Under the pressure of governmental reform, beginning in 1740 and intensifying from the 1770s, opponents of reform in the Austrian Netherlands employed arguments derived from The Spirit of the Laws to contest the need for reform. However, reform had also been advocated by local powers using truisms publicised by The Spirit of the Laws, and during the political upheaval of 1789–1790, democrats and traditionalists clashed bitterly over the form of the new Belgian state, both citing Montesquieu to suit their purposes. (...) This article seeks to trace and account for the influence and use of Montesquieu's thought in the Belgian context. (shrink)

End-of-life issues and questions are complex and frequently cause confusion and anxiety. In _Death with Dignity_,_ _theologian, medical ethicist, and pastoral caregiver Peter A. Clark examines numerous issues that are pertinent to patients, family members, and health care professionals, including physiology, consciousness, the definition of death, the distinction between extraordinary and ordinary means, medical futility, “Do Not Resuscitate” orders, living wills, power of attorney, pain assessment and pain management, palliative and hospice care, the role of spirituality in end-of-life care, (...) and physicians’ communication with terminal patients. Patients, family members, medical students, and health care professionals will find in _Death with Dignity _the_ _practical and ethical knowledge they need to capably and confidently cope with end-of-life challenges. (shrink)

This paper explores Nietzsche’s approach to the question of illness. It develops an account of Nietzsche’s ideas in the wake of Arthur W. Frank’s discussion of the shortcomings of modern medicine and narrative theory. Nietzsche’s approach to illness is then explored in the context of On the Genealogy of Morality and his conception of the human being as “the sick animal”. This account, it is argued, allows for Nietzsche to develop a conception of suffering that refuses to reduce it to (...) modernist restitutive conceptions of well-being. Instead, Nietzsche advocates a more nuanced conception of varying degrees of health. This, it is argued, can be developed into a model that allows for a more satisfying conception of the relation between medical practitioner and patient. (shrink)

This paper explores Nietzsche’s approach to the question of illness. It develops an account of Nietzsche’s ideas in the wake of Arthur W. Frank’s discussion of the shortcomings of modern medicine and narrative theory. Nietzsche’s approach to illness is then explored in the context of On the Genealogy of Morality and his conception of the human being as “the sick animal”. This account, it is argued, allows for Nietzsche to develop a conception of suffering that refuses to reduce it to (...) modernist restitutive conceptions of well-being. Instead, Nietzsche advocates a more nuanced conception of varying degrees of health. This, it is argued, can be developed into a model that allows for a more satisfying conception of the relation between medical practitioner and patient. (shrink)

This study of the "radicalization" of psychiatry analyzes the writings of Laing, Foucault, Szasz, and Goffman, constructs a model for understanding mental illness, and emphasizes collective responsibility for the care of the mentally ill.

Zusammenfassung The question whether the concept of disease is descriptive or normative, is controversial in philosophical debates. A philosophical investigation of medical pathology concerning this question has hitherto been lacking. This paper is based on the reconstruction of general medical pathology as outlined in earlier work of this author. Key concepts of medical pathology are: disease entity, pathologicity, disease criterion, disease value, medical indication. The criteria of pathologicity and the general pathology are briefly sketched. It is shown that these conceptions (...) constitute a dimension of objective value that is rooted in the psychosomatic human nature but is compatible with additional, superposed subjective or sociocultural values concerning disease. The concept and procedure of medical indication constitute the bridge between objective disease values and subjective values or norms. In deciding whether treatment is needed and demanded, the values of the ill subject are decisive. Thus, the controversy between naturalists and normativist may be transformed into a coalition. (shrink)

