This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females (...) and other demographic data on age and educational background were consistent with other studies of the field of medical humanities.Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field. (shrink)

In this article I argue that Part II of the Family LawAct 1996 gives expression to a new form ofresponsibility. I begin by suggesting thatresponsible behaviour has shifted from prohibiting orrequiring particular actions: we now exhibitresponsibility by our attitude towards our actions. I then examine where this new conception ofresponsibility has come from. Through an examinationof the work of post-liberal theorists, principallyMichael Sandel, I argue that a changing view ofpersonhood within post-liberal theory has led to aquestioning of the possibility of (...) choice, and that theabsence of choice necessitates a shift in thedefinition of responsible behaviour. If we are createdby our decisions then we cannot be held to account forour decisions, but only for the care we have takenover them. Responsibility is therefore measured notby our level of self-control but by our level ofself-awareness. Finally I examine the consequences ofthis shift in the meaning of responsibility. Withinthis framework autonomy is illusory thereforedecisions do not need to be respected. This explainswhy the implementation of Part II of the Family LawAct 1996 has been called into question. Within thisframework responsibility is relative therefore itextends indefinitely. This enables the Family Law Actto be uniquely intrusive and judgmental: everydivorcing couple, on being held up to scrutiny, isfound lacking. (shrink)

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

Because of the transcendent nature of the experience of my own self, responsibility for myself necessarily leads to responsibility for others. The aim of this paper is to approach this experience of the transcendence of the self and to show how it relates to a new sense of responsibility which transcends the self through a number of stages. First, the author outlines what might be called the "standard" view of authenticity in Husserl and how (...) this particular view yields a certain view of responsibility as the ability to answer completely for "who" one is and "what" one does. Second, this standard view is challenged with another reading of the "self" in Husserl - one that emphasizes a necessary and productive division within the self. Thus, the author suggests that it is this second view of the self which is developed by Heidegger. Third, he demonstrates how this different view of the "authentic" self, that is inextricably linked to a "loss" of self, leads to a radically distinct view of responsibility for oneself, and for others. (shrink)

The crucial distinction for ethics is between the good and the apparent good, between being and seeming. Tradition is useful for developing our ability to make this distinction and to live ethically or in self-responsibility, but it is also threatening to this ability. The phenomenology of Husserl and of others in the Husserlian tradition, especially Robert Sokolowski, are helpful in spelling out how tradition works; how the difference between the apparent good and the good is bridged in the (...) experience of moral truth but also a permanent, challenging feature of human life; what ethics requires regarding self-responsibility or authenticity; and what the proper voice of tradition is in the ethical or moral life. (shrink)

A particular notion of reason has pervaded studies of practical action throughout the whole tradition of western philosophy up to Wittgenstein and Heidegger. This notion has been centrally located in contexts other than the specific study of practical action itself.This essay examines the relation of reason and practical action by reviewing Habermas' and Husserl's theories of the relation between discourse and action (I), and then proposing Garfinkel's ethnomethodological studies of practical action as an alternative to Husserl's and Habermas' preoccupation with (...) the primacy of theoretical discourse (II). In a final section I shall interpret Garfinkel's studies, following his own suggestions as studies in practical ethics, and make reference to similar themes in philosophical ethics (Ill). (shrink)

Roman Stoic thinkers in the imperial period adapted Greek doctrine to create a model of the self that served to connect philosophical ideals with traditional societal values. The Roman Stoics-the most prominent being Marcus Aurelius-engaged in rigorous self-examination that enabled them to integrate philosophy into the practice of living. Gretchen Reydams-Schils's innovative new book shows how these Romans applied their distinct brand of social ethics to everyday relations and responsibilities. The Roman Stoics reexamines the philosophical basis that instructed (...) social practice in friendship, marriage, parenting, and community. From this analysis emerge Stoics who were neither cold nor detached, as the stereotype has it, but all too aware of their human weaknesses. In a valuable contribution to current discussions in the humanities on identity, autonomy, and altruism, Reydams-Schils ultimately conveys the wisdom of Stoics to the citizens of modern society. (shrink)

