Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various stakeholders (...) involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. Methods and results We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups. The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Conclusion Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. (shrink)

International health research in malaria-endemic settings may include screening for sickle cell disease, given the relationship between this important genetic condition and resistance to malaria, generating questions about whether and how findings should be disclosed. The literature on disclosing genetic findings in the context of research highlights the role of community consultation in understanding and balancing ethically important issues from participants’ perspectives, including social forms of benefit and harm, and the influence of access to care. To inform research practice locally, (...) and contribute to policy more widely, this study aimed to explore the views of local residents in Kilifi County in coastal Kenya on how researchers should manage study-generated information on sickle cell disease and carrier status. (shrink)

BackgroundCurrent guidelines do not clearly outline when assent should be attained from paediatric research participants, nor do they detail the necessary elements of the assent process. This stems from the fact that the fundamental justification behind the concept of assent is misunderstood. In this paper, we critically assess three widespread ethical arguments used for assent: children’s rights, the best interests of the child, and respect for a child’s developing autonomy. We then outline a newly-developed two-fold justification for the assent process: (...) respect for the parent’s pedagogical role in teaching their child to become an autonomous being and respect for the child’s moral worth.DiscussionWe argue that the ethical grounding for the involvement of young children in medical decision-making does not stem from children’s rights, the principle of best interests, or respect for developing autonomy. An alternative strategy is to examine the original motivation to engage with the child. In paediatric settings there are two obligations on the researcher: an obligation to the parents who are responsible for determining when and under what circumstances the child develops his capacity for autonomy and reasoning, and an obligation to the child himself. There is an important distinction between respecting a decision and encouraging a decision. This paper illustrates that the process of assent is an important way in which respect for the child as an individual can be demonstrated, however, the value lies not in the child’s response but the fact that his views were solicited in the first place.SummaryThis paper demonstrates that the common justifications for the process of assent are incomplete. Assent should be understood as playing a pedagogical role for the child, helping to teach him how specific decisions are made and therefore helping him to become a better decision-maker. How the researcher engages with the child supports his obligation to the child’s parents, yet why the researcher engages with the child stems from the child’s moral worth. Treating a child as having moral worth need not mean doing what they say but it may mean listening, considering, engaging or involving them in the decision. (shrink)

BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic (...) bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide.MethodsWe reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.ResultsAccess to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.ConclusionAlthough in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. (shrink)

The practice of making datasets publicly available for use by the wider scientific community has become firmly integrated in genomic science. One significant gap in literature around data sharing concerns how it impacts on scientists’ ability to preserve values and ethical standards that form an essential component of scientific collaborations. We conducted a qualitative sociological study examining the potential for harm to ethnic groups, and implications of such ethical concerns for data sharing. We focused our empirical work on the MalariaGEN (...) Consortium, one of the first international collaborative genomics research projects in Africa. (shrink)

BackgroundThe concept of benefit sharing to enhance the social value of global health research in resource poor settings is now a key strategy for addressing moral issues of relevance to individuals, communities and host countries in resource poor settings when they participate in international collaborative health research.The influence of benefit sharing framework on the conduct of collaborative health research is for instance evidenced by the number of publications and research ethics guidelines that require prior engagement between stakeholders to determine the (...) social value of research to the host communities. While such efforts as the production of international guidance on how to promote the social value of research through such strategies as benefit sharing have been made, the extent to which these ideas and guidelines have been absorbed by those engaged in global health research especially in resource poor settings remains unclear. We examine this awareness among stakeholders involved in health related research in Kenya.MethodsWe conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.ResultsOur study suggests that although people have a sense of justice and the moral aspects of research, this was not articulated in terms used in the literature and the guidelines on the ethics of global health research.ConclusionThis study demonstrates that while in theory several efforts can be made to address the moral issues of concern to research participants and their communities in resource poor settings, quick fixes such as benefit sharing are not going to be straightforward. We suggest a need to pay closer attention to the processes through which ethical principles are enacted in practice and distil lessons on how best to involve individuals and communities in promoting ethical conduct of global health research in resource poor settings. (shrink)

Treating mathematical science as a distinct cultural entity subject to environmental factors which influence its evolution, the author examines the creation and development of its major concepts since early times.

