Advance directives (ADs) have for some time been championed by ethicists and patient associations alike as a tool that people newly diagnosed with dementia, or prior to onset, may use to ensure that their future care and treatment are organized in accordance with their interests. The idea is that autonomous people, not yet neurologically affected by dementia, can design directives for their future care that caregivers are morally obligated to respect because they have been designed by autonomous individuals. In this (...) paper, we first criticize the idea that ADs can retain moral authority in severe dementia by arguing that it is paradoxical. Second, we consider two arguments that initially seem to refute this critique of ADs, but we eventually dismiss them. The first argument states that ADs retain moral authority in severe dementia because autonomously formed interests, for example, ADs, can only be appropriately discarded by autonomous persons. This we term the historical autonomy argument. We dismiss it by demonstrating how we, in analog cases, are not obligated to continue to respect autonomously formed interests even though they have been discarded under nonappropriate conditions. The second argument is that ADs can be justified by what we term external interests. While we agree that people with severe dementia plausible can be said to have external interests, we show that ADs cannot express such interests and hence cannot be justified by them. We conclude that none of the discussed arguments support the use of ADs and because of this, the idea of ADs should be reassigned. (shrink)

PhD, Institute of Public Health, Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099 1014 Copenhagen. Tel: +45 30 32 33 63; Email: s.lauridsen{at}pubhealth.ku.dk ' + u + '@ ' + d + ' '/ /- ->Citizens’ consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on (...) any single principle governing priorities among groups of patients. The Accountability for Reasonableness framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels’ and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare. CiteULike Connotea Del.icio.us What's this? (shrink)

The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack (...) of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions. (shrink)

Triage is a widespread principle for prioritizing patients in emergency departments. The purpose of triage is to ensure that in emergency situations, whenever medical demand exceeds medical supply, limited resources should be directed to the case with the greatest clinical need. Triage fulfills this purpose by ranking patients according to how acute their condition is and then giving priority to the most acute ones. In this paper, I argue that this current practice of triage needs to be supplemented. Contemporary triage (...) is based on a principle of preserving patients’ core capabilities, which is relevant when it comes to prioritizing acute patients above sub‐acute ones, but not for prioritizing among sub‐acute patients, which is the largest group of emergency patients. Henceforth, I propose to supplement triage with what I term the real dialogue model, a framework that, when combined with enhanced professional autonomy for clinical decision‐makers, enables fair prioritizing among sub‐acute patients. (shrink)

Alternative allocations of a fixed bundle of healthcare resources often involve significantly different indirect, non-health effects. The question arises whether these effects must figure in accounts of the conditions under which a distribution of healthcare resources is morally justifiable. In this article we defend a Scanlonian, affirmative answer to this question: healthcare resource managers should sometimes select an allocation which has worse direct, health-related effects but better indirect, nonhealth effects; they should do this when the interests served by such a (...) policy are more urgent than the healthcare interests better served by an alternative allocation. We note that there is a prima facie case for the claim that such benefits (and costs) are relevant—i.e. they are real benefits, and in other contexts our decisions can permissibly be guided by them. We then proceed to rebut three lines of argument that might be thought to defeat this prima facie case: they appeal to fairness, the Kantian Formula of Humanity as an End in Itself, and the equal moral worth of persons, respectively. (shrink)

BackgroundDementia care is essential to promote the well-being of patients but remains a difficult task prone to ethical issues. These issues include questions like whether manipulating a person with dementia is ethically permissible if it promotes her best interest or how to engage with a person who is unwilling to recognize that she has dementia. To help people living with dementia and their carers manage ethical issues in dementia care, we developed the CARE intervention. This is an intervention focused on (...) promoting the ethical self-efficacy of people living with dementia and carers, i.e., their confidence that they can manage ethical issues when they occur. The purpose of this paper is to explain and discuss how we have developed the CARE intervention to promote the ethical self-efficacy of people living with dementia, their family, and professional carers through a specific and, we believe, new use of literary texts.MethodsThe CARE intervention has been developed in two phases: First, we conducted a needs assessment of the occurrence of ethical issues in dementia care and the need for an intervention to support people living with dementia and their carers in managing such issues. Second, in a design phase, we developed the CARE intervention to meet identified needs.ResultsTo address identified ethical issues in dementia care we designed the CARE intervention as a workshop format where people living with dementia and carers can meet, discuss literary texts, and deliberate on how to solve such issues. The workshop is structured by the following elements: An agenda of ethical issues, a collection of literary cases exemplifying ethical issues, a moderator with an understanding of dementia care, and an overview of the ethical principles relevant to the discussion of ethical issues. >This workshop concept is operationalized in three applications tailored to meet the specific ethical issues of each of the study´s three target groups: people living with dementia and family carers, professional and family carers, and professional carers.ConclusionWe conclude the paper by stating that it is possible to develop an intervention that promotes the ethical self-efficacy of people living with dementia and family and professional carers. (shrink)