Background: Some members of the general public feel that patients who cause their own organ failure through smoking, alcohol use, or drug use should not receive equal priority for scarce transplantable organs. This may reflect a belief that these patients (1) cause their own illness, (2) have poor transplant prognoses or, (3) are simply unworthy. We explore the role that social acceptability, personal responsibility, and prognosis play in people's judgments about transplant allocation. Methods: By random allocation, we presented 283 prospective (...) jurors in Philadelphia county with one of five questionnaire versions. In all questionnaires, subjects were asked to distribute transplantable hearts between patients with and without a history of three controversial behaviors (eating high fat diets against doctors’ advice, cigarette smoking, or intravenous drug use). Across the five questionnaire versions, we varied the relative prognosis of the transplant candidates and whether their behavior caused their primary organ Results: Subjects were significantly less willing to distribute organs to intravenous drug users than to cigarette smokers or people eating high fat diets (p le; 0.0005), even when intravenous drug users had better transplant outcomes than other patients. Subjects’ allocation decisions were influenced by transplant prognosis, but not by whether the behavior in question was causally responsible for the patients’ organ failure. Conclusion: People's unwillingness to give scarce transplantable organs to patients with controversial behaviors cannot be explained totally on the basis of those behaviors either causing their primary organ failure or making them have worse transplant prognoses. Instead, many people believe that such patients are simply less worthy of scarce transplantable organs. (shrink)

This article aims: (1) to introduce the wider philosophy of Aristotle to nurses and healthcare practitioners; (2) to show that Aristotle's philosophical system is an interdependent whole; and (3) to defend its plausibility and usefulness despite its ancient and alien origins.Aristotle's system can be set out as a hierarchy, with metaphysics at the top and methodology running throughout. Beneath metaphysics are the sciences, with theoretical, practical and productive (or craft) sciences in hierarchical order. This hierarchy does not imply that, say, (...) metaphysics is superior to biology or nursing, but rather that metaphysics can be understood without reference to the other two but, as we shall see, not vice versa.Two themes run through Aristotelian philosophy. The first is Aristotle's method of inquiry, central to which is that our starting point is not pure empirical data, but rather current puzzles; complementing this method is a realist philosophy. The second theme is teleology, the understanding of action in the world in terms of ends, as when we say a plant grows roots to reach water and nutrients.Implications for nursing. Good health is the good functioning of the material aspect of humans; flourishing is good functioning of humans per se. The goals of nursing, which are based on health, are subsumed by the overall human goal of flourishing, and this helps us to understand and set boundaries to health care. Two examples illustrate this. The first is that mental illness is strongly within the purview of nursing and health care whereas bad decisions, such as smoking, are only marginally so. The second is ethics, where it is argued that the attempt to describe ethical decision‐making as in addition to and separate from the decisions made within nursing and health care itself cannot be sustained. (shrink)

