In this exploratory study, we present findings from semi-structured interviews with 11 self-identified lesbian and gay (LG) humanitarian aid workers of Doctors without Borders (MSF). We investigate their perceptions of workplace inclusion in terms of perceived satisfaction of their needs for authenticity and belonging within two organizational settings, namely office and field. Through our combined deductive and inductive approach, based on grounded theory, we find that perceptions of their colleagues’ and supervisors’ attitudes and behaviors, as well as organizational inclusiveness practices (...) play a role in LGs’ perceived authenticity, but not belonging, in the workplace. However, these organization-level characteristics do not account for between-participant differences in perceived authenticity. Therefore, we inductively construct a typology of three groups, which we coined conscious first-missioners, authentic realists, and idealistic activists, based on how LG humanitarian aid workers assess and deal with not being able to be their authentic selves when they are in the field, because homosexuality is illegal in many project countries. Conscious first-missioners are separated from the other two groups based on having gone to the field once, whereby they felt in control over the decision on how to manage their sexuality. Alternatively, authentic realists and idealistic activists alike felt they did not really have a choice in how to manage their sexuality, but handled that differently. We find the importance of one’s sexuality as well as adherence to the overarching organizational mission relevant individual-level factors herein. Furthermore, we find disclosure of sexual identity to be strongly context-dependent, as participants are ‘out of the closet’ in the office, but go back into the closet when they enter the field, with different country contexts even leading to different decisions concerning self-disclosure, thus demonstrating the importance of careful sexual identity management. This so-called disclosure dilemma, we find, may not be merely an individual choice, but rather a shared dilemma involving multiple stakeholders, such as the organization and fellow team members. We discuss the findings’ contributions to existing literature on LGs’ workplace experiences and implications for future research on inclusion of sexual and other invisible minorities in the workplace. (shrink)

Body feedback is the proprioceptive feedback that denominates the afferent information from position and movement of the body to the central nervous system. It is crucial in experiencing emotions, in forming attitudes and in regulating emotions and behavior. This paper investigates effects of dynamic body feedback on affect and attitudes, focusing on the impact of movement rhythms with smooth vs. sharp reversals as one basic category of movement qualities. It relates those qualities to already explored effects of approach vs. avoidance (...) motor behavior as one basic category of movement shape. Studies 1 and 2 tested the effects of one of two basic movement qualities (smooth vs. sharp rhythms) on affect and cognition. The third study tested those movement qualities in combination with movement shape (approach vs. avoidance motor behavior) and the effects of those combinations on affect and attitudes toward initially valence-free stimuli. Results suggest that movement rhythms influence affect (studies 1 and 2), and attitudes (study 3), and moderate the impact of approach and avoidance motor behavior on attitudes (study 3). Extending static body feedback research with a dynamic account, findings indicate that movement qualities – next to movement shape – play an important role, when movement of the lived body is an independent variable. (shrink)

This work tells the story of the rise of the modern German environmental imagination, with particular emphasis on its narrative and visual components.

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced (...) and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly. (shrink)

Theories of practical reason must meet a psychological requirement: they must explain how normative practical reasons can be motivationally efficacious. It would be pointless to claim that we are subject to normative demands of reason, if we were in fact unable to meet those demands. Concerning this requirement to account for the possibility of rational motivation, internalist approaches are distinguished from externalist ones. I defend internalism, whilst rejecting both ways in which the belief‐desire model can be instantiated. Both the Humean (...) and the Kantian instantiation of that model fail to account for the internal connection between normative and motivating reasons required by internalism. The two classes of reasons rather come to be seen as mutually exclusive. Opposing the belief‐desire model, I argue that rational motivation can only be established by reference to emotion. Emotions are affective perceptions. They have motivational force so that they can contribute to the explanation of action. At the same time they can rationalise actions because they have an intentional content which resembles the content of sensory perception in being representational. Because of this, the emotions can noninferentially justify judgements, which in turn can justify actions. I conclude by outlining the Aristotelian account of practical reason and ethics that emerges from integrating the emotions into practical reasoning. Doing the right thing is much more a matter of seeing things right than of drawing the right inferences. Seeing things right, in its turn, is not only to justify an action: it necessarily implies to be motivated to act accordingly. (shrink)

In a unique cooperation between philosophy, linguistics, art history, and ancient studies, this volume focuses on ways in which the entangled and embodied nature of image and language enables us to symbolically articulate the world and our experience in a great variety of forms. It lays the foundation for a new cultural anthropology of symbolic processes.