Roman Stoics of the imperial period developed a distinctive model of social ethics, one which adapted the ideal philosophical life to existing communities and everyday societal values. Gretchen Reydams-Schils’s innovative book shows how these Romans—including such philosophers as Marcus Aurelius, Seneca, Hierocles, and Epictetus—applied their distinct brand of social ethics to daily relations and responsibilities, creating an effective model of involvement and ethical behavior in the classical world. _The Roman Stoics_ reexamines the philosophical basis that instructed social practice in friendship, (...) marriage, parenting, and community life. From this analysis, Stoics emerge as neither cold nor detached, as the stereotype has it, but all too aware of their human weaknesses. In a valuable contribution to current discussions in the humanities on identity, autonomy, and altruism, Reydams-Schils ultimately conveys the wisdom of Stoics to the citizens of modern society. (shrink)

In this chapter, I propose to examine a specific form of self-awareness in which we become aware of our existence in a problematic sense: wistfulness. In thinking about what it means to have a life, one is often haunted by different senses of possibility: of what could or should be, of what might have been, but just as well, of what could never have been. In such latter instances, we become aware of ourselves not in terms of actuality (who (...) I am) or possibility (who I can or could become), but in terms of impossibility, namely, as the impossible selves that nonetheless, in some sense, define and hence belong to us, as attested to in the experience of regret and remorse, not for what we did (or who we have been) but for what was impossible for us to be (or do). Drawing on Georg Simmel’s philosophy of life, I shall explore various senses in which we are responsible for ourselves, of who we have been and could yet be, as well as who it was impossible for us to once have been. In this regard, what Simmel calls the meta-ethical significance of death refers to the responsibility we have for ourselves in terms of what was both possible and impossible for us. (shrink)

Jan Patočka’s account of responsibility, as developed in Heretical Essays in the Philosophy of History, is configured through the philosopher’s entire model of history, seen less as a scale of progress, but rather as a rupture. Responsibility is possible only for a very specific form of humanity, centered on history, problematicity and selfdisclosure. This type of historic humanity is in profound contrast with the prehistoric one, focused on “daimonic participation.” Responsibility involves the passage from prehistory to history. (...) Despite the fact that it requires an intense “discipline of the soul,” the passage to responsibility cannot become pure and transparent, which in turn means that history is repeatedly threatened by falling back into prehistory. The positive involved in this assumption is that responsibility is not taken for granted; it is not a matter of following metaphysical principles, but rather a matter of a practical, “heretical” decision of embracing history, with its shaken problematicity, and of resisting the temptation of prehistory.La comprensión de Jan Patočka de la responsabilidad, tal como se desarrolladen Ensayos eréticos de filosofía de la Historia, viene configurada por el modelo completo de Historia, vista más como una ruptura que como una escala de progreso. La responsabilidad es posible sólo para una forma muy concreta de humanidad, centrada en la historia, la problematicidad y el autodescubrimiento. Este tipo de humanidad histórica se halla en profundo contraste con el tipo prehistórico, focalizado sobre la “participación demónica”. La responsabilidad implica el tránsito de la prehistoria a la historia. Pese a requerir una intensa “disciplina del alma”, el tránsito a la responsabilidad no puede tornarse puro y transparente, lo que a su vez significa que la historia está constantemente amenzada por una recaída en la prehistoria. El lado positivo que esta asunción envuelve es que la responsabilidad no se da por garantizada; no es una cuestión de seguir principios metafísicos, sino más bien cuestión de una decisión práctica, “herética”, de abrazar la historia, con su problematicidad conmovida, y de resistir la tentación de la prehistoria. (shrink)

Review of Gretchen Reydams-Schils, The Roman Stoics: Self, Responsibility, and Affection. Chicago: The University of Chicago Press, 2005.