The question of the ethical life is arguably one of the most compelling, and urgent, questions of our time. As Peter Singer, among others, has pointed out, almost 10 million children die each year due to poverty, some of whom would not die if the amount of aid that we now offer increases significantly. As Singer has also pointed out, the exploitation of human beings and other animals is a major ethical and practical concern. There can be little reasonable doubt (...) that pain and suffering abound, in the world today, due to many causes such as poverty, disease, environmental degradation and destruction and anthropocentrism among others, just as there can be little reasonable doubt that some of the pain and suffering is preventable. So, what does it mean to live ethically today? Does it mean taking the point of view of the universe, as Sidgwick put it, memorably, rather than a narrow anthropocentric or speciesist view? Does it mean living in accordance with duties or obligations, or in light of recognised virtues, or with the minimisation of pain and suffering primarily in mind? Does it entail a consideration of the interests of other species and a rejection of the principle of the sanctity of human life? Does it mean not eating animals when other healthy alternatives are available, especially when those animals have been treated in ways that are inconsistent with their interests, whatever they may be? Does it mean taking active steps to reduce poverty on our part on a day to day basis? Is ethics exhausted in some sense today? And if we could reach some consensus on these questions, what difference would the ethical life make? Some argue that speciesism and the exploitation of human beings and other animals might diminish; that pain and suffering, especially gratuitous pain and suffering, would decrease, or at the very least, not increase; or that we will become more aware of the limitations of things such as "the traditional ethic of the sanctity of life", as Singer calls it. Some argue that the ethical life is closely related to a life of relationships, reflection and deliberation, all of which deepen our understanding and enrich us personally. Others argue that the ethical life is closely related to our search for a meaningful life - that the ethical life can help us to find meaning in a world in which "meaning", defined broadly, can seem elusive, enigmatic or unsubstantial. These and related issues and questions are explored in this collection, which illustrates the relevance, vitality and dynamism of ethics today. (shrink)

Is morality uniquely human or does morality exist in at least some non-human animals? Are animals full-fledged moral creatures or do they merely exhibit proto-morality—evolutionary building blocks or precursors to morality, but not quite the genuine article? Such questions, prompted by remarkable advances in empirical research into the social and emotional lives of non-human animals, have aroused much recent interest amongst scientists, philosophers, and in the popular media, not least for their apparent bearing on questions of human uniqueness, evolution, and (...) the ethical status of animals. The debate over animal morality has produced many valuable contributions and stimulated new areas for empirical and theoretical research. However, focusing on these questions has led researchers to talk at cross-purposes and down some unproductive paths. The problem concerns the terms ‘morality’ and ‘moral’. (shrink)

Following recent arguments that cultural practices in wild animal populations have important conservation implications, we argue that recognizing captive animals as cultural has important welfare implications. Having a culture is of deep importance for cultural animals, wherever they live. Without understanding the cultural capacities of captive animals, we will be left with a deeply impoverished view of what they need to flourish. Best practices for welfare should therefore require concern for animals’ cultural needs, but the relationship between culture and welfare (...) is also extremely complex, requiring us to rethink standard assumptions about what constitutes and contributes to welfare. (shrink)

Empirical studies of the social lives of non-human primates, cetaceans, and other social animals have prompted scientists and philosophers to debate the question of whether morality and moral cognition exists in non-human animals. Some researchers have argued that morality does exist in several animal species, others that these species may possess various evolutionary building blocks or precursors to morality, but not quite the genuine article, while some have argued that nothing remotely resembling morality can be found in any non-human species. (...) However, these different positions on animal morality generally appear to be motivated more by different conceptions of how the term “morality” is to be defined than by empirical disagreements about animal social behaviour and psychology. After delving deeper into the goals and methodologies of various of the protagonists, I argue that, despite appearances, there are actually two importantly distinct debates over animal morality going on, corresponding to two quite different ways of thinking about what it is to define “morality”, “moral cognition”, and associated notions. Several apparent skirmishes in the literature are thus cases of researchers simply talking past each other. I then focus on what I take to be the core debate over animal morality, which is concerned with understanding the nature and phylogenetic distribution of morality conceived as a psychological natural kind. I argue that this debate is in fact largely terminological and non-substantive. Finally, I reflect on how this core debate might best be re-framed. (shrink)

Reevaluates the ideas of the German general, shows how his writings have been misinterpreted, and applies Clausewitzian theory to twentieth century political history.

Philosophy is one of the most intimidating and difficult of disciplines, as any of its students can attest. This book is an important entry in a distinctive new series from Routledge: "The Great Philosophers." Breaking down obstacles to understanding the ideas of history's greatest thinkers, these brief, accessible, and affordable volumes offer essential introductions to the great philosophers of the Western tradition from Plato to Wittgenstein.In just 64 pages, each author, a specialist on his subject, places the philosopher and his (...) ideas into historical perspective. Each volume explains, in simple terms, the basic concepts, enriching the narrative through the effective use of biographical detail. And instead of attempting to explain the philosopher's entire intellectual history, which can be daunting, this series takes one central theme in each philosopher's work, using it to unfold the philosopher's thoughts. (shrink)

‘To Gödel via Babel’, MIND, July 1966.In (1), the last clause should read: ‘then the GN of the resulting P-sentence is x100.y’ In (21), the expression in Roman numerals should read: ‘$$Y.\frac{\hbox{ L }Y}{\hbox{ XIX }}$$’ In (25) and (27), the expression in Roman numerals should read: ‘$${(\hbox{ C }}^{\hbox{ XVII }}.\hbox{ D })\hbox{ . }\frac{\hbox{ L }\left({\hbox{ C }}^{\hbox{ XVII }}.\hbox{ D }\right)}{\hbox{ XIX }}$$’.