'A comprehensive and important collection that includes essays by some of the leading figures in the field....Essential reading for anyone interested in risk assessment.' Professor Kristin Shrader-Frechette, University of Notre Dame 'The editors are to be congratulated for bringing together a distinguished international group of theorists to reflect on the issues. This volume will be sure to raise the level of debate while at the same time showing the importance of philosophical reflection in approaches to the problems of the age.' (...) Professor Jonathan Wolff, University College London This volume brings together top authors from the fields of risk, philosophy, social sciences and psychology to address the issue of how we should decide how far technological risks are morally acceptable or not. The underlying principles are examined, along with methodological challenges, public involvement and instruments for democratization. A strong theoretical basis is complemented by a range of case studies from some of the most contentious areas, including medical ethics and GM crops. This book is a vital new resource for researchers, students and anyone concerned that traditional approaches to risk management don't adequately address ethical considerations. (shrink)

I discuss two ways in which emotions explain actions: in the first, the explanation is expressive; in the second, the action is not only explained but also rationalized by the emotion's intentional content. The belief-desire model cannot satisfactorily account for either of these cases. My main purpose is to show that the emotions constitute an irreducible category in the explanation of action, to be understood by analogy with perception. Emotions are affective perceptions. Their affect gives them motivational force, and they (...) can rationalize actions because, like perception, they have a representational intentional content. Because of this, an emotion can non-inferentially justify a belief which in its turn justifies or rationalizes an action; so emotions may constitute a source of moral knowledge. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Umberto Eco's Baudolino (2000) never achieved the success of his first novel, The Name of the Rose (1980), although both are historical fictions that provide literary clothing for philosophical ideas. In Baudolino, Eco again dramatizes the disagreement between rationalists and empiricists regarding the sources of our concepts and knowledge, ideas that came to the fore during the medieval period and which continue to be pertinent questions in epistemology. Propositions of either sense experience or logic and reasoning being the basis for (...) knowledge, offer Eco an opportunity for playing what he calls "a game of ambiguity about truth and lies."1 Historical uncertainties, the holes in the fabric of our knowledge about .. (shrink)

This paper discusses the issue of legitimacy and, in particular the processes of building, losing, and repairing environmental legitimacy in the context of the Deepwater Horizon case. Following the Deepwater Horizon catastrophe in 2010, BP plc. was accused of having set new records in the degree of divergence between its actual operations and what it had been communicating with regard to corporate responsibility. Its legitimacy crisis is here to be appraised as a case study in the discrepancy between symbolic and (...) substantive strategies in corporate greening and its communication. A narrative analysis of BP’s “beyond petroleum”-rebranding and the “making this right”-campaign issued in response to the Gulf of Mexico disaster discusses their respective implications for corporate change. Further, the question is addressed why BP’s green image endeavors were so widely accepted at first, only to find themselves dismissed as corporate greenwashing now. The study concludes that where a corporation’s “green narrative” consistently evokes established narratives, its legitimacy will be judged against narrative, rather than empirical truth. Thus, the narrative will be more willingly accepted as speaking for the issuing company’s legitimacy, irrespective of whether it reflects substantive greening or not. (shrink)

“Acceptable Risk” – On the Rationality of Emotional Evaluations of Risk What is “acceptable risk”? That question is appropriate in a number of different contexts, political, social, ethical, and scienti c. Thus the question might be whether the voting public will support a risky proposal or project, whether people will buy or accept a risky product, whether it is morally permissible to pursue this or that potentially harmful venture, or whether it is wise or prudent to test or try out (...) some possibly dangerous hypothesis or product. But complicating all of these queries, the “sand in the machinery” of rational decision-making, are the emotions. It is often noted that voters are swayed by their passions at least as much as they are convinced by rational arguments. And it is obvious to advertisers and retailers that people are seduced by all sorts of appeals to their vanities, their fears, their extravagant hopes, their insecurities. At least one major thread of ethical discourse, the one following Kant, minimizes the importance of the emotions in favor of an emphatically rational decision-making process, and it is worth mulling over the fact that many of those who do not accept Kant’s ethical views more or less applaud his rejection of the “moral sentiment theory” of the time, promoted by such luminary philosophers as David Hume and Adam Smith. (shrink)