Typical structural universals are not just the mereological sum of their constituents. Hence, there is the Structure Problem of explaining this non-mereological structure. The Instantiation Problem is that the predicate "U is instantiated by x, y, etc., in that order" is ill-suited to be a primitive, unanalyzed predicate. The proposed solution to these problems is based on the observation that if universal U is said to supervene upon universals V, W, etc., then it is the instantiation of U that supervenes (...) on the instantiation of V, W, etc. Assuming there are few subvenient universals, which is admittedly a speculation, their instantiation may be explained in ways that would be uneconomic if there were too many. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.4 (2001) 391-400 [Access article in PDF] Bioethics Inside the Beltway A Shooting on Capitol Hill: "The Ruby Satellite System," Mental Illness, and Failure of the American Legal System Peter J. Cohen On 24 July 1998, Russell Eugene Weston, Jr., stormed the United States Capitol, forced his way through a security checkpoint, bypassed a metal detector, and entered the office complex of Representative (...) Tom DeLay (R-TX), the House Majority Whip (Weil 1998). During this period of terror, he shot and killed two officers of the Capitol Police and seriously wounded another as they attempted to end his foray. 1 Weston was severely wounded by several Capital police officers and taken into custody. After being treated for his injuries, he was incarcerated in the District of Columbia. 2On 5 May 1999, Weston was transferred to the Federal Correctional Institute in Butner, North Carolina (United States v. Weston, 69 F. Supp. 2d 99 (D.D.C. 1999), 103), where he remains to this day. He has neither been brought to trial nor received appropriate psychiatric therapy, but continues to be warehoused "in solitary confinement under constant observation... in a psychotic state (United States v. Weston, 255 F.3d 873; LEXIS 16851 (U.S. App. 2001b), 3-4 [LEXIS]). I will briefly detail the legal events responsible for this mad situation and suggest alternative actions that should have been taken at the very onset of the case. Early Chronology Although overtly the crime appeared to be senseless and without any conceivable motivation, Weston believed that his acts were justified and necessary. The story he told to the court-appointed forensic psychiatrist, Sally C. Johnson, M.D., 3 was that while working for NASA in the early 1980s, he had developed a "Ruby Satellite System," a powerful machine that could reverse time. With access to this system, nothing was permanent--the user could simply reverse time and exit from the current scene. However, the "System" was now controlled by cannibals who were developing and spreading "Black Heva," the deadliest disease known to [End Page 391] humankind, similar to HIV or the plague. It resulted from human corpses rotting and turning black. Time was running out, and Weston believed he had to return to override the "Ruby Satellite System" in the Capitol so that he could stem the spread of "Black Heva" and prevent world calamity. He believed that if he were tried, convicted, and even executed, he could simply time reverse himself, place himself in a safe within the Capitol, and subsequently resume his life at whatever point he chose (United States v. Weston, 206 F.3d 9 (D.C. Cir. 2000), 19-20).On 22 April 1999, the district court accepted Dr. Johnson's diagnosis that Weston suffered from paranoid schizophrenia, the symptoms of which were so severe that he would be incapable of understanding the proceedings against him and of assisting in his own defense. On this basis, the court had no difficulty in finding him incompetent to stand trial (U.S. v. Weston 1999, 102).At Weston's initial hearing, Dr. Johnson had testified that medication would be efficacious in treating Weston's delusions: [T]he standard of care in someone suffering from this type of symptom picture would be to treat them with medication.... [T]here is a good likelihood that he'll have a positive response, positive in the sense that his symptoms will diminish in response to treatment.... The potential benefits to treating the defendant far outweigh the risks.... (U.S. v. Weston 1999, 108) The defense presented no expert testimony refuting Dr. Johnson's presentation. The district court then ordered that Weston begin receiving medication in order to render him nondangerous and competent for trial (U.S. v. Weston 1999, 108-9). The Problem Weston refused to be medicated! 4 He has continued to claim that the administration of antipsychotic drugs against his will would violate his Fifth Amendment due process liberty interest in avoiding unwanted bodily intrusion and implicated... (shrink)

In this book, Raabe argues that philosophy can effectively inform and improve conventional methods of treating mental illness. He presents clinical evidence showing that mild and so-called clinical mental illnesses can be both prevented and alleviated with philosophical talk therapy. Raabe offers concrete case examples that support his findings.

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture. Mounting information from many sources, including Pentagon documents, the International Committee of the Red Cross, Amnesty International, Human Rights Watch, etc., indicate that medical personnel failed to maintain medical records, (...) conduct routine medical examinations, provide proper care of disabled and injured detainees, accurately report illnesses and injuries, and falsified medical records and death certificates. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism. (shrink)

The mental illness of substance dependence or addiction is responsible for major economic, social, and personal costs. If we are to elucidate its etiology, understand its mechanisms, and eventually bring it under control, scientific investigation is essential. Research in animals and humans has enhanced our understanding of this disease through examination of genetic, neurophysiological, biochemical, and behavioral factors. But because animals cannot verbalize their subjective responses to drugs and because significant symptoms of addiction cannot be observed in non-drug-dependent humans, it (...) is not surprising that certain investigations of substance dependence have required the participation of addicted or substance-dependent humans. (shrink)

