I first argue that there is no problem about how to justify partialities (though there is a difficulty in justifying impartialities). Then I consider the role of consent in justifying rights and duties, using voluntary associations as a case in which consent has an important but limited role in doing so, a role determined and circumscribed by evaluative considerations. The values explain why consent can bind and bind one to act as one does not wish to do and even (...) as one judges to be ill advised. That opens the way to an explanation of how value considerations relate to non-voluntary membership in socially constituted groups, generating rights and duties that to a considerable extent are independent of the individual’s aims and preferences. -/- . (shrink)

The issue of large-scale, population based DNA collections has become a world-wide discussion, which is hoped to bring substantial improvements in medicine. Continuous access to clinical data linked to the genetic samples is very important for some research that aims to find significant association between genes and diseases. This raises ethical issues related to privacy and confidentiality of medical records and the genetic information of the individuals who may be involved in the research. Genetic databases can also raise challenges for (...) the protection of the rights of the social groups, in avoiding potential stigmatization or discrimination. Informed consent of voluntary participants is another important issue in genetic research.We consider whether a person has ethical duties to donate a sample to a database if it will be used for the improvement of the health services to which they have benefited from. The balance between individual's privacy and public health is needed in genetic research. A good database will contribute to the good of both donors and society. (shrink)

In this paper, I draw a distinction between two fundamentally different kinds of commitments by highlighting some previously unnoticed subtleties in the pragmatics of "commissive" utterances. I argue that theories which seek to model all commitments on promises, or to ground them all on voluntary consent, can account only for one sort of obligation and not for the other. Since social groups are most perspicuously categorized in terms of the sorts of commitments that bind their members together, this (...) puts me in a position to distinguish two importantly different kinds of social groups, which I call aggregations and associations. I try to show that this position can account for features of the normative structure of social groups that are overlooked by those theorists (e.g. Margaret Gilbert) who have attempted to offer a unitary, voluntarist account of the phenomena under investigation. (shrink)

Michael Otsuka sets out to vindicate left-libertarianism, a political philosophy which combines stringent rights of control over one's own mind, body, and life with egalitarian rights of ownership of the world. Otsuka reclaims the ideas of John Locke from the libertarian Right, and shows how his Second Treatise of Government provides the theoretical foundations for a left-libertarianism which is both more libertarian and more egalitarian than the Kantian liberal theories of John Rawls and Thomas Nagel. Otsuka's libertarianism is founded on (...) a right of self-ownership. Here he is at one with 'right-wing' libertarians, such as Robert Nozick, in endorsing the highly anti-paternalistic and anti-moralistic implications of this right. But he parts company with these libertarians in so far as he argues that such a right is compatible with a fully egalitarian principle of equal opportunity for welfare. In embracing this principle, his own version of left-libertarianism is more strongly egalitarian than others which are currently well known. Otsuka argues that an account of legitimate political authority based upon the free consent of each is strengthened by the adoption of such an egalitarian principle. He defends a pluralistic, decentralized ideal of political society as a confederation of voluntary associations. Part I of Libertarianism without Inequality concerns the natural rights of property in oneself and the world. Part II considers the natural rights of punishment and self-defence that form the basis for the government's authority to legislate and punish. Part III explores the nature and limits of the powers of governments which are created by the consensual transfer of the natural rights of the governed. Libertarianism without Inequality is a book which everyone interested in political theory should read. (shrink)

Using a unique data set, the author investigates gender segregation in voluntary organizations. Results indicate that women are more likely than men to belong to gender-segregated groups and women's groups primarily restrict members to contact with persons of the same age, education, and marital and work status. The article ends with a discussion of how segregated voluntary associations help perpetuate a social world that is substantially ordered by gender.

In the first five of these articles I have questioned the justice, and effectiveness, of total dependence in clinical research on willing volunteers. I have explored ways that might better and more equitably spread the burden of participating in clinical research as subjects of it. Here I consider this question: if consent is the barrier, must we regard consent as indispensable?

The goal of my comments regarding the case study of Eve Hyde — presented in the introduction of this symposium — is not first and foremost to resolve the conflict between individual autonomy and medical paternalism regarding non-consensual psychiatric treatment. Instead, the goal is to step back far enough from what is generally accepted as the morally appropriate basis for non-consensual psychiatric treatment, including involuntary hospitalization and medication, and to ask very basic questions about when patients may permissibly (...) be treated without their consent. My goal, in short, is Socratic — to explore aspects of what we take for granted in order better to determine whether we ought to take them for granted. Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients, such as Eve Hyde, in order to preserve the patient’s best interests and restore the patient’s autonomy. Such arguments typically specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighed against other factors. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Background: Clinical and experimental findings have suggested that insomnia is associated with altered emotion processing, such as facial emotion recognition and impairments in executive functions. However, the results still appear non-consensual and have recently been presented by a few number of studies. Accordingly, the aim of the present study was to investigate whether patients with Insomnia disorder will present alterations in recognition of facial emotions and that such alterations will be related to Executive Functions and that Insomnia Disorder patients (...) will exhibit a lower Executive Functions performance when compared to normal controls individuals. Method: A total of 11 individuals diagnosed with insomnia disorder and 15 control participants took part in the present cross-sectional study. They completed questionnaires covering socio-demographic data, a sleep and mood evaluation, and a cognitive assessment. Moreover, they underwent a computerized Facial Emotional Recognition test, consisting of facial emotion labeling and facial emotion matching. Results: Individuals with insomnia presented a lower recognition of facial expressions of fear and sadness in comparison to control volunteers. Perceptual Organization Index was found to be statistically significant lower in the insomnia group compared to the control group. There was a statistically significant association between facial recognition emotional and cognitive processes of in executive functions performance, especially in processes related to the inhibitory control, planning capacity, problem solving and cognitive flexibility in insomnia group. Conclusions: Insomnia disorder impairs the facial emotion recognition of the fear and sadness. Insomniacs with impairment in the facial emotion recognition had impaired performance of executive functions. There is a negative impact on processes related to cognitive-emotional capacity than on processes related to social-emotional recognition. Keywords: insomnia, facial emotional recognition, sleep deprivation, cognition, executive functions. (shrink)

Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’. In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be (...) embedded in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic. (shrink)

Many philosophers accept the idea that there are duties to promote or create just institutions. But are the addressees of such duties supposed to be individuals – the members of the citizenry? What does it mean for an individual to promote or create just institutions? According to the ‘Simple View’, the citizenry has a collective duty to create or promote just institutions, and each individual citizen has an individual duty to do their part in this collective project. The simple view (...) appears to work well with regard to – you guessed it – ‘simple’ scenarios but it is riddled with further questions and problems. In this chapter, we raise five problems for the Simple View: (a) We suggest that one cannot develop a view concerning the citizenry’s duty to promote just institutions in isolation from a conception of the ontological relationship between the state and its citizens; (b) We argue that it is not obvious that the citizenry is the right entity to be attributed duties in the first place; (c) We show that a plausible account of collective duties to promote just institutions must not remain silent on the complexities and difficulties amorphous, unorganized group face in vis-à-vis collective action; (d) We contend that without allocation principles for contributory duties amongst the citizenry, or – alternatively – a method for practical deliberation that is action-guiding in collective action contexts, the claim that the citizens have a collective duty to promote just institutions remains moot; and, finally, (e) We demonstrate that the problem of reasonable disagreement is a serious threat to a collective duty to promote or create just institutions – it potentially undermines such a duty altogether and allows for conflicting contributory duties amongst the citizenry. We hope that our discussion will ultimately help improve existing theories and conceptual frameworks with a view to better understanding citizens’ obligations to promote justice under non-ideal conditions. (shrink)

Context Informed consent is crucial in daily clinical practice and research in medicine and psychiatry. A recent neuroethical investigation explored the psychological factors that are crucial in determining whether or not subjects give consent. While cognitive functions have been shown to play a central role, the impact of empathy and emotions on subjects' decisions in informed consent remains unclear. Objective To evaluate the impact of empathy and emotions on subjects' decision in informed consent in an exploratory study. Design Decisional capacity (...) and informed consent to a subsequent imaging study were evaluated with the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Empathy and emotion recognition were measured with the Multifaceted Empathy Test (MET) and the Florida Affect Battery (FAB). Setting Psychiatric subjects were recruited from a general psychiatric hospital and a forensic state hospital. Patients A mixed group of 98 healthy men and forensic and non-forensic psychiatric subjects were investigated. Results Both empathy (MET) and emotion recognition (FAB) correlated with MacCAT-CR scores. Higher cognitive empathy and good emotion recognition (compared with low empathy and emotion recognition) were associated with increased decisional capacity and higher rates of refusal to give informed consent. Conclusions This study shows an empirical relationship between decision-making and informed consent, on the one hand, and emotions and empathy on the other. While this study is exploratory and preliminary, the findings of a relationship between informed consent, emotions and empathy raise important neuroethical questions with regard to an emotional-social concept of informed consent and potential clinical implications for testing informed consent. (shrink)

Must privacy and freedom of expression conflict? To witness recent debates in Britain, you might think so. Anything other than self-regulation by the press is met by howls of anguish from journalists across the political spectrum, to the effect that efforts to protect people’s privacy will threaten press freedom, promote self-censorship and prevent the press from fulfilling its vital function of informing the public and keeping a watchful eye on the activities and antics of the powerful.[Brown, 2009, 13 January]1 Effective (...) protections for privacy, from such a perspective, inevitably pose a threat to democratic government via the constraints that they place on the press. Such concerns with privacy must be taken seriously by anyone who cares about democratic government, and the freedom, equality and wellbeing of individuals. But if it is one thing to say that privacy and freedom of expression cannot always be fully protected, it is another to suppose that protections for the one must always come at the expense of the other. After all, the economics of contemporary politics and journalism would seem to be partly responsible for our difficulties in protecting personal privacy while sustaining robust and informative forms of public discourse. [Moore, 2010, 10 -141]2 Most newspapers are loss-making businesses and the need to reduce those losses and, if possible, to turn a profit, make investigative journalism an increasingly expensive proposition as compared to both “comment” and more or less elevated forms of gossip. At the same time, politics has increasingly become the prerogative of a narrow group of people with access to the large sums of money necessary successfully to compete for high office. In those circumstances, the need for critical scrutiny is as important as it is difficult. Revising our ideas about privacy and its protection cannot alone reduce the tensions between freedom of expression and personal privacy typical of our societies, necessary though such revision may be. Moreover, this paper can only touch on some aspects of the ways in which we need to rethink our interests in privacy, in order adequately to reflect people’s diverse interests in freedom of expression, and the important role of a free press to democratic government. Nonetheless, I hope to suggest ways of thinking about people’s claims to privacy which can be generalised fairly readily, and can help us to think constructively about the nature, causes and solutions to some important social and political problems, even if, in its nature, philosophical analysis rarely tells us what to do. More specifically, this paper argues that people are entitled to keep some true facts about themselves to themselves, should they so wish, as a sign of respect for their moral and political status, and in order to protect themselves from being used as a public example in order to educate or to entertain other people. The “outing” - or non-consensual public disclosure - of people’s health records or status, or their sexual behaviour or orientation is usually unjustified, even when its consequences seem to be beneficial. Indeed, the paper claims, the reasons to reject outing, as inconsistent with democratic commitments to freedom and equality, are reasons to insist on the importance of privacy to freedom of expression. While a free press is of the utmost importance to democratic government, it is not identical with the free expression of individuals and, on occasion, the former may have to be constrained in order to protect the latter. [Barendt, 2007, 231]. Hence, the paper concludes, we should distinguish the claims of individuals to publish reports about their lives – even if this necessarily involves revealing the private lives of others – from journalistic claims to publish information about the sex lives of consenting adults. I will start by briefly situating my argument within a democratic approach to privacy, before using the “outing” of Oliver Sipple to examine people’s claims to privacy and their implications for freedom of expression and of the press. I will be assuming that some forms of privacy are legitimate, in order to focus more closely on the question of what information, if any, people may keep to themselves. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Life is GoodAnnette ChacosI live in Hervey Bay. I’m a member of several social groups. I have adult children and grandchildren, and many lovely friends. I love to write. Most importantly I love The Lord Jesus Who has been my strength, bringing me through the good times, the not so good times, and the, ‘I’m throwing in the towel’ times.I was first diagnosed with a brain tumour in (...) 1997. Prior to knowing about the tumour and for some time after its removal I had little or no memory of events. The tumour was a left Frontal Meningioma (benign). For some time afterward I was partially [End Page 189] paralyzed. Now there is only some weakness on the right side of my body. Epilepsy too became part of my life. There are different types of seizures, which are rarely, if ever, amusing.Humour is very important. If you can’t laugh at the things that happen life would be a constant tale of woe. I’m very blessed. There are so many people who are much worse off than myself.My storyIn July 1997 my husband went to see if everything was okay because I wasn’t up out of bed yet. I was lying across the bed in a disheveled state. After being cleaned up I was taken to the local hospital. The duty doctor, who hadn’t even seen me, told my son that he didn’t think there was much wrong and to take me home. My sons refused and insisted that the doctor admit me. He did.I was diagnosed with a urinary tract infection. My memories of this are scattered. I learned some time later that I had had a Tonic Clonic seizure (formerly known as “grand mal” seizures which are commonly associated with epilepsy). After I came out of hospital I saw my general practitioner (GP). She sent me for an x–ray, and then to see a Neurosurgeon. An MRI was taken and there was a large tumour in my brain.My memory of this time is poor. I do recall a friend phoning and I told her I was going into hospital to have a brain tumour removed. After fifteen years she is still saying I was so matter of fact about it. I now know that my emotions, like my memory, was at a very low ebb due to the tumour. There was no caring or worrying. If there was, in the next minute, probably second, it was forgotten.Before going into hospital my late husband said to the kids “better take a photograph of your mother in case she dies.” I was told about that comment some time later. What a comfort! Then one day the photo turned up. It was so ugly I tore it up. You’ll note I said the photo was ugly!The operation took place in Canberra hospital, at the end of August. It was to be earlier but they deferred it because an emergency came in. They were going to defer it again, by which time I was mute and non–responsive. My daughter Maria arrived from Melbourne and my daughter Katrina and her husband Kevin came from America with their 3–month–old baby. My son Libe arrived from Sydney. Marcus, my youngest, lived locally, as did my daughter Tania. On hearing the operation was to be deferred again they took action informing hospital staff they were going to the local MP and the A Current Affair television show. So l had the operation—it was much easier to put me under the scalpel than battle the bureaucracy!I have only one film from that MRI. Where the others are I don’t know. According to Dr C, the tumour was very large. But to me, what does size matter—it was no longer there. Most importantly, I survived. The ten days I was in hospital are mostly forgotten. The few people I remember are like snapshots. No one moved, or so it seemed to me.In 2006, the second tumour was removed. It was discovered by the same lovely GP, who found the first one. I was... (shrink)

