This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Studying Penguins to Understand BirdsJacinta O. A. Tan (bio), Anne Stewart (bio), Ray Fitzpatrick (bio), and Tony Hope (bio)Keywordsanorexia nervosa, treatment decision-making, competence, valuesWe are grateful to Grisso, Appelbaum, Charland, and Vollmann for their thoughtful commentaries on our paper. We would like to respond by picking up on some of the points they make, although we do not address all the issues raised.Our general aims in the (...) paper are less immediately pragmatic than are the central concerns of Grisso and Appelbaum. Our interest is primarily in a number of ethical, and related conceptual, issues that arise from empirical data. In the long run, of course, we believe that these ethical and conceptual issues are important to the care of people with mental disorders, but our focus is philosophical.Our central interest is what justifies overriding treatment refusal. We are unhappy with a "status" approach according to which, for example, the mere fact that a person suffers a mental disorder provides grounds for overriding her wishes. Such an approach, it seems to us, fails to identify reasons, and discriminates against those with mental disorder, a view shared by the Law Commission (The Law Commission 1995). We are, on the other hand, attracted by the approach that grounds any overriding of treatment refusal on lack of capacity (or competence) to make treatment decisions. The concept of capacity has been well developed through legal cases and conceptual analysis, not least by Grisso and Appelbaum themselves. We were struck, however, first through clinical experience, and subsequently from the pilot study reported in our paper, that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity, using the current criteria, and yet show features or give reasons that raise serious doubts as to whether it is right to respect their refusal of treatment.To avoid reliance on a "status" approach, the issue with which we are grappling is whether the concept of capacity (and therefore lack of capacity) can be developed to encompass some of our findings, and whether it is ethically right to do so. Charland makes the important point that the concept of competence, or capacity, has both a descriptive and a prescriptive component. It is for this reason that the question of whether, for example, we should extend the criteria for capacity is part of the question of when it is morally right to override treatment refusal.Grisso and Appelbaum suggest that our work advances "our thinking about appreciation, rather than requiring that we add new elements" (2006, 297). From our perspective, and at this stage, it is a secondary issue whether we are suggesting a development of appreciation, or a new element (e.g., "pathological values"). The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in [End Page 299] such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests.We chose to study anorexia nervosa for various reasons, but we expect that the issues raised have a more general relevance (such as to substance abuse and impulse control disorders as Grisso and Appelbaum and Charland suggest). We do not expect the results to be relevant to all, or even most, mental disorders. Our main interest is not the specific management of people with anorexia, but how the data challenge, and help to develop, the concept of capacity, and the ethical analysis of overriding patient refusal of treatment. Our paper aims to address what we understand Charland to be referring to by the "pretheoretical desiderata" (2006, 283) of the concept of capacity. One reason why we chose anorexia as the focus of this work is because it is different from many mental disorders in the issues that it raises. In this it is, perhaps, rather like studying penguins to better understand the concept of bird just because penguins, although clearly birds, have unusual features.We agree, therefore, with Grisso and Appelbaum's caution that it would be unwise to jump in and change the MacCAT-T on the basis of the results... (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

This article represents the outcome of a dialogue between a vet and a healthcare ethicist on the theme of ‘love’ in professional life. We focus on four types or varieties of love in relation to the professional care of humans and animals. We discuss the relevance of Fromm’s core elements of love and consider the implications of these for human and animal health care practice. We present and respond to five arguments that might be waged against embracing love as a (...) professional value in veterinary and medical practice. We argue that a moderated love can and should be reclaimed as a contemporary professional value. It is most helpfully contextualised within virtue ethics or care ethics. We suggest that love is a rich starting point from which to launch an exploration of an interprofessional humanimal clinical ethics. (shrink)

Intent and mitigating circumstances play a central role in moral and legal assessments in large-scale industrialized societies. Al- though these features of moral assessment are widely assumed to be universal, to date, they have only been studied in a narrow range of societies. We show that there is substantial cross-cultural variation among eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural) in the extent to which intent and mitigating circumstances influence (...) moral judgments. Although participants in all societies took such factors into account to some degree, they did so to very different extents, varying in both the types of considerations taken into account and the types of violations to which such considerations were applied. The particular patterns of assessment characteristic of large-scale industrialized societies may thus reflect relatively recently culturally evolved norms rather than inherent features of human moral judgment. (shrink)

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

Assessing Biblical and Classical Sources for the Reconstruction of Persian Influence, History and Culture. Edited by Anne Fitzpatrick-Mckinley. Classica et Orientalia, vol. 10. Wiesbaden: Harrassowitz Verlag, 2015. Pp. 216. €52.