This article is a critical examination of two distinct linguistic approaches to religion. the first employs the principle that peripheral uses of words are parasitic on their central uses to exclude religious language on grounds of a-typicality. this is criticized on grounds that meaning of words is not simply given in language but tied to understanding or explanatory framework. hence a-typicality objections lose force. the second, represented by d z phillips, immunizes religious language against outside criticism by claiming its criteria (...) of intelligibility to be internal. this claim is argued against by means of contradiction between phillips' content and performance; claim to philosophical neutrality is also questioned. (shrink)

Raymond Durgnat here examines literally hundreds of films in an effort to isolate universals of the language of films and to loft their poetics to an articulate level.

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)

_Foucault’s Law_ is the first book in almost fifteen years to address the question of Foucault’s position on law. Many readings of Foucault’s conception of law start from the proposition that he failed to consider the role of law in modernity, or indeed that he deliberately marginalized it. In canvassing a wealth of primary and secondary sources, Ben Golder and Peter Fitzpatrick rebut this argument. They argue that rather than marginalize law, Foucault develops a much more radical, nuanced and (...) coherent theory of law than his critics have acknowledged. For Golder and Fitzpatrick, Foucault’s law is not the contained creature of conventional accounts, but is uncontainable and illimitable. In their radical re-reading of Foucault, they show how Foucault outlines a concept of law which is not tied to any given form or subordinated to a particular source of power, but is critically oriented towards alterity, new possibilities and different ways of being. _Foucault’s Law_ is an important and original contribution to the ongoing debate on Foucault and law, engaging not only with Foucault’s diverse writings on law and legal theory, but also with the extensive interpretive literature on the topic. It will thus be of interest to students and scholars working in the fields of law and social theory, legal theory and law and philosophy, as well as to students of Foucault’s work generally. (shrink)

This edition focuses on Aron's lifelong attempt to bridge the gap between knowledge and action and to understand the dialectical relationship between history ...

Social norms – rules governing which behaviours are deemed appropriate or inappropriate within a given community – are typically taken to be uniquely human. Recently, this position has been challenged by a number of philosophers, cognitive scientists, and ethologists, who have suggested that social norms may also be found in certain non-human animal communities. Such claims have elicited considerable scepticism from norm cognition researchers, who doubt that any non-human animals possess the psychological capacities necessary for normative cognition. However, there is (...) little agreement among these researchers about what these psychological prerequisites are. This makes empirical study of animal social norms difficult, since it is not clear what we are looking for and thus what should count as behavioural evidence for the presence (or absence) of social norms in animals. To break this impasse, we offer an approach that moves beyond contested psychological criteria for social norms. This approach is inspired by the animal culture research program, which has made a similar shift away from heavily psychological definitions of ‘culture’ and to become organized around a cluster of more empirically tractable concepts of culture. Here, we propose an analogous set of constructs built around the core notion of a normative regularity, which we define as a socially maintained pattern of behavioural conformity within a community. We suggest methods for studying potential normative regularities in wild and captive primates. We also discuss the broader scientific and philosophical implications of this research program with respect to questions of human uniqueness, animal welfare and conservation. (shrink)

Acknowledged as perhaps _the_ masterpiece of materialist criticism in the English language, this omnibus ranges over British literary history from George Eliot to George Orwell to inquire about the complex ways economic reality shapes the imagination.