Théologien, historien, philosophe, sociologue et homme politique libéral, Ernst Troeltsch (1865-1923) fait partie du groupe des théologiens protestants allemands appelé " Ecole de l'histoire des religions ". Revendiquant l'héritage de Kant et de Schleiermacher, proche de Max Weber et du néo-kantisme de l'Ecole de Bade, Troeltsch est le théoricien classique du néo-protestantisme. Surtout connu en France comme sociologue de la religion, il est redécouvert aujourd'hui comme philosophe et théologien, éclipsé un temps par Barth, l'existentialisme et Heidegger. Les huit essais rassemblés (...) ici sont écrits à l'horizon d'une réflexion sur le religieux marquée par les sciences humaines et sociales et par une conscience accusée de la pluralité des formes de la religion. Troeltsch y dessine un programme qui inscrit délibérément la théologie dans une perspective historique, tout en s'efforçant d'articuler approche empirique et interrogation touchant les jugements de valeur. Il récuse ainsi toute tentative pour faire valoir un domaine théologique réservé : non seulement le christianisme n'est pas la religion dans sa forme achevée ou " absolue ", mais les tentatives pour déterminer une " essence " du christianisme par-delà ses inscriptions socioculturelles diverses devront également être refusées. En désenclavant la réflexion théologique, Troeltsch oblige à redéfinir son objet et son statut : elle ne sera plus explicitation du croire, mais devra esquisser une théorie du christianisme précisant le statut, la fonction et les limites du religieux dans une modernité marquée par la diversification des instances de rationalisation et de légitimité. Ce faisant, son propos tranche avec les discours théologiques dominants dans la seconde moitié du XXe siècle, tant en protestantisme qu'en catholicisme. Et il ouvre à nouveau la question d'une pertinence sociale et culturelle du religieux et du théologique. A l'heure où les paradigmes modernes se trouvent en profonde interrogation sur eux-mêmes et où la question religieuse fait retour - peut-être pour le meilleur mais souvent pour le pire -, la lecture de Troeltsch peut apporter une contribution bienvenue à un ensemble de questions parmi les plus centrales de notre temps. Publiés pour la première fois en français, les textes présentés ici sont accompagnés d'un important appareil de commentaires historiques aidant le lecteur à reconstituer le contexte et la genèse des débats en cause. (shrink)

Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since heroin (...) addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options. (shrink)

This paper investigates the circumstances under which it is morally permissible to impose non-negligible risks of serious harm on innocent civilians in order not to endanger tangible cultural heritage during armed conflict. Building on a previous account of the value of cultural heritage, it is argued that tangible cultural heritage is valuable because of how it contributes to valuable and meaningful human lives. Taking this account as the point of departure I examine the claim that commanders should be prepared to (...) risk lives of innocent civilians in order to avoid harm to tangible cultural heritage. I argue that imposing high risks of serious harm on innocent civilians without their consent constitutes a wrong that can be justified only in order to avoid a greater evil. It is then argued that damage to cultural heritage sites rarely constitutes the greater evil when weighed against the imposition of non-consensual risks of serious harm on innocent civilians, especially when the risk is substantial. Still, imposing substantial risks might be morally permissible under the condition that they are consensually imposed, even if they are not the lesser evil. However, I argue that even if one has reason to suspect that there are civilians who might consent to at least some significant risks in order to avoid damage to their cultural heritage, it is not clear that commanders should take this into account when deciding what to do. Unless all of those who are at risk consent, the fact that some of those whose lives are at risk consent to the risk of being killed do not make it morally permissible to impose this risk on the group as a whole. (shrink)