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

"In Applied Ethics and Social Problems Tony Fitzpatrick presents introductions to the three most influential moral philosophies: consequentialism, Kantianism ...

L'art occupe dans la pensée de Deleuze une place déterminante. De la littérature au cinéma, de la lettre à l'image, Deleuze théorise le domaine de l'art avec des concepts très nouveaux, attrayants et difficiles : corps sans organes, machines désirantes, devenir-animal, rhizome, lignes de fuite... Il s'agit ici d'en exposer le fonctionnement exact en montrant pourquoi l'art, selon Deleuze, devient une machine à explorer les devenirs des sociétés : critique et clinique, il détecte et rend sensibles les forces sociales. Mais (...) l'art produit surtout des effets réels, et non pas simplement imaginaires : l'image n'est donc pas une donnée mentale mais bien une réalité existante. Cet ouvrage se propose de faciliter l'accès à l'œuvre décisive de Deleuze, en restituant ses parcours dans un souci d'extrême clarté. (shrink)

This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for (...) true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making. (shrink)

Advanced directives and living wills have improved our ability to dictate end-of-life care, but even these cannot guarantee that we will be allowed the dignity of a natural death. Designed by two sisters-one a doctor, one a lawyer-and drawing on their decades of experience, the five-step Compassion Protocol outlined in A Better Way of Dying offers a simple and effective framework for leaving caretakers concrete, unambiguous, and legally binding instructions about your wishes for your last days. Meant for people in (...) every walk of life-from the elderly, to those in the early stages of mentally degenerative diseases like Alzheimer's, to healthy young people planning for an unpredictable future-this book creates space for a discussion we all must have if we wish to ensure comfort and control at the end of our lives.." -- from publisher's website. (shrink)

This volume explores the relationship between individuals and institutions in scholastic thought and practice across the twelfth and fifteenth centuries, setting an agenda for future debates. Written by leading European experts from numerous fields, this theoretically sophisticated collection analyses a wide range of intellectual practices and disciplines. Avoiding narrow approaches to scholasticism, the book addresses ethics, history, heresy, law, inquisition, metaphysics, pastoral care, poetry, religious orders, saints' cults and theology. A substantial introduction establishes an accessible historiographical context for the volume's (...) agenda, and a final afterword examines implications for future research. The history of individuals and institutions in scholasticism has often been unhelpfully treated either as a simple intellectual genealogy of schools and doctrines, or a constitutional history of particular organizational forms. This volume advances our understanding by reconsidering these fields as a whole and addressing two large questions. What was the relationship between particular intellectuals and their wider networks? How did individuals alter their institutions, and how did those institutions shape their individuality? This volume is of major importance to intellectual, religious and cultural historians as well as historians of knowledge and science. It will engage those working on individuals and institutions in the middle ages as well as in other periods. (shrink)

Think Like an Economist is a fun introduction to the main concepts of economics. It illustrates how the subject has a clear, practical purpose vital to our daily lives and thinking; includes stories of many of the world's greatest economists; and covers the history of economics from the early barter system through the Industrial Revolution to the emergence of globalization.

This article explores the themes of trust and ethical conduct in social research, with particular attention to the trust that can develop between the members of a research team as well as between researchers and the researched. The authors draw upon a three-year empirical study of destinations and outcomes for young people excluded from alternative educational provision. They also make reference to a contemporary exposition of Aristotle's writing on friendship in order to explore two sets of relevant distinctions that have (...) a bearing upon our understanding of relationships that emerge in the context of social research projects. These distinctions are between impartiality and selectivity on the one hand, and between universality and particularity on the other. The authors attempt to demonstrate that these distinctions influence the development of trust and the conduct of ethical research, arguing that the latter is not synonymous with compliance to ethical guidelines. (shrink)

The feminist philosopher and social scientist shows how "gendering" has affected the social and natural sciences as she reconciles the long-standing dichotomy between the quantitative and qualitative methods and demonstrates the tandem use of both experimental and intuitive approaches.