The mental illness of substance dependence or addiction is responsible for major economic, social, and personal costs. If we are to elucidate its etiology, understand its mechanisms, and eventually bring it under control, scientific investigation is essential. Research in animals and humans has enhanced our understanding of this disease through examination of genetic, neurophysiological, biochemical, and behavioral factors. But because animals cannot verbalize their subjective responses to drugs and because significant symptoms of addiction cannot be observed in non-drug-dependent humans, it (...) is not surprising that certain investigations of substance dependence have required the participation of addicted or substance-dependent humans. (shrink)

The most comprehensive compilation of the works of Abelard and Heloise ever presented in a single volume in English, _The Letters and Other Writings_ features an accurate and stylistically faithful new translation of both _The Calamities of Peter Abelard_ and the remarkable letters it sparked between the ill-fated twelfth-century philosopher and his brilliant former student and lover—an exchange whose intellectual passion, formal virtuosity, and psychological drama distinguish it as one of the most extraordinary correspondences in European history. Thanks to (...) this edition, Latin-less readers will be better placed than ever to see why this undisputed milestone in the intellectual life of medieval France is also a masterpiece of Western literature. In addition to the _The Calamities_ and the letters--the first complete English translation of all seven in more than eighty years--this volume includes an Introduction, a map, and a chronology, Abelard's _Confession of Faith_, letters between Heloise and Peter the Venerable, the Introduction to _The Questions of Heloise_, and selected songs and poems by Abelard, among them a previously untranslated shaped poem, Open Wide Your Eyes. Extracts of lost letters sometimes ascribed to Abelard and Heloise are given in appendixes. (shrink)

In this book, Raabe argues that philosophy can effectively inform and improve conventional methods of treating mental illness. He presents clinical evidence showing that mild and so-called clinical mental illnesses can be both prevented and alleviated with philosophical talk therapy. Raabe offers concrete case examples that support his findings.

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, (...) but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient? (shrink)

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, (...) but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient? (shrink)

I suggest that part of the reason the on-going debate in the West between the liberal democrats and the communitarians about the future and/or the ills of democracy is futile because both sides are committed to conceptually different accounts of democracy. The roots of communitarianism in the Athenian polis and that of liberalism in the atomistic individualism of the Enlightenment are contrasted in order to discern the motivating visions and overarching structures of both. Whereas communitarian democracy is willdominated, liberal democracy (...) is choice-dominated. My purpose here is not to argue for the supremacy of one over the other, but to call attention to the distinctions between the two that are often blurred in contemporary discussion about democracy. (shrink)

Holding God to be transcendent does not mean having to regard the grammar of the word ‘God’ as isolated or unique or inscrutable: and in speaking of grammar I use this word in its familiar sense, not in some ill-explained neo-Wittgensteinian sense. I want to make a methodological suggestion. When a sentence containing the word ‘God’ is puzzling, it may help to look at a grammatically possible replacement for the word. For example, if we wish to understand the statement that (...) God is man's last end, let us consider what it implies to say that gold, or sex, or military glory, is a given man's last end. (shrink)

Holding God to be transcendent does not mean having to regard the grammar of the word ‘God’ as isolated or unique or inscrutable: and in speaking of grammar I use this word in its familiar sense, not in some ill-explained neo-Wittgensteinian sense. I want to make a methodological suggestion. When a sentence containing the word ‘God’ is puzzling, it may help to look at a grammatically possible replacement for the word. For example, if we wish to understand the statement that (...) God is man's last end, let us consider what it implies to say that gold, or sex, or military glory, is a given man's last end. (shrink)

This critical review of Soames's history of analytic philosophy evaluates Soames's enterprise by reference to the degree to which it achieves his goals of (i) providing an overview of analytic philosophy 1900-75, (ii) explaining what the most important analytic philosophers thought, (iii) selecting some of the most important works of each philosopher for discussion, and (iv) properly evaluating the developments of the period. On all counts Soames's history is found sorely wanting. The overview it offers is riddled with distortion, its (...) explanations are frequently mistaken and uncomprehending, its selection is demonstrably inadequate and its evaluations ill-informed and ill-judged. (shrink)