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited (...) abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process. (shrink)

In ordinary discourse, a single duty is often attributed to a plurality of agents. In "Group Duties: Their Existence and Their Implications for Individuals", Stephanie Collins claims that such attributions involve a “category error”. I critically discuss Collins’ argument for this claim and argue that there is a substantive sense in which non-agential groups can have moral duties. A plurality of agents can have a single duty to bring about an outcome by virtue of a capacity of each to practically (...) reason about what they ought to do together. I also argue that Collins’ attempt to give a reductive account of such “we-reasoning” fails. (shrink)

In liberal political philosophy, a prevalent view holds that groups are typically voluntary associations. Members of voluntary associations can accept, revise or reject group practices as a matter of choice. In this article, I challenge this view. Appealing to the concept of joint commitment developed in philosophy of social science, I argue that individuals who jointly commit their wills to a goal or a belief form a ‘We’-group. Members of ‘We’-groups are under an obligation to defer to (...) ‘Our’ will embodied in ‘Our’ norms as a matter of course. I further show the ubiquity of We-groups. This joint commitment account of group authority raises a much-overlooked question of group legitimacy: Do members have good reasons to obey norms of their group? I show that state-centric views of legitimacy are inapt to answer it. A group-centric view, revived from the old communitarian literature, is defended. (shrink)

In research involving patients with implantable brain–computer interfaces (BCIs), there is a regulatory gap concerning post-trial responsibilities and duties of sponsors and investigators towards implanted patients. In this article, we analyse the case of patient R, who underwent non-voluntary explantation of an implanted BCI, causing a discontinuation in her sense of agency and self. To clarify the post-trial duties and responsibilities involved in this case, we first define the ontological status of the BCI using both externalist (EXT) and internalist (...) (INT) theories of cognition. We then give particular focus to the theories of extended and embedded cognition, hence considering the BCI either as a constitutive component of the patient’s mind or as a causal supporter of her brain-based cognitive capacities. We argue that patient R can legitimately be considered both as an embedded and extended cognitive agent. Then, we analyse whether the non-voluntary explantation violated patient R’s (neuro)rights to cognitive liberty, mental integrity, psychological continuity and mental privacy. We analyse whether and how different mental ontologies may imply morally relevant differences in interpreting these prima facie neurorights violations and the correlational duties of sponsors and investigators. We conclude that both mental ontologies support the identification of emerging neurorights of the patient and give rise to post-trial obligations of sponsors and investigators to provide for continuous technical maintenance of implanted BCIs that play a significant role in patients’ agency and sense of self. However, we suggest that externalist mental ontologies better capture patient R’s self-conception and support the identification of a more granular form of mental harm and associated neurorights violation, thus eliciting stricter post-trial obligations. (shrink)

Previous research showed that fear-inducing graphic warning labels can lead to cognitive dissonance and defensive responses. Less threatening, social-related warning labels do not elicit these defensive responses, making them more effective in preventing smoking in adults. Given that smoking numbers are still too high among youngsters, it is crucial to investigate how warning labels should be designed to prevent teenagers from starting smoking in the first place. In two studies, we investigated whether comparable effects of social-related warning labels (...) could be observed in a group of teenagers (14-17 years) who are not yet legally allowed to smoke. In addition, we tried to replicate earlier findings with smoking and non-smoking adults. Participants were presented with either health warning labels, social warning labels, or no warning labels. Subsequently, their explicit cognitions (i.e., risk perception, attitude towards smoking) and their implicit associations of smoking with healthiness/unhealthiness (Study 1a and Study 1b) and with positivity/negativity (Study 2a and Study 2b) were assessed. Results showed that in both studies, adult smokers had a higher risk perception and a more positive attitude towards smoking than adult non-smokers. Additionally, social warning labels lead to stronger implicit associations between smoking and negativity in Study 2 in the adult groups. In the teenage group, social warning labels lead to more positive attitudes than health warning labels in Study 2. No further effects on risk perception or implicit associations were found in the teenage group. Possible explanations are discussed. (shrink)

Until recently, any sex or sexual activity with a person under the age of 16 was criminalised, regardless of consent. All such incidents were considered criminal offences and needed to be reported to the police. This paper explores the knowledge, practices and perspectives of seventeen social workers in KwaZulu-Natal in relation to their mandatory reporting responsibilities on consensual underage sex. All social workers were clear about their reporting responsibilities regarding child abuse and non-consensual underage sex. However, (...) findings suggest that social workers were less clear on the exact circumstances in which they ought to report consensual underage sex. Most participants indicated that they would make individual assessments about when to report underage consensual sex and sexual activity. Such decisions would be influenced by structural factors, the personal circumstances of affected children and the availability of other interventions to address early sexual activity. This study has shown that social workers are struggling to comply with mandatory reporting responsibilities involving underage consensual sex. Most social workers approach reporting of consensual sex and sexual activity differently to other reporting responsibilities and use a case-by-case approach. Given these findings, it is argued that parliament should consider reforming mandatory reporting provisions so that there is a distinction between the obligation to report consensual and non-consensual sexual offences against children. The mandatory obligation to report non-consensual sexual offences against children should remain but the obligation to report consensual sex or sexual activity should be discretionary and depend on the facts of each case. (shrink)

Teachers´ attitudes toward their students have been associated with differential teachers´ expectations and, in turn, with students´ educational pathways. Theories of social cognition can explain the link between attitudes and behavior. In this regard, the distinction between implicit and explicit attitudes is worth to be considered, whereby implicit attitudes are automatically activated when the attitude object is present and guide automatic behavior. In contrast, explicit attitudes infer deliberation and reflection, hence affecting controlled behavior. As teachers often are required to (...) act immediately in situations that do not allow for thoughtful reflection due to time restraints, teachers´ implicit attitudes concerning different student groups with shared characteristics, such as gender or ethnicity, may be especially important when considering teachers´ behavior in relation to students´ educational pathways. This notion is reflected by an increased interest in adopting implicit methodology in the educational domain. Over the last 10 years, several studies have been conducted in different countries, involving in- and preservice teachers and investigating their attitudes toward different student groups. Estimates of effects have varied and may be affected by sampling bias. To systematically review and integrate data from different studies, this meta-analysis focuses on teachers´ implicit attitudes. Following the systematic search of the database and initial screening, 43 articles were identified from which 22, describing 34 studies, were retained for the meta-analysis after further inspection. First analyses revealed an estimated average effect size of 0.56 for implicit attitudes in favor of non-marginalized groups. As there was a large extent of heterogeneity between studies, several moderator variables, were investigated. Results showed that the employed implicit measure and stimulus materials as well as the student target group affected the effect sizes. Low or non-significant relationships were reported between implicit and explicit attitudes. Findings are discussed in terms of theory and future research. (shrink)

