A corpus of 60 articles published in Spanish, English, and Portuguese was analyzed to account for the integrative literature review on the concept of vulnerability from bioethics, identifying the following thematic trends: risk, susceptibility, autonomy, and culture in people and communities. The methodological approach has been mainly qualitative. We found that the disciplines that most addressed the concept belong to the human and social sciences. The authors recommend conducting studies of the concept from people’s perspectives and that ethics committees review (...) the informed consent and information guides according to these results. The categories give way to the concept of vulnerability, which must be analyzed beyond principlism in bioethics. (shrink)

Objetivo: analizar las tendencias de la formación bioética e intercultural en los programas de enfermería, y establecer los aspectos que deben contemplarse para mejorar la formación. Materiales y método: búsqueda de información en bases de datos científicas de acceso libre y repositorios de tesis doctorales de universidades; se utilizaron las palabras clave: “Bioética”, “Educación”, “Formación”, “Enfermería”, “Cultura”, en español e inglés. No se establecen límites según la fecha de publicación. Resultados: la mayoría de investigaciones se enfocan en el currículo académico, (...) hay poca información sobre interculturalidad, pero se retoma el tema de transculturalidad. Conclusión: es necesario hacer de la ética y la bioética un tema trasversal en los currículos académicos, además de incluir la interculturalidad en los planes de estudio. (shrink)

Many published instruments for assessing adolescent adjustment can be implemented in the school context. However, most of them fail to include a comprehensive and positive theoretical perspective of adolescent development and, even when they do, priority is often given to the clinical perspective, or problems with ecological validity and cost-effectiveness emerge. The Magallanes Adaptation Scale is a 90-item Likert-instrument designed for Spanish-speaking adolescents in order to screen several adjustment areas from a holistic and positive perspective of development. Although some evidence (...) of its psychometric robustness has been tested, no confirmatory analysis of its structure has been published. This paper analyzes the items and the factor structure (exploratory factor analysis and confirmatory factor analysis, using the split-half method) of the scales. Participants were 948 Spanish adolescents (49.84% girls) aged between 11 and 17 and stratified sampled. Thirty-six items were removed from the item analysis. The results of the exploratory factor analysis revealed five factors, excluding mother’s adaptation. Several models were tested during the confirmatory factor analyses, with a 24-item second-order four-factor solution being found to have the best adjustment indicators. The short version proposed in this paper can constitute a helpful tool with screening purposes to help school teachers to assess students’ overall development beyond mere academic performance, although further validity research is needed. (shrink)

Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.

This paper argues that our folk-psychological expertise is a special case of extended and enculturated cognition where we learn to regulate both our own and others’ thought and action in accord with a wide array of culturally shaped folk-psychological norms. The view has three noteworthy features: it challenges a common assumption that the foundational capacity at work in folk-psychological expertise is one of interpreting behaviour in mentalistic terms, arguing instead that successful mindreading is largely a consequence of successful mindshaping; it (...) argues that our folk-psychological expertise is not only socially scaffolded in development, it continues to be socially supported and maintained in maturity, thereby presenting a radically different picture of what mature folk-psychological competency amounts to; it provides grounds for resisting a recent trend in theoretical explanations of quotidian social interaction that downplays the deployment of sophisticated mentalizing resources in understanding what others are doing. (shrink)

What is hope? Though variously characterized as a cognitive attitude, an emotion, a disposition, and even a process or activity, hope, more deeply, a unifying and grounding force of human agency. We cannot live a human life without hope, therefore questions about the rationality of hope are properly recast as questions about what it means to hope well. This thesis is defended and elaborated as follows. First, it is argued that hope is an essential and distinctive feature of human agency, (...) both conceptually and developmentally. The author then explores a number of dimensions of agency that are critically implicated in the art of hoping well, drawing on several examples from George Eliot’s Middlemarch. The article concludes with a short section that suggests how hoping well in an individual context may be extended to hope at the collective level. (shrink)

Volume 3, Issue 1, March 2019, Page 48-59.

