify his model most precisely. The prototype of Conrad's famous character is biblical. He is a modern version of Abraham, and the work most intimately related to Heart of Darkness is Kierkegaard's panegyric on Abraham: Fear and Trembling. Conrad's story is, in fact, an addendum to Fear and Trembling written from the point of view of a poet-narrator—Marlow—who has accepted some, but not all, of the tenets of Kierkegaard's own poet-narrator, Johannes de Silentio. It is Marlow's quarrel with de Silentio that explains the structure of Heart ofDarkness, that constitutes its deepest message, and that tells the reader who the model for Kurtz was. An appreciation of that quarrel also helps clarify other matters. It makes plain, for example, the symbolism of light and dark that Conrad uses as an accompaniment to his argument.6 Heart of Darkness is, unarguably, a meditation on several subjects. It is about the Belgian Congo under the administration of King Leopold. It is also about European colonialism in general. It may be about other matters as well. Its primary subject, however, is the relationship of the religious to the ethical and the aesthetic. Since for Conrad the ethical and the aesthetic were allied, this subject may be best cast as the relationship ofreligion to art. It is introduced at the very start ofthe novella. Conrad's primary narrator there offers a theme for his seafaring friend, Marlow, to meditate on aloud: the great English knights-errant of the sea who, like "jewels flashing in the night of time," have born the torch of civilization into the mystery of an unknown earth.7 As this theme is announced, what was a mournful gloom that had hung over London becomes a lurid glare under the stars, and Marlow begins to talk of these, and still other, kinds of light and their relationship to the dark. The primary narrator has already identified what the dark stands for: time. Marlow does not challenge that equation. He only asks who, and with the aid of what kind of light, effectively combats "the night of time." During his meditation he considers four answers to his question, three of which are of primary importance. Certain "redeeming facts," illustrated by the restraint shown by hungry cannibals, quietly dazzle with reassurance, and so what mightbe called the person ofethical conduct— when stripped bare of pretense and the opaque "cloak of time... (shrink)

Such a serious historical journey into the country of ideas as is demanded by the present topic should give one initial pause for salutary reflection. That this should be the case is due in no small way to the fact that one must be prepared, equivalently, to pay court, woo and win not one—task enough in itself—but two ladies–in–waiting. They are no less than Clio, the Muse of History and the fair Lady Philosophy. In the spirit of monogamy, one may (...) well wish to speak of Cliophil, the Muse of the History of Philosophy. (shrink)

The phenomenon of synesthesia has undergone an invigoration of research interest and empirical progress over the past decade. Studies investigating the cognitive mechanisms underlying synesthesia have yielded insight into neural processes behind such cognitive operations as attention, memory, spatial phenomenology and inter-modal processes. However, the structural and functional mechanisms underlying synesthesia still remain contentious and hypothetical. The first section of the present paper reviews recent research on grapheme-color synesthesia, one of the most common forms of synesthesia, and addresses the ongoing (...) debate concerning the role of selective attention in eliciting synesthetic experience. Drawing on conclusions of the first half, the paper’s second half examines the various models proposed to explain the cognitive mechanisms behind grapheme-color synesthesia, and discusses the explanatory virtues of a new model suggesting that grapheme-color synesthesia is grounded in memory. The last section offers an examination of some of the broader philosophical implications of synesthesia. (shrink)

The Ethics Working Group of Clinton's Health Care Task Force developed a list of principles and values that should govern health care reform. These principles and values are compatible with central moral and political traditions, as well as with more rigorous theoretical accounts of justice and health care, but they are "freestanding" points of agreement, not presupposing any particular theoretical background. Though imprecise and not ranked by priorities, the principles guide thinking about the fairness of alternative reform proposals. Their use (...) is illustrated by comparing alternatives on universality of access, phase-in period, the creation of unequal tiers, and the provision for wise allocation and rationing. Keywords: principles, health care reform, rationing, universal access CiteULike Connotea Del.icio.us What's this? (shrink)

Response to Gopal Sreenivasan, “Health Care and Equality of Opportunity".

Joel Feinberg, Harm to Self Oxford: Oxford University Press, 1986, xxiii + 412 pp.

Critically examines the theories of some of the major moral philosophers of the past, and moves toward some concluding suggestions about the content of an acceptable ethical theory.

A recurring problem in psychiatry is the meaningfulness, or otherwise, of its domain. Critics of psychiatry accuse the discipline of misconstruing mental phenomena and behavior, including the verbal sort, as meaningless symptoms, in keeping with other medical specialisms. A myoclonic jerk is taken by the neurologist to mean nothing beyond signaling pathology of the nervous system. But this approach, critics argue, strips psychiatric phenomena of their meaning. Accordingly, Louis Sass has described a tendency, "particularly among organic psychiatrists… to ignore the (...) psychological interpretation or empathic understanding of mental symptoms". Neuropsychiatric symptoms such as visual hallucinations... (shrink)