Should immigrants have fewer cultural and language rights than citizens and long-settled groups, and if so, on what moral ground? In the first part of the paper, we develop a novel critique of Kymlicka’s account of voluntary cultural rights alienation, arguing that it is only plausible in the context of emigration, not immigration. We argue that the choice to immigrate cannot be considered voluntary without it being sufficiently clear to the migrant what her rights and duties will be (...) in the new society. If so, then voluntariness cannot morally ground a particular rights regime in the destination country. Any such rights regime must be justified on independent moral grounds. Secondly, we argue that voluntariness can play a different role in a normative argument for cultural rights-differentiation between citizens and denizens. It can i) mitigate the overall injustice of differential treatment; and it can ii) instantiate the justice of how rules apply to the immigrant in a reasonably just society. Thirdly, we sketch an alternative moral grounding of cultural and language rights differentiation that rests, not on voluntariness, but on a contextual analysis of the relevant interests involved. While the protection of these relevant interests gives us reasons to prioritize the language(s) of long-settled groups in many cases, there is no general case for restricting the full recognition of language and culture to long-settled groups. (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (shrink)

Voluntary abortions are relatively frequent and their care is complex due to the social stigma that surrounds these losses. This interpretive meta-ethnography of 11 original qualitative articles aims to synthesize the moral experiences of nurses and midwives who cared for women and couples that decided to abort or terminate the pregnancy due to foetal abnormalities. Lines of argument synthesis emerged after reciprocal and refutational translations, together with the metaphor, ‘Going with the flow or swimming against the tide’. Caring (...) in these situations was an ethical dilemma when a conflict existed between their professional duty and their moral principles. In these instances, care was associated with a significant emotional cost. They did not feel sufficiently prepared or with adequate resources, which favoured avoidance behaviours. However, the feeling of professional duty was stronger than their prejudices, and they became engaged in caring. These results could improve knowledge, clinical practice and education, being a (highly) reasonable representation of the phenomenon of interest. (shrink)

Nearly 400 million adults have been vaccinated against COVID-19. Children have been excluded from the vaccination programmes owing to their lower vulnerability to COVID-19 and to the special protections that apply to children’s exposure to new biological products. WHO guidelines and national laws focus on medical safety in the process of vaccine approval, and on national security in the process of emergency authorisation. Because children suffer much from social distancing, it is argued that the harms from containment measures should (...) be factored in a broader perspective on the good of the child. Considering the available knowledge on the disease, vaccine, and coping strategies, the decision about vaccine access to children is a public responsibility. The ultimate choice is a matter of paediatric informed consent. Moreover, jurisdictions that permit non-participation in established childhood vaccination programmes should also permit choice of vaccines outside of the approved programmes. Even if vaccine supply is too short to cover the paediatric population, the a priori exclusion of children is unjust. It may also exacerbate local and global inequalities. The second part of the paper delineates a prudent and ethical scheme for gradual incorporation of minors in vaccination programmes that includes a rigorous postvaccination monitoring. This is a theoretical paper in ethics that uses the Pfizer vaccine as a stock example, without discussing possible differences among existing vaccines. The key purpose is reflection on the good of the child in emergencies and vaccine policymaking. All data relevant to the study are included in the article and in its refernces. (shrink)

Under what conditions is it morally permissible to commit suicide, to assist in someone’s suicide, or to kill another person with his/her consent? Under what conditions is it morally permissible to use force to prevent such acts? I shall defend a libertarian answer to these questions. On this view, autonomous agents initially fully own themselves in the same sense that one can fully own an inanimate object such as a car. Just as full owners of cars are morally permitted, under (...) a broad range of conditions, to destroy their cars or have someone else do so, autonomous agents who fully own themselves are permitted, under a broad range of conditions, to terminate their lives or to have someone else do so. Furthermore, under these conditions, other agents are not permitted to use force to prevent a full self-owner’s consensual death. I shall focus on consensual killing (i.e., with the killed person’s consent) of autonomous agents. This includes suicide, assisting with suicide, voluntary euthanasia, and even cases where a non-sick person requests that another kill her. I shall not address cases of killing that are involuntary (against the will of the person killed) or non-voluntary (where the being killed is not autonomous; e.g., killing animals, children, and incapacitated adults). These are important issues, but they cannot be addressed here. (shrink)

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents (...) a rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. (shrink)

One of the essential ethical issues in the employment relationship is the loss of employee voice. Many of the ways employees have previously exercised voice in the employment relationship have been rendered less effective by (1) the changing nature of work, (2) employer preferences for flexibility that often work to the disadvantage of employees, and (3) changes in public policy and institutional systems that have failed to protect workers. We will begin with a discussion of how work has changed in (...) the last 20 years in countries like Australia and the United States, and then take up the issue of employees as organizational stakeholders and the ethical duties that are owed them, with special attention given to issues of power. We will then consider whether voluntary action by employers such as social auditing is sufficient to ensure equity for employees, and conclude with a discussion of how changes in public policy might ensure greater fairness in the employment relationship by bringing employers and employees together in partnership. (shrink)

Political liberals typically hold that reasonable citizens should not form political associations (e.g. political parties) with unreasonable citizens. This is because unreasonable citizens are unlikely to conform to the duty of civility—the duty to be able, and willing, to use public reasons in their public political deliberations. Here I argue that a general prohibition on political associations with the unreasonable can undermine the fair value of their political liberties. This is because unreasonable citizens can grow up in epistemic environments that (...) make it difficult to be reasonable, and so to direct citizens to not associate with them can deprive citizens from certain social backgrounds the equal opportunity for political influence. I propose instead that political liberals should distinguish between unreasonable citizens who are disposed to support de re publicly justifiable laws and policies and unreasonable citizens who support illegitimate laws and policies. Reasonable citizens may form political associations with the former group, but not the latter group. (shrink)