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in (...) analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)

A contrarian scientist wrestles with the big questions that modern physics raises, and what physics says about the human condition Not only can we not currently explain the origin of the universe, it is questionable we will ever be able to explain it. The notion that there are universes within particles, or that particles are conscious, is ascientific, as is the hypothesis that our universe is a computer simulation. On the other hand, the idea that the universe itself is conscious (...) is difficult to rule out entirely. According to Sabine Hossenfelder, it is not a coincidence that quantum entanglement and vacuum energy have become the go-to explanations of alternative healers, or that people believe their deceased grandmother is still alive because of quantum mechanics. Science and religion have the same roots, and they still tackle some of the same questions: Where do we come from? Where do we go to? How much can we know? The area of science that is closest to answering these questions is physics. Over the last century, physicists have learned a lot about which spiritual ideas are still compatible with the laws of nature. Not always, though, have they stayed on the scientific side of the debate. In this lively, thought-provoking book, Hossenfelder takes on the biggest questions in physics: Does the past still exist? Do particles think? Was the universe made for us? Has physics ruled out free will? Will we ever have a theory of everything? She lays out how far physicists are on the way to answering these questions, where the current limits are, and what questions might well remain unanswerable forever. Her book offers a no-nonsense yet entertaining take on some of the toughest riddles in existence, and will give the reader a solid grasp on what we know-and what we don't know. (shrink)

English law gives the competent patient the right to refuse life-saving medical treatment, either contemporaneously or in an advance directive, and a physician commits a battery when treating a patient who validly refused treatment. However, with regard to the details of a physician's liability, many questions remain unanswered, and it is not at all clear under what circumstances a patient's tort action for unwanted life-saving treatment will succeed, and what remedies would be available to the patient. The article suggests that (...) a physician should be liable in battery for administering life-saving treatment, even if he/she had doubts about the validity of the patient's treatment refusal, unless a defence of reasonable mistake can be established. Furthermore, in case of a battery which resulted in keeping the patient alive, the patient should not only be able to claim nominal damages, but general and special damages, including mental and physical pain and suffering caused by the prolongation of the patient's life, should equally be available. (shrink)

Using the example of architecture, this article defends the thesis that designing should not be regarded as a kind of experimenting. This is in contrast to a widespread methodological claim that design processes are equivalent to experimentation processes. The contrary thesis can be proven by focusing on actual practices, techniques and design strategies. Closely connected with the thesis is an even more important epistemological claim, which contends that designing serves not only to develop artefacts but is also a means of (...) acquiring genuine knowledge. When the epistemic relevance of said practices, techniques and strategies is reassessed, designing emerges clearly as an independent epistemic praxis. To defend the thesis, the present article draws on and analyses empirical material from an ethnographic field study in order to back up the conceptual analysis. (shrink)

Wenn es in der ersten Hälfte des 20. Jahrhunderts so etwas wie die "arme Verwandtschaft" unter den philosophischen Themen gab, so waren das die Gefühle. Zwar hatten sich Klassiker wie Platon, Aristoteles, Spinoza, Descartes und Hume eingehend mit ihnen befaßt, aber seit Kant, der sie als "Gegner der Vernunft" abtat, wurde den Gefühlen in der Philosophie nur noch wenig Beachtung geschenkt. Erst seit den 1960er Jahren rückten sie wieder in den Fokus des Interesses, und zwar aufgrund der Einsicht, daß Gefühle (...) kognitive mentale Zustände sind, die dazu dienen können, andere Zustände und Handlungen rational zu machen. Strittig ist indes, von welcher Art emotionale Kognitionen sind. Der Band versammelt in historisch-systematischen Einzelstudien die wichtigsten Positionen in der Philosophie der Gefühle und eignet sich gleichermaßen als umfassende Einführung in die Thematik wie auch als Seminarvorlage. (shrink)