We show that the theory, consisting of the usual axioms of but with the power set axiom removed—specifically axiomatized by extensionality, foundation, pairing, union, infinity, separation, replacement and the assertion that every set can be well‐ordered—is weaker than commonly supposed and is inadequate to establish several basic facts often desired in its context. For example, there are models of in which ω1 is singular, in which every set of reals is countable, yet ω1 exists, in which there are sets of (...) reals of every size, but none of size, and therefore, in which the collection axiom fails; there are models of for which the Łoś theorem fails, even when the ultrapower is well‐founded and the measure exists inside the model; there are models of for which the Gaifman theorem fails, in that there is an embedding of models that is Σ1‐elementary and cofinal, but not elementary; there are elementary embeddings of models whose cofinal restriction is not elementary. Moreover, the collection of formulas that are provably equivalent in to a Σ1‐formula or a Π1‐formula is not closed under bounded quantification. Nevertheless, these deficits of are completely repaired by strengthening it to the theory, obtained by using collection rather than replacement in the axiomatization above. These results extend prior work of Zarach. (shrink)

The class forcing theorem, which asserts that every class forcing notion ${\mathbb {P}}$ admits a forcing relation $\Vdash _{\mathbb {P}}$, that is, a relation satisfying the forcing relation recursion—it follows that statements true in the corresponding forcing extensions are forced and forced statements are true—is equivalent over Gödel–Bernays set theory $\text {GBC}$ to the principle of elementary transfinite recursion $\text {ETR}_{\text {Ord}}$ for class recursions of length $\text {Ord}$. It is also equivalent to the existence of truth predicates for the (...) infinitary languages $\mathcal {L}_{\text {Ord},\omega }$, allowing any class parameter A; to the existence of truth predicates for the language $\mathcal {L}_{\text {Ord},\text {Ord}}$ ; to the existence of $\text {Ord}$ -iterated truth predicates for first-order set theory $\mathcal {L}_{\omega,\omega }$ ; to the assertion that every separative class partial order ${\mathbb {P}}$ has a set-complete class Boolean completion; to a class-join separation principle; and to the principle of determinacy for clopen class games of rank at most $\text {Ord}+1$. Unlike set forcing, if every class forcing notion ${\mathbb {P}}$ has a forcing relation merely for atomic formulas, then every such ${\mathbb {P}}$ has a uniform forcing relation applicable simultaneously to all formulas. Our results situate the class forcing theorem in the rich hierarchy of theories between $\text {GBC}$ and Kelley–Morse set theory $\text {KM}$. (shrink)

In The Concept of Mind, Gilbert Ryle argued that a more sophisticated understanding of the dispositional nature of ‘intelligent capacities’ could bolster philosophical resistance to the tempting view that the human mind is possessed of metaphysically ‘occult’ powers and properties. This temptation is powerful in the context of accounting for the special qualities of responsible agency. Incompatibilists indulge the temptation; compatibilists resist it, using a variety of strategies. One recent strategy, reminiscent of Ryle’s, is to exploit a more sophisticated understanding (...) of dispositional properties to account for these qualities. But ‘new dispositionalists’ run up against a ‘hard problem’ that threatens the approach. This paper argues that the threat may be averted by embracing a yet more radical ‘Rylean’ view of the distinctive dispositional nature of ‘intelligent capacities’. (shrink)

In philosophy, the last thirty years or so has seen a split between 'simulation theorists' and 'theory-theorists', with a number of variations on each side. In general, simulation theorists favour the idea that our knowledge of others is based on using ourselves as a working model of what complex psychological creatures are like. Theory-theorists claim that our knowledge of complex psychological creatures, including ourselves, is theoretical in character and so more like our knowledge of the world in general. The body (...) of this paper is divided into three parts. In Part I, I introduce the 'contrastive case' of autism. Autism is a developmental disorder that has recently become the focus of sustained philosophical and psychological attention because of the selective way in which it affects individuals' social capacities. Theory-theorists argue that autistic children's unique profile of assets and deficits is most fruitfully explained by their inability to develop and deploy a theory of mind. After considering the strengths of this hypothesis, I claim theory-theorists face two unresolved difficulties: explaining why high-functioning autistics who develop some theory of mind capacities still fail to engage in normal psychological knowing; and explaining why autistics are generally as unknowable to us in the privileged sense of normal psychological knowing as we are to them. In Part II, I provide the theoretical framework for addressing these challenges by developing an account of normal psychological knowing as psycho-practical expertise. In Part III, I return to the problem of autism, showing how this psycho-practical approach to normal psychological knowing may further suggest how to encompass various aspects of the disorder that tend to be ignored under the prevailing theory-theory approach. (shrink)

The generic Vopěnka principle, we prove, is relatively consistent with the ordinals being non-Mahlo. Similarly, the generic Vopěnka scheme is relatively consistent with the ordinals being definably non-Mahlo. Indeed, the generic Vopěnka scheme is relatively consistent with the existence of a \-definable class containing no regular cardinals. In such a model, there can be no \-reflecting cardinals and hence also no remarkable cardinals. This latter fact answers negatively a question of Bagaria, Gitman and Schindler.

If ZFC is consistent, then the collection of countable computably saturated models of ZFC satisfies all of the Multiverse Axioms of Hamkins.