Miller analyzes the relationship between consent and autonomy by offering three pictures. For autonomy, Miller distinguishes between procedural, substantive, and weak substantive autonomy. The corresponding views of consent are what Miller has termed as consensual minimalism, consensual idealism, and consensual realism. The requirements of sexual consent under consensual minimalism are a voluntary informed agreement. However, feminist critiques reveal the inadequacies of this simple position. Consensual idealism, which corresponds with substantive autonomy, offers a robust picture (...) where consent and autonomy must be based on non-oppression. However, this view is considered too ideal and it ignores context. Weak substantive autonomy takes into account the context in the sexual domain. Correspondingly, consensual realism takes into account the context and still fulfills the requirements of consent. (shrink)

"What do grown children owe their parents?" Over two decades ago philosopher Jane English asked this question and came up with the startling answer: nothing (English 1979). English joins many contemporary philosophers in rejecting the once-traditional view that grown children owe their parents some kind of fitting repayment for past services rendered. The problem with the traditional view, as argued by many, is, first, that parents have duties to provide fairly significant services to their growing children, and persons do not (...) owe repayment for others' mere performance of duty; second, even where parents go above and beyond duty in their loving and generous rearing of their children, the benefits are bestowed, at least on young children, without their voluntary acceptance and consent, and so, again, fail to generate any obligation of subsequent repayment on their part (see Blustein 1982: 182-3). Moreover, the entire idiom of obligation and repayment, in English's 1 words, "tends to obscure, or even to undermine, the love that is the correct ground of filial obligation" (352). English's alternative, however -- that children strictly "owe" their parents nothing except what flows naturally from whatever love and affection exist between them -- also strikes many as problematic. Christina Hoff Sommers offers examples of what seem to be clearly delinquent adult children, who simply don't "feel" like sharing their lives with their aging parents, or providing any emotional or financial support to them, and so don't (Sommers 1986: 440-41). Sommers points out that we need some talk of obligations in order to fill in the cracks in human relationships where love and affection fail: "The ideal relationship cannot be 'duty-free,' if only because sentimental ties may come unraveled, often leaving one of the parties at a material disadvantage'" (450-51). Sommers proposes as her alternative to English that legitimate duties arise out of special relationships defined by social roles: being a father or mother, a son or a daughter, "is socially as well as biologically prescriptive; it not only defines what one is; it also defines who one is and what one owes" (447).. (shrink)

Background: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines.Method: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998–99 policies of 38 organisations—18 medical associations , nine physician group practices , and 12 health plans —selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a (...) reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society.Results: A majority in all three groups mention “fiduciary obligations” of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians’ obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations.Conclusions: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Legal CommentarySumy Menon, Senior Associate in ResearchThis case involves the balancing of a young person’s right to autonomy and the desire to protect her from harm. No Singapore court decision has determined whether the doctor owes a duty to the parents of the doctor’s 16-year-old patient, to warn them that their child is engaging in sexual activities, and who subsequently has had an abortion. Similarly, the issue of whether (...) the doctor has a duty to protect the minor in such circumstances has also not been tested in the Singapore courts. Nonetheless, it is very unlikely that either duty will be found in this case.The general rule is that doctors owe a duty of confidentiality to their patients. This duty extends to children, and although no Singapore court has ruled on the matter, the law in England is clear.1 It is enshrined in section 4.2.3.1 of the Ethical Code & Ethical Guidelines of the Singapore Medical Council. It is not absolute and a number of exceptions have been carved out. The confidentiality duty can be overridden by legislation, court order, the public interest, or other justifiable circumstances that the doctor believes warrants disclosure.The age of consent for non-commercial consensual sexual activities in Singapore is 16.2 Therefore, there is no statutory responsibility on Dr. C under the criminal law to report the patients’ sexual activities to the authorities or anyone else. There is no other legislation or court order that compels disclosure. It is highly unlikely that the public interest would be served by disclosure. The consequences of such disclosure to the public interest were aptly put in a recent English case, when J. Silber held that if a confidentiality duty was not imposed, it “would probably or might well deter young people [End Page 262] from seeking advice and treatment on contraception, sexually transmitted diseases and abortion, and this would have undesirable and troubled consequences”.3 The last exception offers the greatest latitude for doctors to disclose if they believe there are other justifiable circumstances that would shift the balance in favour of disclosure. There are strong reasons to maintain confidentiality in Miss M’s case and although an argument can be made for disclosure, that argument is relatively weak.Miss M’s parents are understandably worried about her but Dr. C should not breach the duty of confidentiality owed to the patient even though she is only 16 years old. It is irrelevant that Miss M’s parents are paying for their daughter’s treatment. The doctor-patient relationship is between Dr. C and Miss M, and her parents have never been involved in the consultations or treatment decision-making process. They have not insisted on attending the consultations with their daughter, nor did they appear to object to Miss M consenting to treatment. Prior to their complaint, they had not sought any update or information about their daughter’s condition from Dr. C. Miss M specifically asked Dr. C not to reveal the contents of their conversations to her parents at the first consultation and the doctor agreed after attempting to convince her that it would be preferable to include her parents in the consultations. Miss M was obviously concerned about confidentiality and sought clarification from Dr. C. It appears as though Dr. C determined that Miss M had the capacity to exclude her parents from the consultations, and later to make her own treatment decisions, as a mature minor, and their doctor-patient relationship proceeded on that basis.It may be in the public interest for Dr. C to disclose confidential information about Miss M, even if she refuses to consent to it, if the doctor believes it is necessary to protect her from serious harm. Any such decision must be made with the patient’s best interests in mind. Examples of such harm include situations where the patient is at risk of serious physical abuse or has voiced a desire to commit suicide. Engaging in sexual activity with an older boy is unlikely to result in such serious harm, although harm may result. In this case, that harm manifested itself in an unwanted pregnancy... (shrink)