For valid informed consent, it is crucial that patients or research participants fully understand all that their consent entails. Testing and revising informed consent documents with the assistance of their addressees can improve their understandability. In this study we aimed at further developing a method for testing and improving informed consent documents with regard to readability and test-readers’ understanding and reactions. We tested, revised, and retested template informed consent documents for biobank research by means of 11 focus group interviews with (...) members from the documents’ target population. For the analysis of focus group excerpts we used qualitative content analysis. Revisions were made based on focus group feedback in an iterative process. Focus group participants gave substantial feedback on the original and on the revised version of the tested documents. Revisions included adding and clarifying explanations, including an info-box summarizing the main points of the text and an illustrative graphic. Our results indicate positive effects on the tested and revised informed consent documents in regard to general readability and test-readers’ understanding and reactions. Participatory methods for improving informed consent should be more often applied and further evaluated for both, medical interventions and clinical research. Particular conceptual and methodological challenges need to be addressed in the future. (shrink)

BackgroundHealthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use.MethodsPubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract (...) screened according to defined inclusion and exclusion criteria, resulting in 44 papers whose full texts were analysed using the Kuckartz method of qualitative text analysis.ResultsArtificial Intelligence might increase patient autonomy by improving the accuracy of predictions and allowing patients to receive their preferred treatment. It is thought to increase beneficence by providing reliable information, thereby, supporting surrogate decision-making. Some authors fear that reducing ethical decision-making to statistical correlations may limit autonomy. Others argue that AI may not be able to replicate the process of ethical deliberation because it lacks human characteristics. Concerns have been raised about issues of justice, as AI may replicate existing biases in the decision-making process.ConclusionsThe prospective benefits of using AI in clinical ethical decision-making are manifold, but its development and use should be undertaken carefully to avoid ethical pitfalls. Several issues that are central to the discussion of Clinical Decision Support Systems, such as justice, explicability or human–machine interaction, have been neglected in the debate on AI for clinical ethics so far.Trial registrationThis review is registered at Open Science Framework (https://osf.io/wvcs9). (shrink)

This paper addresses the question of whether the appearance ofthen in a conditional construction has any effect on the meaning of the sentence as a whole. It will be suggested thatthen does make a contribution by way of a particular presupposition associated with it. This also results inthen sometimes conflicting with the intended meaning of the sentence; in such cases its appearance is precluded. Certain aspects of the syntax ofthen will be discussed in parallel.

I argue that, in experiencing a recalcitrant emotion, one does not violate a rational requirement of any sort. Rational requirements, as the expression has come to be used, are requirements of coherence. Accordingly, my argument is that there is nothing incoherent in any way about experiencing a recalcitrant emotion. One becomes incoherent only if one allows the emotion to influence one's reasoning and/or action, in which case one violates the ‘consistency principle’ and/or the ‘enkratic principle’. From the standpoint of rationality, (...) it would even be counterproductive to put subjects under the obligation that their emotional experiences and their evaluative judgements must always fit together. When we nevertheless intuitively sense that the subject is irrational in experiencing a recalcitrant emotion this is in cases in which the emotion challenges the subject's agential identity. However, emotions can, but need not, challenge one's agential identity, and, furthermore, perceptions can do so as well. In any case, challenges of this kind do not involve the violation of a rational requirement. (shrink)

Almost all contemporary philosophers on the subject agree that emotions play an indispensable role in the justification (as opposed to the mere causation) of other mental states and actions. However, how this role is to be understood is still an open question. At the core of the debate is the phenomenon of conflict without contradiction: why is it that an emotion need not be revised in the light of better judgment and knowledge? Conflict without contradiction has been explained either by (...) difference in content between emotion and judgment, or by a difference in the respective attitude towards content. I argue that conflict without contradiction is due to both differences, where difference in content is prior to difference in attitude. (shrink)

Evaluativism about desire, the view that desires just are, or necessarily involve, positive evaluations of their objects, currently enjoys widespread popularity in many philosophical circles. This chapter argues that evaluativism, in both of its doxastic and perceptual versions, overstates and mischaracterises the connection between desires and evaluations. Whereas doxastic evaluativism implausibly rules out cases where someone has a desire, despite evaluating its object negatively, being uncertain about its value, or having no doxastic attitude whatsoever towards its evaluative status at all, (...) perceptual evaluativism cannot even properly apply to the large class of standing desires. It is also argued that evaluativism about desire is not even well-motivated in the first place: the theory is supposed to solve a particular puzzle about the role desires play in the explanation of action, yet, in fact, it does not offer any help whatsoever in dealing with the relevant puzzle. (shrink)

This book opens up a new route to the study of knowledge dynamics and the sociology of knowledge. The focus is on the role of metaphors as powerful catalysts and the book dissects their role in the construction of theories of knowledge and will therefore be of vital interest to social and cognitive scientists alike.