Cognitive theories of metaphor understanding are typically described in terms of the mappings between different kinds of abstract, schematic, disembodied knowledge. My claim in this paper is that part of our ability to make sense of metaphorical language, both individual utterances and extended narratives, resides in the automatic construction of a simulation whereby we imagine performing the bodily actions referred to in the language. Thus, understanding metaphorical expressions like ‘grasp a concept’ or ‘get over’ an emotion involve simulating what it (...) must be like to engage in these specific activities, even though these actions are, strictly speaking, impossible to physically perform. This process of building a simulation, one that is fundamentally embodied in being constrained by past and present bodily experiences, has specific consequences for how verbal metaphors are understood, and how cognitive scientists, more generally, characterize the nature of metaphorical language and thought. (shrink)

Human communities teem with a variety of social norms. In order to change unjust and harmful social norms, it is crucial to identify the psychological processes that give rise to them. Most researchers take it for granted that social norms are uniquely human. By contrast, we approach this matter from a comparative perspective, leveraging recent research on animal social behaviour. While there is currently only suggestive evidence for norms in nonhuman communities, we argue that human social norms are likely produced (...) by a wide range of mechanisms, many of which we share with nonhuman animals. Approaching this variability from a comparative perspective can help norm researchers expand and reframe the range of hypotheses they test when attempting to understand the causes of socially normative behaviours in humans. First, we diagnose some of the theoretical obstacles to developing a comparative science of social norms, and offer a few basic constructs and distinctions to help norm researchers overcome these obstacles. Then we develop a six-dimensional model of the psychological and social factors that contribute to variability in both human and potential nonhuman norms. -/- This article is part of the theme issue ‘Social norm change: drivers and consequences’. (shrink)

Cognitive theories of metaphor understanding are typically described in terms of the mappings between different kinds of abstract, schematic, disembodied knowledge. My claim in this paper is that part of our ability to make sense of metaphorical language, both individual utterances and extended narratives, resides in the automatic construction of a simulation whereby we imagine performing the bodily actions referred to in the language. Thus, understanding metaphorical expressions like ‘grasp a concept’ or ‘get over’ an emotion involve simulating what it (...) must be like to engage in these specific activities, even though these actions are, strictly speaking, impossible to physically perform. This process of building a simulation, one that is fundamentally embodied in being constrained by past and present bodily experiences, has specific consequences for how verbal metaphors are understood, and how cognitive scientists, more generally, characterize the nature of metaphorical language and thought. (shrink)

This paper explores the trade-off between cognitive effort and cognitive effects during immediate metaphor comprehension. We specifically evaluate the fundamental claim of relevance theory that metaphor understanding, like all utterance interpretation, is constrained by the presumption of optimal relevance (Sperber and Wilson, 1995, p. 270): the ostensive stimulus is relevant enough for it to be worth the addressee's effort to process it, and the ostensive stimulus is the most relevant one compatible with the communicator's abilities and preferences. One important implication (...) of optimal relevance is that listeners follow a path of least effort and stop processing at the first interpretation that satisfies their expectation of relevance. They do this by trying to minimize cognitive effort while maximizing cognitive effects. Some relevance theory scholars suggest that metaphors should require additional cognitive effort to be understood, and that in return they yield more cognitive effects than does literal speech. Others claim that metaphors may be understood quickly, as soon as people infer enough effects for the speaker's utterance to meet their expectation of optimal relevance. Our analysis of the experimental evidence suggests that there is no systematic relationship between cognitive effort and cognitive effects in metaphor comprehension. We conclude that relevance theory need not make any general predictions about the effort needed to comprehend metaphors. Nevertheless, relevance theory is consistent with many of the findings in psycholinguistics on metaphor understanding, and can account for aspects of metaphor understanding that no other theory can explain. (shrink)

This paper explores the trade-off between cognitive effort and cognitive effects during immediate metaphor comprehension. We specifically evaluate the fundamental claim of relevance theory that metaphor understanding, like all utterance interpretation, is constrained by the presumption of optimal relevance (Sperber and Wilson, 1995, p. 270): the ostensive stimulus is relevant enough for it to be worth the addressee’s effort to process it, and the ostensive stimulus is the most relevant one compatible with the communicator’s abilities and preferences. One important implication (...) of optimal relevance is that listeners follow a path of least effort and stop processing at the first interpretation that satisfies their expectation of relevance. They do this by trying to minimize cognitive effort while maximizing cognitive effects. Some relevance theory scholars suggest that metaphors should require additional cognitive effort to be understood, and that in return they yield more cognitive effects than does literal speech. Others claim that metaphors may be understood quickly, as soon as people infer enough effects for the speaker’s utterance to meet their expectation of optimal relevance. Our analysis of the experimental evidence suggests that there is no systematic relationship between cognitive effort and cognitive effects in metaphor comprehension. We conclude that relevance theory need not make any general predictions about the effort needed to comprehend metaphors. Nevertheless, relevance theory is consistent with many of the findings in psycholinguistics on metaphor understanding, and can account for aspects of metaphor understanding that no other theory can explain. (shrink)

Background Community advisory boards have expanded beyond high-income countries and play an increasing role in low- and middle-income country research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. Methods We searched five databases for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed (...) articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. Results Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa, China, and Thailand having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. Conclusions Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs. (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)