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers’ self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in (...) Liberia combining basic neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers’ own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers’ knowledge of students’ social and emotional needs, and promoting educational improvement. (shrink)

This is a study of Roman adaptations of Stoic doctrine that seeks to portray a model of the self functioning as a mediator between philosophical and traditional values (1). The author’s aim is ‘to let the Roman Stoics’ self arise out of a comprehensive analysis of their extant philosophical work and to conduct that analysis from the vantage point of the specific question of social embeddedness. Such an approach yields a Stoic self that is constituted by the (...) encounter between challenges and normative expectations’ (2). Overall, this aim is met. The Roman Stoics referred to are Seneca, Musonius Rufus, Epictetus, Marcus Aurelius, and to a lesser extent Hierocles, who ‘all had to come to terms with the sociopolitical challenges of imperial Rome’ (3). The tame thesis advanced is that the doctrine of these Roman Stoics ‘shows a distinctive pattern of emphasizing social responsibility’ (3). This social responsibility includes commitments to the political community, marriage, and parenthood. (shrink)

This is a study of Roman adaptations of Stoic doctrine that seeks to portray a model of the self functioning as a mediator between philosophical and traditional values (1). The author’s aim is ‘to let the Roman Stoics’ self arise out of a comprehensive analysis of their extant philosophical work and to conduct that analysis from the vantage point of the specific question of social embeddedness. Such an approach yields a Stoic self that is constituted by the (...) encounter between challenges and normative expectations’ (2). Overall, this aim is met. The Roman Stoics referred to are Seneca, Musonius Rufus, Epictetus, Marcus Aurelius, and to a lesser extent Hierocles, who ‘all had to come to terms with the sociopolitical challenges of imperial Rome’ (3). The tame thesis advanced is that the doctrine of these Roman Stoics ‘shows a distinctive pattern of emphasizing social responsibility’ (3). This social responsibility includes commitments to the political community, marriage, and parenthood. (shrink)

The issue of how to identify the liability of subjects after a traffic accident takes place remains a puzzle regarding the SAE classification system. The SAE system is not good at dealing with the problem of responsibility evaluation; therefore, building a new classification system for self-driving cars from the perspective of the subject's liability is a possible way to solve this problem. This new system divides automated driving into three levels: i) assisted driving based on the will of (...) drivers, ii) automated driving based on the will of the manufacturers, and iii) fully automated driving based on social will. The corresponding responsible subjects for level one, level two, and level three are the drivers, the manufacturers, and society, respectively. (shrink)

According to Dewey, we are responsible for our conduct because it is “ourselves objectified in action”. This idea lies at the heart of an increasingly influential deep self approach to moral responsibility. Existing formulations of deep self views have two major problems: They are often underspecified, and they tend to understand the nature of the deep self in excessively rationalistic terms. Here I propose a new deep self theory of moral responsibility called the (...) class='Hi'>Self-Expression account that addresses these issues. The account is composed of two parts. The first part answers the question, What is a deep self? Theorists have tended to favor cognitive views that understand the deep self in terms of rationally formed evaluative judgment. I propose instead a conative view that says one’s deep self consists of a distinctive kind of pro-attitude, cares, and I provide an account of cares in terms of their distinctive psychological functional role. The second part answers the question, When does an action express one’s deep self? I criticize the agentially demanding conditions set out in existing views and propose a more minimalist alternative. I show that the Self-Expression account handles issues that bedeviled traditional deep self views, including how to explain moral responsibility for spontaneous, out of character, and weak-willed actions. (shrink)

Self-control is integral to successful human agency. Without it we cannot extend our agency across time and secure central social, moral, and personal goods. But self-control is not a unitary capacity. In the first part of this paper we provide a taxonomy of self-control and trace its connections to agency and the self. In part two, we turn our attention to the external conditions that support successful agency and the exercise of self-control. We argue that (...) what we call moral security is a critical foundation for agency. Parts three and four explore what happens to agency when moral security is lacking, as in the case of those subject to racism, and those living in poverty. The disadvantages suffered by those who are poor, in a racial minority or other oppressed group, or suffering mental illness or addiction, are often attributed to a lack of individual self-control or personal responsibility. In particular, members of these groups are often seen as irresponsibly focused on short-term pleasures over long-term good, a view underwritten by particular psychological theories of self-control. We explore how narratives about racism and poverty undermine moral security, and limit and distort the possibility of synchronic and diachronic self-control. Where moral security is undermined, the connection between self-control and diachronic goods often fails to obtain and agency contracts accordingly. We close with some preliminary reflections on the implications for responsibility. (shrink)