One of the numerous characterizations of a Ramsey cardinal κ involves the existence of certain types of elementary embeddings for transitive sets of size κ satisfying a large fragment of ZFC. We introduce new large cardinal axioms generalizing the Ramsey elementary embeddings characterization and show that they form a natural hierarchy between weakly compact cardinals and measurable cardinals. These new axioms serve to further our knowledge about the elementary embedding properties of smaller large cardinals, in particular those still consistent with (...) V = L. (shrink)

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...) coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter’s claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter’s policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might—like the proverbial canary in the coalmine—act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice. (shrink)

Ian Hacking proposes that ways of talking about autistic experience can shape, or even transform, what it is like to be autistic. I explore the grounds for two nonexclusive interpretations of this thesis. The informative interpretation holds that, because nonautistics cannot read mental states into autistic behaviour as they normally do with one another, autistic self‐narratives give nonautistics unique insights into what it is like to be autistic. This in turn affects how nonautistics interact with autistic individuals, enriching their social (...) environment in various ways. The more radical, transformative interpretation holds that autistic experience is itself moulded under the influence of developing a language‐game for talking about autistic experience. I endorse both theses, albeit with some cautionary remarks. (shrink)

This article contends that feminism is haunted by its past, and that to be haunted means that feminists need to bear witness to the possibilities, often unrealized, of that past and to actively resist the policing and defensiveness that have marked feminism's relationship to its diverse history in recent years. It engages with the work of Terry Castle and Avery Gordon in order to make this argument, and to map out a methodology for looking for the ghosts of the recent (...) feminist past. In looking for one such ghost - the figure of the feminist-as-lesbian - the article asks, how does the trope of the apparitional in lesbian cultural visibility structure cultural memories of the second wave movement? To that end the article discusses the presence of the ghost in a recent feminist/queer study of feminist historicity and in the popular press respectively. The final section looks back to the 1980s in order to trace the connections between then and now, and, therefore, something of what the ghost wants us to remember. (shrink)

Alcibiades is one of the most explicitly sexualized figures in fifth-century Athens, a "lover of the people" whom the demos "love and hate and long to possess" (Ar. Frogs 1425). But his eros fits ill with the normative sexuality of the democratic citizen as we usually imagine it. Simultaneously lover and beloved, effeminate and womanizer, Alcibiades is essentially paranomos, lawless or perverse. This paper explores the relation between Alcibiades' paranomia and the norms of Athenian sexuality, and argues that his eros (...) reveals an intrinsic instability within the sexual economy of the democracy: the desire he embodied blurred the categories that defined Athenian masculinity; the desire he inspired rendered the demos passive and "soft." This same instability can be seen in Thucydides' juxtaposition of the mutilation of the Herms and the legend of Harmodius and Aristogeiton. These two episodes (obscurely linked by Thucydides) together tell of an idealized citizen body under threat. The tyrannicide story figures the democratic citizen as an elite lover, whose sexual dominance is vital to his political autonomy. The Herms, with their prominent phalloi, symbolized this citizen-lover, and thus their mutilation was an assault on the masculinity, as well as political power, of the demos. The tyrannicide legend seems to promise a defense against this threat of civic castration; but instead of shoring up the sexually-dominant citizen, Thucydides' version of the legend merely reveals his frailty and fictionality: even in Athens' heroic past there is no inviolable democratic eros to cure the impotence of mutilation and tyranny. Reading these two episodes against the backdrop of Alcibiades' paranomia (as described by Plutarch and Plato), this paper examines the nature of democratic masculinity, the (eroticized) relation between demagogue and demos, and the place of perverse desire within the protocols of sex. (shrink)

Two arguments are famously held to support the conclusion that consciousness cannot be explained in purely physical or functional terms – hence, that physicalism is false: the modal argument and the knowledge argument. While anti‐physicalists appeal to both arguments, this paper argues there is a methodological incoherence in jointly maintaining them: the modal argument supports the possibility of zombies; but the possibility of zombies undercuts the knowledge argument. At best, this leaves anti‐physicalists in a considerably weakened rhetorical position. At worst, (...) it shows that commonsense intuitions on which anti‐physicalists rely mislead us about the true nature of conscious experience. (shrink)

