Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self‐determination—a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical ‘problem frames’ for dependency and to increase our understanding of how dependency can be navigated in (...) practices of long‐term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as ‘dependency work’, a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self‐determination, one of parity and one of self‐worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long‐term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work. (shrink)

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion (...) for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness. (shrink)

Abstract‘Social inclusion’ is the leading ideal in services and care for people with intellectual disabilities in most countries in the Global North. ‘Social inclusion’ can refer simply to full equal rights, but more often it is taken to mean something like ‘community participation’. This narrow version of social inclusion has become so ingrained that it virtually goes unchallenged. The presumption appears to be that there is a clear moral consensus that this narrow understanding of social inclusion is good. However, that (...) moral consensus is not clear in the case of people with profound intellectual and/or multiple disabilities (PIMD), who are not able to express their needs and preferences verbally. Moreover, social inclusion has proven to be difficult to conceptualize and implement for people with PIMD. Therefore, it becomes imperative to ask about the ethical rationale of the narrow understanding of social inclusion. For what reasons do we think social inclusion is good? And do those reasons also apply for people with PIMD? This article addresses these questions by providing an ethical analysis of the ideal of social inclusion for people with PIMD. It discusses four ethical arguments for social inclusion and probes their relevance for people with PIMD. The article argues that none of these arguments fully convince of the value of the narrow understanding of social inclusion for people with PIMD. It ends with advocating for an ethical space for imagining a good life for people with PIMD otherwise. (shrink)

This paper examines the prevalence of the ideal of “independence” in intellectual disability care in the Netherlands. It responds to a number of scholars who have interrogated this ideal through the lens of Michel Foucault’s vocabulary of governmentality. Such analyses hold that the goal of “becoming independent” subjects people with intellectual disabilities to various constraints and limitations that ensure their continued oppression. As a result, these authors contend, the commitment to the ideal of “independence” – the “ethic of autonomy” – (...) actually threatens to become an obstacle to flourishing in the group home. This paper offers an alternative analysis. It does so by drawing on a case study taken from an ethnographic study on group home life in the Netherlands. Briefly put, the disagreement stems from differing conceptualizations of moral life. Put in the vocabulary of moral anthropologist Cheryl Mattingly, the authors propose to approach the group home more from a “first-person” perspective rather than chiefly from a “third-person” perspective. They then draw on Mattingly to cast the group home as a “moral laboratory” in which the ethic of autonomy is not just reproduced but also enacted, and in which the terms of (in)dependence constantly get renegotiated in practice. What emerges is not only a new perspective on the workings of the “ethic of autonomy” in the group home, but also an argument about the possible limitations of the vocabulary of governmentality for analysing care practices. (shrink)

Dependency functions as a keyword in care theory. However, care theorists have spelled out the ontological and moral ramifications of dependency in different and often conflicting ways. In this article, I argue that conceptual disputes about dependency betray a fundamental discordance among authors, rooted in the empirical premises of their arguments. Hence, although authors appear to share a vocabulary of dependency, they are not writing about quite the same phenomenon. I seek to elucidate these differences by teasing out and comparing (...) different conceptions of dependency found in the literature. Borrowing a phrase from Eva Kittay, I trace four “paradigm cases” of dependency: the infant, the physically disabled person, the profoundly intellectually disabled person, and the refugee. These paradigm cases serve as the empirical touchstone from which theorists extract their conceptions of dependency. Each paradigm case, moreover, permits a particular ethical sensibility toward care. How we understand and value dependency thus seems to determine how we understand and value care, and vice versa. In this way, I contend, our normative orientation toward care might influence what sorts of dependency we see—and, by extension, which forms of dependency we fail to notice. (shrink)

This paper examines explore the issues of intergenerational equity raised by climate change. A number of different reasons have been suggested as to why current generations may legitimately favor devoting resources to contemporaries rather than to future generations. These - either individually or jointly - challenge the case for combating climate change. In this paper, I distinguish between three different kinds of reason for favoring contemporaries. I argue that none of these arguments is persuasive. My answer in each case appeals (...) to the concept of human rights. It maintains that a human rights-centered perspective to climate change enables us to address each of these reasons. (shrink)

The task of axiomatizing physical theories has attracted, in recent years, some interest among both empirical scientists and logicians. However, the axiomatizations produced by either one of these two groups seldom appear satisfactory to the members of the other. It is the purpose of this paper to develop an approach that will satisfy the criteria of both, hence permit us to construct axiomatizations that will meet simultaneously the standards and needs of logicians and of empirical scientists.