Conceptual engineers seek to revise or replace the devices we use to speak and think. If this amounts to an effort to change what natural language expressions mean, conceptual engineers will have a hard time. It is largely unfeasible to change the meaning of e.g. ‘cause’ in English. Conceptual engineers may therefore seem unable to make the changes they aim to make. This is what I call ‘the implementation problem’. In this paper, I argue that the implementation problem dissolves if (...) we expand our view of how conceptual engineers could implement the products of their work. I describe four implementation options: Standing Meaning, Meaning Modulation, Speaker-Meaning and Different Language. I query the feasibility and worth of pursuing these options. Unless each option fails because it is unfeasible or not worthwhile, conceptual engineers do not face an implementation problem worth worrying about. I argue that some of the options are feasible and worthwhile, and therefore, that conceptual engineers do not face an implementation problem worth worrying about. (shrink)

On a representationalist view, conceptual engineering is the practice of changing the extensions and intensions of the devices we use to speak and think. But if this view holds true, conceptual engineering has a bad rationale. Extensions and intensions are not the sorts of things that are better or worse as such. A representationalist account of conceptual engineering thus falls prey to the objection that the practice has a bad rationale. To account for the assumption that conceptual engineering is worthwhile, (...) we propose to view what is being engineered as inferential devices, as opposed to representational devices. The objective is not to establish that being or having an inferential role is all there is to meaning or conceptual content. Rather, our agenda is to recommend a shift of focus from the representational features of content to the inferential features of content for the purposes of doing and thinking about conceptual engineering. Inferentialism about conceptual engineering makes better sense of the practice than a representationalist approach: In addition to accounting for the rationality of engaging in conceptual engineering, inferentialism provides a sound interpretation of what is at stake in concrete examples of conceptual engineering. (shrink)

Many theorists of conceptual engineering appeal to the functions, roles, purposes or aims of concepts to articulate how conceptual engineering ought to be done. The functional approach to conceptual engineering is well-motivated: It promises a good account of the limits of revision, and of what makes some concept good. In this paper, I raise a problem for the functional approach which concerns the existence of harmful and methodologically insignificant concept functions. I examine whether we can deal with these problematic functions (...) by adopting a technical notion of function. I thus review the prospects for using the notions of a contextually stable function, of a designed function, of a proper function, and of a system function as our operative notion of function. None of them help us resolve the problem. On this basis, I argue that advocates of the functional approach should be committed to a comparatively weak claim, according to which functions must be assessed case-by-case, and that we are best served by employing an unsophisticated notion of function, according to which the function of a concept just is something the concept is used for. (shrink)

Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or “hidden rationing”, into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of (...) individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients’ individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy. (shrink)

During his lifetime, Friedrich Schleiermacher went on many journeys, not only within Germany but also abroad. His last journey took him, in the last year of his life (1833), to Scandinavia, where he during many weeks travelled through parts of Sweden, Norway and Denmark. His stay in Copenhagen at the end of the journey is sufficiently documented by scholars but there exists, as far as I know, no corresponding account of the many weeks on Swedish and Norwegian soil. The aim (...) of the present paper is therefore to examine this longest part of the journey: Which way did Schleiermacher travel, which towns and places did he visit, whom did he have contact with and what else did he experience on his way? And – finally: what was the motivation of this 64 years old scholar for embarking on such a strenuous undertaking which a journey of many weeks – on land and at sea – certainly must have been in this period of our history? (shrink)

During his lifetime, Friedrich Schleiermacher went on many journeys, not only within Germany but also abroad. His last journey took him, in the last year of his life (1833), to Scandinavia, where he during many weeks travelled through parts of Sweden, Norway and Denmark. His stay in Copenhagen at the end of the journey is sufficiently documented by scholars but there exists, as far as I know, no corresponding account of the many weeks on Swedish and Norwegian soil. The aim (...) of the present paper is therefore to examine this longest part of the journey: Which way did Schleiermacher travel, which towns and places did he visit, whom did he have contact with and what else did he experience on his way? And – finally: what was the motivation of this 64 years old scholar for embarking on such a strenuous undertaking which a journey of many weeks – on land and at sea – certainly must have been in this period of our history? (shrink)

Many moral and political theorists have recently argued that the fact that an agent has innocently benefited from wrongdoing or injustice can ground special moral duties to help out the victims or simply give up the benefits. This idea is often referred to as the ‘Beneficiary Pays Principle’. This article critically assesses three recent attempts at providing a rationale for the BPP and argues that there are profound problems with each of them. It argues that even if we accept plausible (...) versions of the different normative ideas these accounts appeal to, we have no reason to accept the BPP. (shrink)