The fact that the emergence of “technoscience,” resulting from the coalescing of science and technology, may have serious social and cultural impact has been debated in recent years particularly with regard to the field of medicine. The present article is exploring the scope and limits of the “technoscientization” of medicine using the example of rare disease patient associations. It is investigated whether and to what extent these organizations adopt technoscientific illness identities and subscribe to the research priorities and objectives of (...) biomedicine. In addition, it is analyzed whether Paul Rabinow’s highly influential concept of biosociality entails a technoscientific model of identity or, quite to the contrary, offers a framework for contesting biomedical ascriptions of identities. As the article shows, patient associations do refer to technoscientific definitions of diseases yet constantly modify and transform them based on their everyday illness experiences. Likewise, the “biosociality” of rare disease patients emerges from the shared experience of having been neglected by mainstream medical research rather than from supposedly objective biomedical classifications. (shrink)

Multiple drug resistant strains of HIV and continuing difficulties with vaccine development highlight the importance of psychologi- cal interventions which aim to in uence the psychosocial and emo- tional factors empirically demonstrated to be significant predictors of immunity, illness progression and AIDS mortality in seropositive persons. Such data have profound implications for psychological interventions designed to modify psychosocial factors predictive of enhanced risk of exposure to HIV as well as the neuroendocrine and immune mechanisms mediating the impact of such factors (...) on disease progression. Many of these factors can be construed as unconscious mental ones, and psychoanalytic self-psychology may be a useful framework for conceptualizing psychic and immune de- fence as well as bodily and self-integration in HIV infection. Al- though further prospective studies and cross-cultural validation of research are necessary, existing data suggest that psychoanalytic insights may be useful both in therapeutic interventions and evaluative research which would require an underlying epistemology of the complementarity of mind and matter. (shrink)

Objectives: To identify ethical attitudes about involuntary admission (known in Great Britain as formal admission) in mental health professionals and lay-people in England and Germany, especially looking at possible differences between Mental Health Professionals who are directly involved in the involuntary admission process and those who are not.Method: Three scenarios of potentially certifiable patients (known in Great Britain as sectionable patients) were presented to identify attitudes. A questionnaire asked about attitudes towards involuntary admission as well as treatment. A questionnaire analysis (...) was then performed.Results: There were similar attitudes towards involuntary admission between laypeople and mental health professionals involved in the involuntary admission process with the exception of professionals not actively involved in the involuntary admission process. Neither personal or professional experience with mental illness nor the different legal frameworks between Germany and England influenced attitudes much. Support for involuntary admission broadly increased with age.Conclusions: Psychiatrists and other mental health workers are in tune with society with regards to attitudes to involuntary admission. People involved with mentally ill patients but not in the involuntary admission process have negative attitudes towards involuntary admission. This may influence Mental Health Tribunals suggested in the new draft Mental Health Bill (2002) for England and Wales, because these Tribunals will potentially lack any involvement of professionals involved in the involuntary admission process. (shrink)

The child shall have things better than his parents: he shall not be subject to the necessities which they have recognized as dominating life. Illness, death, renunciation of enjoyment, restrictions on his own will, shall not touch him; the laws of nature, like those of society, are to be abrogated in his favor; he is really to be the center and heart of creation, “His Majesty the Baby,” as we once fancied ourselves to be.... At the weakest point of all (...) in the narcissistic position, the immortality of the ego which is so relentlessly assailed by reality, security is achieved by fleeing to the child. Parental love, which is so touching and at bottom so childish, is nothing but parental narcissism born again.... Sigmund Freud, “On Narcissism”. (shrink)

ABSTRACT Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life – if they are able to swallow and digest them. But despite President Bush's oft‐repeated statements that his philosophy is to ‘trust individuals (...) to make the right decisions’ and his opposition to ‘distant bureaucracies’, his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician‐assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia. (shrink)

This introduction reflects on some key passages on illness in the P?li suttas, especially as regards the relationship of illness and karma, and whether Buddhist meditative qualities might be seen to alleviate or cure physical illnesses.