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents, which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, the article argues that in order for any collateral damage to be morally permissible, violent agents must comply with (...) high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him- or herself. It is argued that accidentally but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, can unintended harm to innocents – incidental or accidental – be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently using. (shrink)

A fallibilist theory of knowledge is employed to make sense of the idea that agents know what they are doing 'without observation' (as on Anscombe's theory of practical knowledge).

WINNER BEST SOCIAL PHILOSOPHY BOOK IN 2021 / NASSP BOOK AWARD 2022 -/- Together we can often achieve things that are impossible to do on our own. We can prevent something bad from happening or we can produce something good, even if none of us could do it by herself. But when are we morally required to do something of moral importance together with others? This book develops an original theory of collective moral obligations. These are obligations that individual moral (...) agents hold jointly, but not as unified collective agents. To think of some of our obligations as joint or collective is the best way of making sense of our intuitions regarding collective moral action problems. Where we have reason to believe that our efforts are most efficient as part of a collective endeavor we may incur collective obligations together with others who are similarly placed as long as we are able to establish compossible individual contributory strategies towards that goal. The book concludes with a discussion of “massively shared obligations” to large-scale moral problems such as global poverty. (shrink)

Two experiments were run to demonstrate the presence of a partial reinforcement extinction effect (PREE) and a partial punishment effect (PPE) 4 weeks after training in a 1-trial/day procedure. In the PREE paradigm, two groups of animals were trained to run a straight alley for food reward; one group was rewarded on every trial (CRF), whereas the other was rewarded on only 50% of the trials (PRF). In the test phase, extinction, no reward was present on any trial. Four weeks (...) after the end of acquisition, and subsequent to 7 days of CRF retraining, PRF animals showed greater resistance to extinction than did their CRF controls. The PPE paradigm resembled the PREE paradigm in all aspects, except that mild electric foot shock, together with the food reward, was used instead of nonreward on 50% of the acquisition trials. In the test phase, all animals were shocked and given a food reward on every trial. Four weeks after the end of acquisition and retraining, the animals with previous experience of shock in acquisition showed greater resistance to punishment than did their controls. (shrink)

Together we can achieve things that we could never do on our own. In fact, there are sheer endless opportunities for producing morally desirable outcomes together with others. Unsurprisingly, scholars have been finding the idea of collective moral obligations intriguing. Yet, there is little agreement among scholars on the nature of such obligations and on the extent to which their existence might force us to adjust existing theories of moral obligation. What interests me in this paper is the perspective of (...) the moral deliberating agent who faces a collective action problem, i.e. the type of reasoning she employs when deciding how to act. I hope to show that agents have collective obligations precisely when they are required to employ ‘we-reasoning’, a type of reasoning that differs from I-mode, best response reasoning, as I shall explain below. More precisely, two (or more) individual agents have a collective moral obligation to do x if x is an option for action that is only collectively available (more on that later) and each has sufficient reason to rank x highest out of the options available to them. (shrink)

The standard view of ignorance is that it consists in the mere lack of knowledge or true belief. Duncan Pritchard has recently argued, against the standard view, that ignorance is the lack of knowledge/true belief that is due to an improper inquiry. I shall call, Pritchard’s alternative account the Normative Account. The purpose of this article is to strengthen the Normative Account by providing an independent vargument supporting it.

What is it that makes us as citizens liable for the actions – including the wrongdoings – of our state? Answering this question is part of the larger debate on the nature of complicity and collective action. When are we connected to joint endeavours and collective outcomes in a way that makes us (on some level) responsible for them? -/- Of particular interest within this debate is the normative relationship of citizens to their state. For instance, when states pay reparations (...) for past crimes the costs are – one way or another – borne by their citizens. In Responsible Citizens, Irresponsible States (OUP 2021), Avia Pasternak examines with admirable clarity and circumspection if states are justified in imposing the cost of their past wrongdoings on all of their citizens, including those who played no obvious part in those crimes. (shrink)