This book examines the speculative core of Karl Barth’s theology, reconsidering the relationship between theory and practice in Barth’s thinking. A consequence of this reconsideration is the recognition that Barth’s own account of his theological development is largely correct. Sigurd Baark draws heavily on the philosophical tradition of German Idealism, arguing that an important part of what makes Barth a speculative theologian is the way his thinking is informed by the nexus of self-consciousness, reason and, freedom, which was most (...) fully developed by Kant, Fichte, and Hegel. The book provides a new interpretation of Barth’s theology, and shows how a speculative understanding of theology is useful in today’s intellectual climate. (shrink)

Some normative theorists believe that there is a principled moral reason not to retain benefits realized by injustice or wrongdoing. However, critics have argued that this idea is implausible. One purported problem is that the idea lacks an obvious rationale and that attempts to provide one have been unconvincing. This paper articulates and defends the idea that the principled reason in question has an expressive quality: it gets its reason-giving force from the symbolic aptness of such an act as an (...) expressive response to wrongdoing. The paper thus argues that at least in a certain subset of cases, renouncing benefits realized by injustice amounts to a powerful and uniquely apt expression of protest against the disrespect for the victim that is implied by the wrongdoer’s actions. The paper shows how this idea can inform the question of reparations for slavery and its aftermath in the United States. Lastly it develops an important objection to the argument presented and gives an account of how this objection can be met. (shrink)

This paper proposes that the “beneficiary pays principle” may be grounded in a brand of respect for autonomy. I first argue that on one understanding, such respect implies that as far as we are not morally required to make some sacrifice in service of some purpose, we each have legitimate authority to ourselves decide the purposes for which we should make sacrifices. I then argue that the problem with retaining benefits realized by imposed sacrifices, which the victim was not required (...) to make in order to realize the benefits in question, is that doing so is disrespectful of the victim’s autonomy. (shrink)

This article discusses Hans Jonas’ argument for teleology in living organisms, in light of recently raised concerns over enactivism’s “Jonasian turn.” Drawing on textual resources rarely discussed in contemporary enactivist literature on Jonas’ philosophy, we reconstruct five core ideas of his thinking: 1) That natural science’s rejection of teleology is methodological rather than ontological, and thus not a proof of its non-existence; 2) that denial of the reality of teleology amounts to a performative self-contradiction; 3) that the fact of evolution (...) makes it implausible that only humans actualize purpose; 4) that the concept of metabolism delimits and gestures towards beings performing purposive activity; and 5) that concrete encounters with living organisms are indispensable for the judgment that they are purposive. Lastly, we draw attention to how Jonas’ understanding of teleology and inwardness in nonhuman life in terms of degrees of identity with human life poses a problem for his view. In this way, we hope to clarify what Jonas, as an important source of inspiration for the enactivist project, is proposing. (shrink)

Written for both theoretical and practical purposes, Dysfunctional Culture discusses how to understand and identify political ideologies as cultural systems. Using examples related to family morality and reproduction, this book argues that belief in individual rights as the main basis for morality is not an adequate response to the moral challenges of the future.

Name der Zeitschrift: Zeitschrift für Religionswissenschaft Jahrgang: 22 Heft: 2 Seiten: 150-175.

A recurring theme in the thought of Hans Skjervheim is the following question: How to live good lives together with others? But Skjervheim’s «the other» is always a human other. In the light of the ecological crisis we should also ask ourselves: How can we live good lives together with nonhuman others? I suggest that a part of the answer to that question is an extended critique of objectivism. Through interpretations of Hans Jonas’ The Phenomenon of Life and Arne Johan (...) Vetlesen’s The Denial of Nature, I argue, in contrast to Skjervheim, that nonhuman others are subjects with a kind of freedom, and that their subjectivity and freedom marks a limit to the exercise of human power. Further I argue that humans and nonhumans can share a common world and that humans can suffer a kind of alienation in the relation to nature, as well as the better known kinds of alienation in relation to other humans. I conclude that Skjervheim deserves to be read because he provides good critiques of objectivism of humans, but that the ecologically concerned philosopher has to move beyond Skjervheim’s philosophical framework. (shrink)

We characterise the intermediate logics which admit a cut-free hypersequent calculus of the form \, where \ is the hypersequent counterpart of the sequent calculus \ for propositional intuitionistic logic, and \ is a set of so-called structural hypersequent rules, i.e., rules not involving any logical connectives. The characterisation of this class of intermediate logics is presented both in terms of the algebraic and the relational semantics for intermediate logics. We discuss various—positive as well as negative—consequences of this characterisation.