Epistemic justification of non-summative group beliefs is studied in this paper. Such group beliefs are understood to be voluntary acceptances, the justification of which differs from that of involuntary beliefs. It is argued that whereas epistemic evaluation of involuntary beliefs can be seen not to require reasons, justification of voluntary acceptance of a proposition as true requires that the agent, a group or an individual, can provide reasons for the accepted view. This basic idea is studied in relation (...) to theories of dialectical justification in which justification is taken to require ability to justify. Since the reasons offered can in principle always be challenged, there is no ultimate end to the dialectical chain of justification. This makes justification of acceptance, and thus group belief, social and, in a way, contextual, but this does not seem to entail strong forms of epistemic relativism. (shrink)

According to the Behavioral View of consent, consent must be expressed in behavior in order to release someone from a duty. By contrast, the Mental View of consent is that normatively efficacious consent is entirely mental. In previous work, I defended a version of the Behavioral View, according to which normatively efficacious ‘consent always requires public behavior, and this behavior must take the form of communication in the case of high-stakes consent’. In this essay, I respond to two arguments by (...) proponents of the Mental View. First, Larry Alexander, Heidi Hurd and Peter Westen have argued that my view has mistaken implications concerning the culpability of different actors. I counter that my version of the view does not have these implications, as it leaves us free to draw moral and legal distinctions between different offences involving non-consensual behavior. Second, Larry Alexander and Kimberly Ferzan have argued for an analogy between consent and abandonment: on the grounds that the normative power to abandon resides in one’s will, Alexander and Ferzan concludes consent does too. I counter that abandonment requires behavior, and call into question the assumption that the ethics of property have much to teach us about the ethics of sexual consent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narcissism, Empathy and Moral ResponsibilityRonald W. Pies, MD (bio)Professor Fatic’s timely and wide-ranging essay demonstrates how the topic of narcissism has undergone a resurgence of interest in recent decades. This may owe, in part, to the controversial claim that narcissism is on the rise in the United States, at least among American college students (Twenge & Foster, 2010). As I discuss presently, the term “narcissism” is open to many (...) interpretations, and differs somewhat from the specific designation, Narcissistic Personality Disorder (NPD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (American Psychiatric Association, 2013). As Fatic rightly notes,Narcissism as a personality structure may or may not be diagnosed as NPD, depending on various criteria, perhaps most importantly on whether the narcissistic person actually encounters functional and emotional difficulties and shows up for diagnosis and evaluation.As Professor Fatic’s essay clearly shows, narcissism (variously defined) has important “ethical ramifications.” Fatic is primarily interested in exploring the relationship between what he calls the narcissist’s “emotional incompetence” and that person’s degree of moral responsibility. To oversimplify Fatic’s complex set of interlinked arguments, Fatic concludes that “emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality Disorder or not.” Drawing on the moral theories of Philip Pettit and Michael Slote—in particular, Slote’s “sentimentalist ethics” with its emphasis on empathy (Slote, 2004)—Fatic argues that narcissism is both “a moral failure and a psychopathology.” Nevertheless, for Fatic, narcissists remain “fully morally responsible for their insensitivity and interpersonal emotional incompetence.” Why? Because they have the moral duty “to acquire the moral and emotional competence required for the making of moral choices.”Some Philosophical ConcernsAs I understand Fatic’s argument, he is asserting that the narcissist ought to be held responsible for a kind of self-education process that will ameliorate his or her emotional incompetence. Fatic writes,[W]e develop our morality through constant moral education and testing, which we receive both through socialization and through our own efforts later in life, as autonomous human beings. [End Page 173]We are thus responsible for what kind of moral actors we are and are becoming based on our way of life, and have a moral duty to improve our own moral senses and sensibilities by constantly working on the development of virtues.It seems to me that this line of reasoning assumes that all, or most, narcissists possess the capacity to seek and acquire this “moral education.” Perhaps so—but I am not sure Fatic has demonstrated this. It seems at least plausible that, in virtue of the adverse developmental and perhaps even neurological factors that may generate the narcissistic personality (Fan et al., 2011), some narcissists may lack the capacity to modify their psychopathology by means of “moral education.” This leads me to wonder whether Professor Fatic has adequately explored the very heterogeneous nature of narcissism. Indeed, Fatic’s thesis seems to point toward a kind of Platonic “essence” of narcissism, conveyed by his frequent allusion to “the narcissist”—one of whose defining or essential features is said to be a lack of empathy.But, as I will suggest presently, this is at best an oversimplification of narcissism as psychiatrists understand the term. Indeed, there are degrees and varieties of narcissism, differing in their capacity for empathy—which is itself a psychologically complex term. Recent research suggests that “narcissistic personality disorder symptomatology does not reflect a “narcissist” category but rather a continuum of narcissistic pathology” (Aslinger, Manuck, S. Pilkonis, Simms, & Wright, 2018).Furthermore, Professor Fatic’s thesis seems to view “moral responsibility” as a binary construct; i.e., either one possesses, or does not possess, full moral responsibility. But as I have argued elsewhere, moral responsibility may be viewed as lying along a continuum that reflects varying degrees of voluntariness for any given individual (Pies, 2007).Consequently, in my view, any valid assessment of the “the narcissist’s” moral responsibility must consider both the heterogeneity of narcissism and the non-binary (i.e., continuous) nature of moral responsibility.One way of conceptualizing this “two-track” model is... (shrink)

Do individuals have moral duties to fulfil all the demands of their jobs? In this paper, we discuss how to understand such ‘occupational duties’ and their normative bases, with a specific focus on duties that go beyond contractually agreed upon duties. Against views that reduce occupational duties to contractual duties, we argue that they often have greater moral weight, based on skills, roles, and the duty of social cooperation. We discuss what it would take to make sure that individuals (...) are not unfairly overburdened by such occupational duties, distinguishing between choice conditions (voluntariness, availability of alternatives, full information) and conditions concerning the role and the social structures within which such duties are embedded (feasible role design, existence of support structures, employee voice). These conditions, however, are not fulfilled for many existing jobs, especially for jobs typically occupied by structurally disadvantaged groups such as women or ethnic minorities. This leads to a dilemma between the claims of those who depend on the occupational duties to be fulfilled, and the rights of those who hold these occupations and are unfairly overburdened. We conclude by arguing for the need for structural reform to dissolve this dilemma. (shrink)