Scholars agree that the environmental and societal impacts of consumption require greater attention, and need examining in more diverse market contexts. This editorial essay focuses on the nascent area of ethical/sustainable luxury, and critically considers how the scope of ethical/sustainable consumption can be broadened in the luxury sector. We address the compatibility of ethicality/sustainability and luxury by examining a range of opportunities and inherent tensions in relation to improving the ethical/sustainable consumption practices within the luxury sector. We also introduce several (...) original articles published as part of this Thematic Symposium, whose arguments underscore both the merits, and flaws, of ethical/sustainable luxury. On the basis of this and prior research, we present a balanced perspective by identifying various factors that facilitate or inhibit the acceptance and furtherance of ethicality/sustainability within sector. Thus, this essay serves as a springboard for further research and development in ethical/sustainable luxury whilst simultaneously highlighting the importance of the topic in general. (shrink)

The National Institute for Health and Care Excellence (NICE) is the UK’s primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled ‘Social value judgements: Principles for the development of NICE guidance’ (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of NICE’s (...) methods between 2008 and 2020, this study examines whether this new document (‘Principles’) offers a transparent account of NICE’s current normative approach. It finds that it does not, deriving much of its content directly from SVJ and failing to fully acknowledge or explain how and why NICE’s approach has since changed. In particular, Principles is found to offer a largely procedural account of NICE decision-making, despite evidence of the increasing reliance of NICE’s methods on substantive decision-rules and ‘modifiers’ that cannot be justified in purely procedural terms. Thus, while Principles tells NICE’s stakeholders much about how the organisation goes about the process of decision-making, it tells them little about the substantive grounds on which its decisions are now based. It is therefore argued that Principles does not offer a transparent account of NICE’s normative approach (either alone, or alongside other documents) and that, given NICE’s reliance on transparency as a requirement of procedural justice, NICE does not in this respect satisfy its own specification of a just decision-maker. (shrink)

One of the most urgent debates of our time is about the exact role that new technologies can and should play in our societies and particularly in our public decision-making processes. This paper is a first attempt to introduce the idea of CrowdLaw, defined as online public participation leveraging new technologies to tap into diverse sources of information, judgments and expertise at each stage of the law and policymaking cycle to improve the quality as well as the legitimacy of the (...) resulting laws and policies. First, we explain why CrowdLaw differs from many previous forms of political participation. Second,we reproduce and explain the CrowdLaw Manifesto that the rising CrowdLaw community has elaborated to foster such approaches around the world. Lastly, we introduce some preliminary considerations on the notions of justice, legitimacy and quality of lawmaking and public decision-making, which are central to the idea of CrowdLaw. (shrink)

Some 40 years ago, Dana Scott proved that every countable Scott set is the standard system of a model of PA. Two decades later, Knight and Nadel extended his result to Scott sets of size ω₁. Here, I show that assuming the Proper Forcing Axiom (PFA), every A-proper Scott set is the standard system of a model of PA. I define that a Scott set X is proper if the quotient Boolean algebra X/Fin is a proper partial order and A-proper (...) if X is additionally arithmetically closed. I also investigate the question of the existence of proper Scott sets. (shrink)

This volume explores the conceptual terrain defined by the Greek word eikos: the probable, likely, or reasonable. A term of art in Greek rhetoric, a defining feature of literary fiction, a seminal mode of historical, scientific, and philosophical inquiry, eikos was a way of thinking about the probable and improbable, the factual and counterfactual, the hypothetical and the real. These thirteen original and provocative essays examine the plausible arguments of courtroom speakers and the 'likely stories' of philosophers, verisimilitude in art (...) and literature, the likelihood of resemblance in human reproduction, the limits of human knowledge and the possibilities of ethical and political agency. The first synthetic study of probabilistic thinking in ancient Greece, the volume illuminates a fascinating chapter in the history of Western thought. (shrink)

In this essay, I want to explore the possibility that the success of narrative in stimulating empathy comes from the relation that narrative bears to emotion—where emotion is a kind of proto-narrative that possibly accounts for the structure and range of narratives themselves —and that our familiarity with emotions as micro-narratives results in the motivation of narrative. That is, the resolution of events occurs in terms of feeling rather than other forms of closure, since other forms of closure represent literal (...) endings as, quite simply, the cessation of events whereas emotion achieves its end by being felt or translated in empathetic terms and in ways that endure beyond the formality of the fictive event that ends the narrative. I will be using Kim Scott’s Benang: From the Heart (1999) and Peter Carey’s Jack Maggs (1997) to discuss narrative and emotions, or the role of emotion in motivating narrative events and the role of narrative in conveying and stirring emotion in the reader. (shrink)