Exploring Nature's Texture brings together a collection of internationally-known group of artists, theologians, anthropologists and philosophers to look at the imaginative possibilities of using the visual arts to address the breakdown of the human relationship with the environment.

This timely collection of essays by leading international scholars across religious studies and the environmental humanities advances a lively discussion on materialism in its many forms. While there is little agreement on what 'materialism' means, it is evident that there is a resurgence in thinking about matter in more animated and active ways. The volume explores how debates concerning the new materialisms impinge on religious traditions and the extent to which religions, with their material culture and beliefs in the Divine (...) within the material, can make a creative contribution to debates about ecological materialisms. Spanning a broad range of themes, including politics, architecture, hermeneutics, literature, and religion, the book brings together a series of discussions on materialism in the context of diverse methodologies and approaches. The volume investigates a range of issues including space and place, hierarchy and relationality, the relationship between nature and society, human and other agencies, and worldviews and cultural values. Drawing on literary and critical theory, and queer, philosophical, theological and social theoretical approaches, this ground-breaking book will make an important contribution to the environmental humanities. It will be a key read for postgraduate students, researchers and scholars in religious studies, cultural anthropology, literary studies, philosophy and environmental studies. (shrink)

Human mobility is dramatically on the rise; globalization and modern technology have increased transportation and migration. Frequent journeys over large distances cause huge energy consumption, severely impact local and global natural environments and raise spiritual and ethical questions about our place in the world. 'Spaces of Mobility' presents an analysis of the socio-political, environmental, and ethical aspects of mobility. The volume brings together essays that examine why and how modern modes of transport emerge, considering their effect on society. The religious (...) significance of contemporary travel is outlined, namely its impact on pilgrimage, Christology and ethics. The essays examine the interaction between humans and their surroundings and question how increased mobility affects human identity and self-understanding. 'Spaces of Mobility' will be of interest to students and scholars seeking to understand the impact of mobility on modern culture and society, the ethics behind contemporary transport systems and the conditions of immigrants in a world of constant travel. (shrink)

Human mobility is dramatically on the rise; globalization and modern technology have increased transportation and migration. Frequent journeys over large distances cause huge energy consumption, severely impact local and global natural environments and raise spiritual and ethical questions about our place in the world. 'Spaces of Mobility' presents an analysis of the socio-political, environmental, and ethical aspects of mobility. The volume brings together essays that examine why and how modern modes of transport emerge, considering their effect on society. The religious (...) significance of contemporary travel is outlined, namely its impact on pilgrimage, Christology and ethics. The essays examine the interaction between humans and their surroundings and question how increased mobility affects human identity and self-understanding. 'Spaces of Mobility' will be of interest to students and scholars seeking to understand the impact of mobility on modern culture and society, the ethics behind contemporary transport systems and the conditions of immigrants in a world of constant travel. (shrink)

A residuated lattice is said to be integrally closed if it satisfies the quasiequations \ and \, or equivalently, the equations \ and \. Every integral, cancellative, or divisible residuated lattice is integrally closed, and, conversely, every bounded integrally closed residuated lattice is integral. It is proved that the mapping \\backslash {\mathrm {e}}\) on any integrally closed residuated lattice is a homomorphism onto a lattice-ordered group. A Glivenko-style property is then established for varieties of integrally closed residuated lattices with respect (...) to varieties of lattice-ordered groups, showing in particular that integrally closed residuated lattices form the largest variety of residuated lattices admitting this property with respect to lattice-ordered groups. The Glivenko property is used to obtain a sequent calculus admitting cut-elimination for the variety of integrally closed residuated lattices and to establish the decidability, indeed PSPACE-completenes, of its equational theory. Finally, these results are related to previous work on BCI-algebras, semi-integral residuated pomonoids, and Casari’s comparative logic. (shrink)

A Heyting algebra is supplemented if each element a has a dual pseudo-complement \, and a Heyting algebra is centrally supplement if it is supplemented and each supplement is central. We show that each Heyting algebra has a centrally supplemented extension in the same variety of Heyting algebras as the original. We use this tool to investigate a new type of completion of Heyting algebras arising in the context of algebraic proof theory, the so-called hyper-MacNeille completion. We show that the (...) hyper-MacNeille completion of a Heyting algebra is the MacNeille completion of its centrally supplemented extension. This provides an algebraic description of the hyper-MacNeille completion of a Heyting algebra, allows development of further properties of the hyper-MacNeille completion, and provides new examples of varieties of Heyting algebras that are closed under hyper-MacNeille completions. In particular, connections between the centrally supplemented extension and Boolean products allow us to show that any finitely generated variety of Heyting algebras is closed under hyper-MacNeille completions. (shrink)