Local opposition to infrastructure projects implementing renewable energy (RE) such as wind farms is often strong even if state-wide support for RE is strikingly high. The slogan “Not In My BackYard” (NIMBY) has become synonymous for this kind of protest. This paper revisits the question of what is wrong with NIMBYs about RE projects and how to best address them. I will argue that local opponents to wind farm (and other RE) developments do not necessarily fail to contribute their fair (...) share to producing a desirable public good (clean energy). In fact, with landscape concerns being at the heart of much protest, the question of fair burden distribution becomes sidelined: landscape impacts cannot be distributed nor compensated for. Protests may be attempts to express a true conflict of (incommensurable) values. Understanding them as such will help us better address NIMBY concerns and overcome such opposition through ensuring procedural justice. (shrink)

Une morale pour les mortels est une etude d'ensemble de l'ethique de Platon et d'Aristote, a partir de la problematique philosophique qui lui donne corps: la mortalite de l'etre humain, source de ses desirs et de leur perpetuelle insatisfaction. Par contraste avec une morale du devoir, on decouvre ici une morale qui s'exprime par un il faut, poussant vers une fin qui puisse repondre au manque et au besoin qui marquent la condition humaine. A partir de cette problematique sont repris (...) et eclaires tous les concepts et theses classiques de l'ethique ancienne: la question de la mesure et de l'harmonie, la vertu dans son unite et sa pluralite, le bonheur, le bien, le plaisir, l'amitie, l'amour de soi, la volonte et les autres desirs, l'intention, l'action, et surtout la verite du paradoxe nul n'est mechant de plein gre, dont sont exposees la resistance face aux critiques d'Aristote et les consequences dans le domaine penal. L'ensemble met en valeur la specificite de l'etre humain decelee par les Anciens: qu'il soit un etre tout a la fois desirant et pensant. (shrink)

Humans are prone to producing morally suboptimal and even disastrous outcomes out of ignorance. Ignorance is generally thought to excuse agents from wrongdoing, but little attention has been paid to group-based ignorance as the reason for some of our collective failings. I distinguish between different types of first-order and higher order group-based ignorance and examine how these can variously lead to problematic inaction. I will make two suggestions regarding our epistemic obligations vis-a-vis collective (in)action problems: (1) that our epistemic obligations (...) concern not just our own knowledge and beliefs but those of others, too and (2) that our epistemic obligations can be held collectively where the epistemic tasks cannot be performed by individuals acting in isolation, for example, when we are required to produce joint epistemic goods. (shrink)

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

It is often argued that our obligations to address structural injustice are collective in character. But what exactly does it mean for ‘ordinary citizens’ to have collective obligations visà- vis large-scale injustice? In this paper, I propose to pay closer attention to the different kinds of collective action needed in addressing some of these structural injustices and the extent to which these are available to large, unorganised groups of people. I argue that large, dispersed and unorganised groups of people are (...) often in a position to perform distributive collective actions. As such, ordinary citizens can have massively shared obligations to address structural injustice through distributive action, but, ultimately, such obligations are ‘collective’ only in a fairly weak sense. (shrink)

In early China, was it correct for a woman to disobey her father, contradict her husband, or shape the public policy of a son who ruled over a dynasty or state? According to the _Lienü zhuan_, or_ Categorized Biographies of Women_, it was not only appropriate but necessary for women to step in with wise counsel when fathers, husbands, or rulers strayed from the path of virtue. Compiled toward the end of the Former Han dynasty (202 BCE-9 CE) by Liu (...) Xiang (79-8 BCE), the _Lienü zhuan_ is the earliest extant book in the Chinese tradition solely devoted to the education of women. Far from providing a unified vision of women's roles, the text promotes a diverse and sometimes contradictory range of practices. At one extreme are exemplars resorting to suicide and self-mutilation as a means to preserve chastity and ritual orthodoxy. At the other are bold and outspoken women whose rhetorical mastery helps correct erring rulers, sons, and husbands. The text provides a fascinating overview of the representation of women's roles in early legends, formal speeches on statecraft, and highly fictionalized historical accounts during this foundational period of Chinese history. Over time, the biographies of women became a regular feature of dynastic and local histories and a vehicle for expressing and transmitting concerns about women's social, political, and domestic roles. The _Lienü zhuan_ is also rich in information about the daily life, rituals, and domestic concerns of early China. Inspired by its accounts, artists across the millennia have depicted its stories on screens, paintings, lacquer ware, murals, and stone relief sculpture, extending its reach to literate and illiterate audiences alike. (shrink)