This article seeks to place the theodicy of the Anglican theologian Austin Farrer, as expressed in Love Almighty and Ills Unlimited , within the context of philosophical and theological approaches to the so‐called “problem of evil”. Farrer's work is initially contrasted with the theodicies of John Hick and Richard Swinburne. This comparison reveals some of the rationalist and foundationalist moral assumptions of modern philosophical theodicy of which Hick and Swinburne are representatives. By contrast, it is argued that Farrer's approach is (...) thoroughly theological and begins not with a pre‐conceived ethics, but with God's self‐revelation in Jesus Christ. Farrer is thus deemed to have much in common with pre‐Enlightenment thinkers such as Augustine and Aquinas.Although Farrer's theodicy is seen to be theological , it is argued that he resists trends in recent theological approaches to theodicy that claim that God is passible . This article defends divine impassibility and argues that, although Farrer's later “metaphysical personalism” implies that God may be personal to the point that he could be said to suffer, his Augustinian notion of the nature of evil as privatio boni strongly implies impassibility. This Farrer is seen to avoid two anthropomorphic approaches to theodicy: one that judges God by the standards of a foundational secular morality, and the other that ascribes certain “personal” emotions to the divine.This article defends Farrer's theological approach to theodicy and his emphasis on ecclesiology and soteriology. However, the lack of a convincing and thorough dogmatic theology is seen to render his theodicy uncompelling. Despite this weakness, it is argued that Farrer's work points theodicy towards a theological encounter with particular narratives of evil and suffering and away from the consideration of a single “problem of evil” by means of “rational”, philosophical enquiry. (shrink)

This paper examines what agents should do when others fail to comply with their responsibilities to prevent dangerous climate change. It distinguishes between six different possible responses to noncompliance. These include what I term (1) 'target modification' (watering down the extent to which we seek to prevent climate change), (2) ‘responsibility reallocation’ (reassigning responsibilities to other duty bearers), (3) ‘burden shifting I’ (allowing duty bearers to implement policies which impose unjust burdens on others, (4) 'burden shifting II’ (allowing some to (...) protect peoples rights in ways which impose otherwise unjustified burdens on the duty bearers, (5) 'compromising moral ideals' (permitting agents to compromise non-justice ideals that they are otherwise bound by); and (6) ‘promoting compliance (implementing policies and creating institutions which reduce noncompliance). It concludes by outlining a methodological framework for evaluating these options, and by setting out my tentative and provisional evaluation of which responses are the least bad. (shrink)

For each k 1, let Γk be the countable universal homogeneous k-hypergraph. In this paper, we shall classify the closed permutation groups G such that Aut G Sym. In particular, we shall show that there exist only finitely many such groups G for each k 1. We shall also show that each of the associated reducts of Γk is homogeneous with respect to a finite relational language.

How can we equalize opportunities while respecting people’s freedom? According to a view that I call libertarian resourcism, people’s fair shares of resources should normally take the form of uncon...

Boghossian's discrimination argument for the incompatibility of externalism and a priori self-knowledge presupposes the relevant-alternatives account of knowledge, more precisely, the claim that the ability to rule out relevant alternatives is a necessary condition for knowledge. In the first two sections of this essay, I object to Boghossian's argument by showing that the standard way of supporting the claim just mentioned, namely with recourse to Goldman's famous barn example, will not convince a rational externalist who knows the relevant facts. In (...) section three, a second challenge to the discrimination argument is developed. First, a descriptive variant of Goldman's barn example is distinguished from a demonstrative variant of this scenario. Then, it is argued that the fact that Goldman's protagonist does not have knowledge in the demonstrative variant cannot be explained by the claim that the ability to rule out relevant alternatives is necessary for knowledge. From this it is concluded that it is not possible to substantiate the claim just mentioned with recourse to Goldman's barn example. The upshot of the discussion in sections one through three is that one cannot argue for the incompatibility of externalism and a priori self-knowledge by drawing on the claim that the ability to rule out relevant alternatives is required for knowledge. In the final section of the article, it is shown that one can furthermore not argue for the incompatibility thesis by invoking the contention that so-called global reliability is necessary for knowledge. (shrink)

Rather than defend each instance of problem suggested by Williams, what I propose to do is to respond by making two clarificatory points: first, I rule out two ways of understanding mathematical problems that might be clouding the water; and then, second, I further characterise how Deleuze thinks some mathematical problems, two in particular, are not just examples of mathematical problems, but provide mathematical models for what a mathematical problem in general can be understood to be. This is important because (...) it is how mathematical problems can be modelled in mathematics that provides Deleuze with a model for how problems can be modelled in other discourses. This will then get to the bottom of what is at stake in my approach to Deleuze and to Deleuze studies in general. (shrink)