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and sexuality in (...) residents’ lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship. (shrink)

Dans le contexte pénitentiaire actuel de la lutte contre la désocialisation, des associations offrent un soutien psychologique et social aux familles des prisonniers. La recherche-action « Regards d’enfants sur l’incarcération » dont rend compte cet article, menée en collaboration avec deux de ces associations, consiste à créer des groupes de soutien pour les enfants qui ont un parent ou un proche en prison. L’objectif de cette recherche-action est d’évaluer les conditions, moyens et outils qui permettraient d’offrir une possibilité d’échange (...) aux enfants pour leur rendre possible de partager leurs expériences et d’exprimer ce qui ne peut être dit à des parents, des proches et à leur environnement social (amis, école, voisins...). Les résultats confirment le besoin manifeste de renforcer les pratiques professionnelles autour des familles, et notamment des enfants, grands absents dans nos dispositifs d’accompagnement français. (shrink)

This thesis is the first step in a research project which aims to develop an accurate and robust theory of global justice. The thesis concerns the content of our duties of global justice, under strict compliance theory. It begins by discussing the basic framework of my theory of global justice, which consists in two aspects: duties of minimal wellbeing, which are universal, and duties of fairness and equality, which are associative and not universal. With that in place, it briefly discusses (...) the nature of duties of fairness and equality. I shall argue that they are associative, because they are derived from the form of cooperation at hand; and that there are three kinds of them in our contemporary world: states, local cooperation and trans-state cooperation. It is from their forms of cooperation that these duties are derived. After that, the thesis focuses exclusively on duties of minimal wellbeing. Against the usual account of these duties - the human-flourishing account - I argue for my human-life account. This account argues that the function of these duties is to secure a human life for individuals; and it begins with a Razian conception of wellbeing, which states that the wellbeing of an individual is fundamentally constituted by: (a) the satisfaction of his biological needs, and (b) his success in whole-heartedly pursuing socially defined and determined goals and activities which are in fact valuable. An account of what constitutes a human life is then derived from this conception of wellbeing – it is a life that consists in having a level of wellbeing that is higher than the satisfaction of biological needs, where this is constituted by the pursuit of goals and activities with a sense of what is worth doing; and this in turn consists in: (a) being able to forms ideas of what is worth doing, (b) being able to revise them in light of further reasons, and (c) being able to coordinate one's actions according to them. I then determine the specific objects of duties of minimal wellbeing (means for the satisfaction of biological needs, education, physical security, freedom of belief, association and expression, freedom of non-harmful conduct, and minimal resources), by determining what is involved in securing such a human life for individuals. (shrink)

Let the individuals of a population be divided into two groups with different personal habits. The core group is associated with health risk behaviors; the non-core group avoids unhealthy activities. Assume that the infected individuals of the core group can spread a contagious disease to the whole population. Also, assume that cure does not confer immunity. Here, an epidemiological model written as a set of ordinary differential equations is proposed to investigate the infection propagation in this population. In the model, (...) migrations between these two groups are allowed; however, the transitions from the non-core group into the core group prevail. These migrations can be either spontaneous or stimulated by social pressure. It is analytically shown that, in the scenario of spontaneous migration, the disease is either naturally eradicated or chronically persists at a constant level. In the scenario of stimulated migration, in addition to eradication and constant persistence, self-sustained oscillations in the number of sick individuals can also be found. These analytical results are illustrated by numerical simulations and discussed from a public health perspective. (shrink)

Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in the (...) late stages of Alzheimer’s disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called ‘marginal agents,’ which include young children and patients in the middle stages of Alzheimer’s disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of ‘pre-forms’ of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions – namely, they express the _value_ of autonomy. As I will argue, autonomy is a value worthy of protection and promotion – even in its non-reflexive forms. Against this background, it becomes clear _why_ we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients. (shrink)

Do children have a right to be loved? An affirmative answer faces two immediate challenges: (i) a child's basic needs can be met without love, therefore a defence of such a right cannot appeal to the role of love in protecting children's most basic needs, and (ii) since love is non-voluntary, it seems that there cannot be a corresponding duty on the part of parents to love their child. In this essay, I defend an affirmative answer that overcomes both (...) of these challenges. First, I argue that the right of children to be loved is grounded in the value of children leading meaningful lives. Second, I argue that the right of children to be loved gives rise to a duty on the part of the state to do all that it legitimately can to ensure that procreation and parenting follows from a truly voluntary decision on the part of its citizens. -/- . (shrink)

This article develops a cross-cultural and historical theory of antifeminist movements. Such movements are composed of two elements, which often involve very different types of people: vested-interest groups and voluntary associations. Five predictions concerning the social composition of antifeminist vested-interest groups and voluntary organizations and antifeminist movement ideology are derived from the theory. Evidence taken from existing literature pertaining to both first-wave and second-wave antifeminist movements in a variety of nations is reviewed. Substantial support is found for (...) all five predictions. We conclude that antifeminist movement adherents are responding to realistic threats. For men and vested-interest groups, the threat is primarily class based, but also extends to their status as family head; for women, it is primarily status based as wives and mothers, but also class-based inasmuch as their husbands' economic interests are threatened. (shrink)

Dans le contexte pénitentiaire actuel de la lutte contre la désocialisation, des associations offrent un soutien psychologique et social aux familles des prisonniers. La recherche-action « Regards d’enfants sur l’incarcération » dont rend compte cet article, menée en collaboration avec deux de ces associations, consiste à créer des groupes de soutien pour les enfants qui ont un parent ou un proche en prison. L’objectif de cette recherche-action est d’évaluer les conditions, moyens et outils qui permettraient d’offrir une possibilité d’échange (...) aux enfants pour leur rendre possible de partager leurs expériences et d’exprimer ce qui ne peut être dit à des parents, des proches et à leur environnement social (amis, école, voisins...). Les résultats confirment le besoin manifeste de renforcer les pratiques professionnelles autour des familles, et notamment des enfants, grands absents dans nos dispositifs d’accompagnement français. (shrink)