There is a widespread conviction amongst nature lovers, environmental activists, and many writers on environmental ethics that the value of the natural world is not restricted to its utility to humankind, but contains an independent intrinsic worth as weIl. Most contemporary value theories, however, are psychologically based and thus ill-suited to characterize such natural intrinsic value. The theory of “value asrichness” presented in this paper attempts to articulate a plausible nonpsychological theory of value that accomodates environmentalist convictions as weIl as (...) more traditional value concems. It has implications not only for our care for and preservation of nature, but also for the enrichment of human lives. (shrink)

There is a widespread conviction amongst nature lovers, environmental activists, and many writers on environmental ethics that the value of the natural world is not restricted to its utility to humankind, but contains an independent intrinsic worth as weIl. Most contemporary value theories, however, are psychologically based and thus ill-suited to characterize such natural intrinsic value. The theory of “value asrichness” presented in this paper attempts to articulate a plausible nonpsychological theory of value that accomodates environmentalist convictions as weIl as (...) more traditional value concems. It has implications not only for our care for and preservation of nature, but also for the enrichment of human lives. (shrink)

Despite the bad press that revenge has received from moral philosophers and legal theorists, it can be a legitimate way to forge a link between wrongful behavior and penalties that karmic moral theories can only postulate. It can be especially effectual in commonplace cases that are under the radar of formal systems of justice. In such cases it can play a positive role in strengthening the moral foundations of a community. In those cases acts of revenge can provide a morally (...) valuable antidote to the negative participant reactive attitudes of community members. They can be an expression of morality in and for itself while exorcizing such pent up emotions as resentment, hatred, indignation, anger, antipathy, annoyance, umbrage, and ire. I maintain that responding in morally appropriate ways to insults, derisions, disparagements, and other forms of perceived wrongful disrespect and ill will is elemental in sustaining equitable human relations. To reiterate and paraphrase a point Robert Nozick made, the only power that morality has to affect human affairs resides in the critical responses moral people feel obliged to make upon recognizing the wrongful quality of another person’s acts or will. In this paper I apply the four criteria I defended in the book The Virtues of Vengeance to rather mundane cases of perceived maltreatment, exploitation, oppression, and/or neglect, and I deal with the issue of regulating multiple avengers who are bent on dealing out revenge to offenders in such commonplace cases. (shrink)

From a medical perspective, patients who do not comply with the doctor's orders are usually seen as deviant and deviance requires correction. But many chronically ill people view their behavior differently, as a matter of self‐regulation. In this light noncompliance supports people's desires for independence and autonomy, desires that align closely with the therapeutic goals of caregivers.

This essay disputes the approach to so-called 'mental illness' in which the individual patient is presumed to be the locus of hi or her 'disorder,' and should therefore be treated with brain-altering drugs. My position is predicated on the conviction that no one's mind is identical to their brain. Nor is anyone's mind a totally isolated island in the dynamic sea of human interactions and cognitions, and should not be treated as such.