Causal queries about singular cases, which inquire whether specific events were causally connected, are prevalent in daily life and important in professional disciplines such as the law, medicine, or engineering. Because causal links cannot be directly observed, singular causation judgments require an assessment of whether a co‐occurrence of two events c and e was causal or simply coincidental. How can this decision be made? Building on previous work by Cheng and Novick (2005) and Stephan and Waldmann (2018), we propose a (...) computational model that combines information about the causal strengths of the potential causes with information about their temporal relations to derive answers to singular causation queries. The relative causal strengths of the potential cause factors are relevant because weak causes are more likely to fail to generate effects than strong causes. But even a strong cause factor does not necessarily need to be causal in a singular case because it could have been preempted by an alternative cause. We here show how information about causal strength and about two different temporal parameters, the potential causes' onset times and their causal latencies, can be formalized and integrated into a computational account of singular causation. Four experiments are presented in which we tested the validity of the model. The results showed that people integrate the different types of information as predicted by the new model. (shrink)

Unconscious stimuli can influence participants’ motor behavior but also more complex mental processes. Recent research has gradually extended the limits of effects of unconscious stimuli. One field of research where such limits have been proposed is spatial cueing, where exogenous automatic shifts of attention have been distinguished from endogenous controlled processes which govern voluntary shifts of attention. Previous evidence suggests unconscious effects on mechanisms of exogenous shifts of attention. Here, we applied a cue-priming paradigm to a spatial cueing task with (...) arbitrary cues by centrally presenting a masked symmetrical prime before every cue stimulus. We found priming effects on response times in target discrimination tasks with the typical dynamic of cue-priming effects indicating that central symmetrical stimuli which have been associated with endogenous orienting can modulate shifts of spatial attention even when they are masked. Prime–Cue Congruency effects of perceptual dissimilar prime and cue stimuli suggest that these effects cannot be entirely reduced to perceptual repetition priming of cue processing. In addition, priming effects did not differ between participants with good and poor prime recognition performance consistent with the view that unconscious stimulus features have access to processes of endogenous shifts of attention. (shrink)

This article argues that integrated infrastructural planning is necessary for building cities that encourage tolerance as a civic behaviour. It argues in favour of open planning and insists that tolerance must be tolerance of risk and uncertainty in urban experience.

Understanding subjective processes in mindfulness-based interventions and during contemplative learning is the goal pursued by Medeiros et al. in the present target article. Implicitly, they touch ….

Keine ausführliche Beschreibung für "Metaphysik einst und jetzt" verfügbar.

Measures are designed to evaluate the processes and outcomes of care associated with the delivery of clinical (and non-clinical) services. They allow for intra- and interorganizational comparison to be used continuously to improve patient health outcomes. The use of performance measures always means to abstract the complex reality (medical scenarios and procedures) in order to provide an understandable and comparable output. Measures can focus on global performance. The more detailed data are available the more specific judgements with respect to the (...) appropriateness of clinical decision-making and implementation of evidence are feasible. Externally reported measures are intended both to inform and lead to action. By providing this information, deficiencies in patient care and unnecessary variations in the care process can be uncovered. Such variations have contributed to disparities in morbidity and mortality. The developments in information technology, especially world-wide interconnectivity, standards for electronic data exchange and facilities to store and manage large amounts of data, offer the opportunity to analyse health-relevant information in order to make the delivery of healthcare services more transparent for consumers and providers. Global performance measures, such as the overall life expectancy (mortality) in a country, can give a rough orientation of how well health systems perform but they do not offer general solutions nor spe-cific insights into care processes that have to be improved. In contrast to population-based measures, case-based performance measures use a defined group of patients depending on specific patient characteristics and features of disease. By means of these measures we are able to compare the number of patients that receive a necessary medical procedure against those patients who do not. The use of case-based measures is a bottom-up approach to improve the overall performance in the long run. They are not only a tool for global orientation but can offer a straightforward link to the areas of deficient care and the underlying procedures. Performance measures are relevant to providers as well as consumers, from their own individual perspective. Cased-based measures focus on the management of individual patient. This approach to performance measurement can inform physicians in a meaningful and constructive way by monitoring their individual performance and by pointing out possible areas of improvement. (shrink)