Although the academic interest in ethical mutual fund performance has developed steadily, the evidence to date is mainly sample-specific. To tackle this critique, new research should extend to unexplored countries. Using this as a motivation, we examine the performance and risk sensitivities of Canadian ethical mutual funds vis-à-vis their conventional peers. In order to overcome the methodological deficiencies most prior papers suffered from, we use performance measurement approaches in the spirit of Carhart (1997, Journal of Finance 52(1): 57–82) and Ferson (...) and Schadt (1996, Journal of Finance 51(2): 425–461). In doing so, we investigate the aggregated performance and investment style of ethical and conventional mutual funds and allow for time variation in the funds’ systematic risk. Our␣Canadian evidence supports the conjecture that any␣performance differential between ethical mutual funds and their conventional peers is statistically insignificant. (shrink)

‘Scientific advice to politics’, the ‘nature of expertise’, and the ‘relation between experts, policy makers, and the public’ are variations of a topic that currently attracts the attention of social scientists, philosophers of science as well as practitioners in the public sphere and the media. This renewed interest in a persistent theme is initiated by the call for a democratization of expertise that has become the order of the day in the legitimation of research funding. The new significance of ‘participation’ (...) and ‘accountability’ has motivated scholars to take a new look at the science – politics interface and to probe questions such as "What is new in the arrangement of scientific expertise and political decision-making?", "How can reliable knowledge be made useful for politics and society at large, and how can epistemically and ethically sound decisions be achieved without losing democratic legitimacy?", "How can the objective of democratization of expertise be achieved without compromising the quality and reliability of knowledge?" Scientific knowledge and the ‘experts’ that represent it no longer command the unquestioned authority and public trust that was once bestowed upon them, and yet, policy makers are more dependent on them than ever before. This collection of essays explores the relations between science and politics with the instruments of the social studies of science, thereby providing new insights into their re-alignment under a new régime of governance. (shrink)

Empirical-ethical research constitutes a relatively new field which integrates socio-empirical research and normative analysis. As direct inferences from descriptive data to normative conclusions are problematic, an ethical framework is needed to determine the relevance of the empirical data for normative argument. While issues of normative-empirical collaboration and questions of empirical methodology have been widely discussed in the literature, the normative methodology of empirical-ethical research has seldom been addressed. Based on our own research experience, we discuss one aspect of this normative (...) methodology, namely the selection of an ethical theory serving as a background for empirical-ethical research. (shrink)

Within the ethical debate on Machine Learning-driven decision support systems (ML_CDSS), notions such as “human in the loop” or “meaningful human control” are often cited as being necessary for ethical legitimacy. In addition, ethical principles usually serve as the major point of reference in ethical guidance documents, stating that conflicts between principles need to be weighed and balanced against each other. Starting from a neo-Kantian viewpoint inspired by Onora O'Neill, this article makes a concrete suggestion of how to interpret the (...) role of the “human in the loop” and to overcome the perspective of rivaling ethical principles in the evaluation of AI in health care. We argue that patients should be perceived as “fellow workers” and epistemic partners in the interpretation of ML_CDSS outputs. We further highlight that a meaningful process of integrating (rather than weighing and balancing) ethical principles is most appropriate in the evaluation of medical AI. (shrink)

The IAB’s selection of the Qatar-based Research Center for Islamic Legislation & Ethics (CILE) for hosting the 2024 World Congress of Bioethics does not leave the international bioethics community...

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity (...) have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.We recommend a pragmatic approach: empirical research on personality changes arising from brain disorders or interventions, comprehensive information about risks of personality changes, and advance directives, particularly Ulysses contracts. (shrink)