In discussing the psychiatric diagnoses, the author explores not the “formal” diagnoses of the so-called mental illnesses, but the “informal” judgments made by psychotherapists in regard to their method or the process of their therapy. These diagnoses include transference, repression, resistance, denial, negativism, projection, and suppression. While these are not precisely the symptoms of psychopathology, they are an integral part of the language which psychotherapists use to describe and label what they see as problems in their patients. These so-called problems, (...) which are interpreted by the therapist as existing within the patient, can be reinterpreted and largely avoided in philosophical counseeling.The author argues that, when a person is observed or diagnosed by a psychotherapist as exhibiting one of these supposedly problematic traits the therapist is in fact misinterpreting what is going on. (shrink)

Our aim in this chapter is to draw lessons from current theory on the evolution of human cooperation for the management of contemporary commons. Evolutionary theorists have long been interested in cooperation but social scientists have documented patterns of cooperation in humans that present unusual problems for conventional evolutionary theory (and for rational choice explanations as well). Humans often cooperate with nonrelatives and are prone to cooperate in one-shot games. Cooperation is quite dependent on social institutions. We believe that this (...) last fact is the critical clue to understanding human cooperation. Models of cultural evolution suggest that group selection is a more potent force on culture than on genes. Evolutionary theory is in essence a theory of preferences in terms of rational actor theory and is thus complementary to the bounded rational choice models that underpin so much theorizing in the social sciences. Thus, the theory suggests a source for prosocial impulses, and leads to predictions about the limits of human altruism and constraints likely to be imposed upon the evolution of social institutions. We also consider the dynamics of genes as they coevolved with increasingly sophisticated cultural institutions over the long course of human evolution in the Pleistocene. We hypothesize that the long exposure of human populations to group selected cultural norms and preferences is likely to have resulted in an innate psychology adapted to living in egalitarian, cooperative societies of a few hundred to a few thousand people. We call this the tribal social instincts hypothesis. The evolution of complex societies in the past few thousand years constitutes a series of natural experiments that test this hypothesis. If it is correct, the institutions of complex societies must somehow take advantage of the prosocial elements of the tribal instincts while finessing the problem that the tribal social instincts are ill adapted to life in large, hierarchical, inegalitarian societies with extensive dominance of subordinates by elites.. (shrink)

The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to an ethics deriving from the centrality of moral relationships and virtues. A brief analysis of the connections between moral relationships and moral rules is offered. Such an ethics would lower (...) the value that philosophical fashion places on truth-telling and autonomy and leave decisions about truth-telling and the terminally ill more dependent on the circumstances of particular cases. (shrink)

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite (...) over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

This paper offers critical reflection on the contemporary tendency to approach health care in instrumentalist terms. Instrumentalism is means-ends rationality. In contemporary society, the instrumentalist attitude is exemplified by the relationship between individual consumer and a provider of goods and services. The problematic nature of this attitude is illustrated by Michael Oakeshott’s conceptions of enterprise association and civil association. Enterprise association is instrumental; civil association is association in terms of an ethically delineated realm of practices. The latter offers a richer (...) ethical conception of the relation between person and society than instrumentalism does. Oakeshott’s conception is further illustrated by reflection on the connection between morality and religion that he explores in an early essay concerning “religious sensibility”. Religious sensibility turns on the acknowledgement of the vulnerability of the self to the vicissitudes of life. This vulnerability cannot be bargained over instrumentally without imperilling the self. Religious sensibility is thus a valuable resource for criticising instrumentalist attitudes. It allows for the cultivation of ethical self-understanding that is essential to comprehending the conditions in virtue of which genuine civil life is possible. These conditions need to be taken into account in health care. Health care is not simply about substantive wants. It also necessarily concerns the universal and constant condition of being prey to illness that is the common lot of all citizens. (shrink)

Between 1724 and 1760, in the frontier area of the Habsburg empire waves of a hitherto unknown epidemic disease emerged: vampirism. In remote villages of southeastern Europe, cases of unusual deaths were reported. Corpses did not decay and, according to the villagers, corporeal ghosts were haunting their relatives and depriving them of their vital force. Death occurred by no later than three to four days. The colonial administration, alarmed by the threat of an epidemic illness, dispatched military officers and physicians (...) to examine the occurrences. Soon several reports and newspaper articles circulated and made the untimely resurrection of the dead known to the perplexed public, Europe-wide. “Vampyrus Serviensis”, the Serbian vampire, became an intensively discussed phenomenon within academe, and thereby gained factual standing. My paper depicts the geopolitical context of the vampire’s origin within the Habsburg states. Secondly, it outlines the epistemological difficulties faced by observing physicians in the field. Thirdly, it delineates the scholarly debate on the apparent oxymoron of the living dead in the era of enlightened reason. Fourthly, the early history of vampirism shows that ghosts and encounters with the undead are not superstitious relics of a pre-modern past, or the Enlightenment’s other, but intimate companions of Western modernity. (shrink)