Using hokku poet Basho’s aesthetics of wandering, as defined by Thomas Heyd, I argue that, by detailing the excruciating pointlessness of work undertaken according to commands that take little or no account of their feasibility, Richard Flanagan’s novel, The Narrow Road to the Deep North (which takes its title from Basho's work) transforms the features of this aesthetics into the lived experience of prisoners of war on the ‘line’. In doing so, Flanagan transfers Basho’s aesthetics into a represented actuality through (...) the privileging of subjectivity over identity and the dissolution of the body on the line. The three prongs to Basho’s aesthetics are found in Flanagan’s novel. In this, Flanagan is identifying the complexity of meanings evident in the terminology of such aesthetics, rendering what appears positive in the context of Basho’s poetry negative in its practical application as this is articulated through the prisoners’ wartime experiences. Rather than being formative, Flanagan’s novel suggests wartime experience has a complexly ‘opposite’ effect. This is apparent in the complications of identity represented in post-war terms as a disunity (rather than a coherent unity), as articulated through the use of spatial metaphors that reverse the formative intensities of subjectivity and body through symbolic acts of dispersal and dissolution. (shrink)

Narrated in the first person, Peter Carey’s novel about the life of Australian bushranger Ned Kelly incorporates other aspects of speech derived both from Carey’s personal experience and from the editorial process. Kelly's voice is toned down to some extent by virtue of the latter, introducing expressions Kelly himself would not have used. Identifying these elements, along with the specific attributes of Kelly’s own speech, enjoins a diversity of cultural and social groupings that intersect and, in some instances, compete with (...) or contradict one another. Shifts in speakers might be signalled by textual markers or by adopting different expressive qualities and speech patterns, which may or may not include a change in grammatical person. In this novel, at one instance, a shift in person is apparent, but I want to argue, not necessarily a shift in the identity of the speaker because, although the grammatical voice shifts, its qualitative features are largely unaltered. The shift nonetheless introduces a significant change. Paradoxically, as far as literary theory is concerned, the subjective qualities produced through voice mean that stylisations of speech may be indicative of character point of view, rather than what is understood to be narrative voice, because they might function in narrative as inflections of speech that do not correspond to the established voice of the grammatically instanced speaker—offering a focalised perspective instead. The shift in True History presents problems in these terms, however: the point of view instanced here is clearly that belonging to the speaker, though the voice is Kelly’s, for the narrator’s point of view determines the generality of the descriptive terms where once these were specific and personal. Had the novel been narrated wholly in third person, an unproblematic reading of Kelly’s point of view, suggested by the use of his voice, would be possible. But the shift undermines this—Kelly’s point of view gives way to another, instanced in the shift that takes place in narrative voice. Carey, in other words, inverts the convention. This is not an instance of free indirect style or discourse, where grammatical mood is at odds with the speaker’s position and tenses align with the implicated subject position of another. The same features of voice that might identify character point of view must, in absence of any disparity of mood or tone, function in respect to narrative voice to convey something of its speaker’s subjectivity, and this seems apparent here: the speaker shares Kelly’s subjective emotional and intellectual perspective, but no longer occupies the subject position. Carey’s voicing of the bushranger therefore complicates distinctions between voice and point of view by revealing qualitative features of voice to be important to the question of who is speaking the narrative. (shrink)

Background As the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that (...) a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE’s formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. Methods The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. Findings Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE’s formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE’s specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. Conclusion At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence. (shrink)

Scientific articles have been traditionally written from single points of view. In contrast, new knowledge is derived strictly from a dialectical process, through interbreeding of partially disparate perspectives. Dialogues, therefore, present a more veritable form for representing the process behind knowledge creation. They are also less prone to dogmatically disseminate ideas than monologues, alongside raising awareness of the necessity for discussion and challenging of differing points of view, through which knowledge evolves. Here we celebrate 250 years since the discovery of (...) the chemical identity of the inorganic component of bone in 1769 by Johan Gottlieb Gahn through one such imaginary dialogue between two seasoned researchers and aficionados of this material. We provide the statistics on ups and downs in the popularity of this material throughout the history and also discuss important achievements and challenges associated with it. The shadow of Samuel Beckett’s Waiting for Godot is cast over the dialogue, acting as its frequent reference point and the guide. With this dialogue presented in the format of a play, we provide hope that conversational or dramaturgical compositions of scientific articles—albeit virtually prohibited from the scientific literature of the day—may become more pervasive in the future. (shrink)

Biocentric individualism, the position that all life has intrinsic value, is of no practical help in policy-making contexts. Examples commonly used in discussions of biocentric individualism are themselves alienating and threaten to make environmental philosophy appear irrelevant to policy decisions. Hence, both biocentric individualism and typical discussions of it are problematic for those wishing to make environmental philosophy useful in policy. A recent article by Jason Kawall, in which he attempts to defend biocentric individualism, demonstrates these points.

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because (...) it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings. (shrink)