America's patchwork quilt of health care coverage is coming apart at the seams. The system, such as it is, is built upon an inherently problematic base: employment. By definition, an employment-based approach, by itself, will not assure universal coverage of the entire population. If an employment-based approach is to be the centerpiece of a system that provides universal coverage, special attention must be paid to all the categories of individuals who are not employees – children, unemployed spouses or singles, the (...) unemployable ill and disabled, persons between jobs, students, retirees, the elderly. Moreover, in a purely voluntary employment-based arrangement, some employers will not provide insurance at all, and others will provide inadequate coverage, necessitating other special provisions for coverage. As a consequence, about one out of six people now has no health coverage whatsoever, and even more have inadequate coverage. All the while, the rapidly-increasing transaction costs of sustaining this grossly inadequate pluralistic system eat up sufficient funds to provide basic benefits to the entire population. The time for systematic reforms has come and gone; what is now needed is action to prevent disaster, followed by a complete rebuilding of this country's health coverage system. Although perhaps more likely to be tried than more radical, completely nationalized, ones, stepwise reforms may not go far enough to cure the significant ills of the current employment-based system. Passage of inadequate reforms, then, could well set the stage for nationalized health care in the not too distant future. (shrink)

At the time of his death in 1984, Foucault’s late career forays into Stoicism and other sets of ancient texts were often little understood, except as part of a larger project on the history of sexuality. Indeed, outside of France and outside of an incipient queer theory, Foucault was often taken up in terms of debates over post-structuralism and postmodernism—themes all but absent from his writings. More than thirty years later, after the publication of all of his lecture courses at (...) the Collège de France from 1970-1984 as well as his collected writings, we have gained a better understanding of the deep continuities in his set of concerns from Histoire de la folie à l’âge classique to the third volume of his history of sexuality series, Le Souci de soi. Yet many Foucault scholars continue to see momentous shifts in his writings, e.g., from knowledge to power to ethics, and the almost bewildering range of texts he covered in the years after finishing the first volume of his history of sexuality series, La Volonté de savoir, lead to very different interpretations concerning what Foucault was attempting to do and how much his rendering of ancient texts differed from his own claims. Stuart Elden’s Foucault’s Last Decade steps into this breach, using archival work to fill in many of the details of this period, from when and on what Foucault was lecturing to listing those with him in that amusing late photo of a beaming Foucault in an ill-fitting cowboy hat. The publication of Elden’s book marks a good time to assess this often misunderstood period in Foucault’s work, and we have gathered Stuart Elden and two more of Foucault’s best interpreters, Eduardo Mendieta and Dianna Taylor, to do so. (shrink)

This paper analyses the problem of shame in the thinking of Lucius Annaeus Seneca. The authors examine this problem primarily in two contexts. The first, social meaning, understands shame as an emotion that appears during a conflict between a person’s “self” and social norms. Seneca mainly tackles this question concerning providing “benefits” (beneficia) in his On Benefits and eighty-first letter of Moral Epistles. The second therapeutic and didactic meaning utilises shame as an instrument to manage some illnesses of the mind (...) (for example, anger). Moreover, to educate a “Stoic disciple” (proficiens), deliberate exposure to shame in public marks one of the important techniques to near the perfect ideal of “the wise man” (sapiens) and to prepare oneself for service in public office. Especially in Moral Epistles, we find a detailed description of this didactic approach and the limiting factors to using this technique. (shrink)