The self-deceived are usually held to be moral responsible for their state. I argue that this attribution of responsibility makes sense only against the background of the traditional conception of self-deception, a conception that is now widely rejected. In its place, a new conception of self-deception has been articulated, which requires neither intentional action by self-deceived agents, nor that they possess contradictory beliefs. This new conception has neither need nor place for attributions of moral (...) class='Hi'>responsibility to the self-deceived in paradigmatic cases. Accordingly, we should take the final step toward abandoning the traditional conception, and drop the automatic attribution of responsibility. Self-deception is simply a kind of mistake, and has no more necessary connection to culpability than have other intellectual errors. (shrink)

Contemporary philosophers of moral responsibility are in widespread agreement that we can only be blamed for actions that express, reflect, or disclose something about us or the quality of our wills. In this paper I reject that thesis and argue that self disclosure is not a necessary condition on moral responsibility and blameworthiness: reactive responses ranging from aretaic appraisals all the way to outbursts of anger and resentment can be morally justified even when the blamed agent’s action (...) expresses or discloses nothing significant about his or her “deep self,” judgments and cares, or the quality of his or her will. I argue that the self-disclosure requirement on responsibility overestimates the extent to which our blaming practices and responsibility judgments are responsive to agents as opposed to actions, and that this mistake has the potential to distort both our reactive responses and our understanding of blamed agents’ characters. (shrink)

I present two different models of moral responsibility -- two different accounts of what we value in behavior for which the agent can legitimately be held morally responsible. On the first model, what we value is making a certain sort of difference to the world. On the second model, which I favor, we value a certain kind of self-expression. I argue that if one adopts the self-expression view, then one will be inclined to accept that moral (...) class='Hi'>responsibility need not require alternative possibilities. (shrink)

I try to show that agent responsibility is an inadequate basis for the attribution of liability, by discrediting the Risk Argument and showing how the Responsibility Argument in fact collapses into the Risk Argument. I have concentrated on undermining these as philosophical theories of self-defense, although I at times note that our theory of self-defense should not be predicated on assumptions that are inapplicable to the context of war. The potential combatant, I conclude, should not look (...) to the agency view to ease his conscience about the killing he will do in war. If he is to fight without violating rights, then he will need a different theory of self-defense; if there are no more defensible theories, then he must either accept pacifism—which I think is a live possibility—or seek to identify stronger countervailing reasons, which can override the great force of his victims’ rights to life. (shrink)

The political shift toward an economic liberalism in many developed market economies, emphasizing the importance of the marketplace rather than government intervention in the economy and society (Dorman, Systematic Occupational Health and Safety Management: Perspectives on an International Development, 2000; Tombs, Policy and Practice in Health and Safety 3(1): 24-25, 2005; Walters, Policy and Practice in Health and Safety 03(2):3-19, 2005), featured a prominent discourse centered on the need for business flexibility and competitiveness in a global economy (Dorman, 2000; Tombs, (...) 2005). Alongside these developments was an increasing pressure for corporate social responsibility (CSR). The business case for CSR - that corporations would benefit from voluntarily being socially responsible — was increasingly promoted by governments and corporations as part of the justification for self-regulation. The aim of the article is to examine more closely the proposition that self-regulation is effective, with particular reference to the business case for workplace equality and safety. Based on a comprehensive literature review and documentary analysis, it was found that current predominant management discourse and practice focusing on diversity and safety management systems (OHSMS) resonate well with a government and corporate preference for the business case and self-regulation. However, the centrality of individual rather than organizational factors in diversity and OHSMS means that systemic discrimination and inherent workplace hazards are downplayed, making it less likely that employers will initiate structural remedies needed for real change. Thus, reliance on the business case in the argument for self-regulation is problematic. In terms of government policy and management practice, the business case needs to be supplemented by strong, proactive legislation, and worker involvement. (shrink)

These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, frustration (...) and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath. (shrink)

This paper focuses on the question of whether and, if so, when people can be responsible for their self-deception and its consequences. On Intentionalist accounts, self-deceivers intentionally deceive themselves, and it is easy to see how they can be responsible. On Motivationist accounts, in contrast, self-deception is a motivated, but not intentional, and possibly unconscious process, making it more difficult to see how self-deceivers could be responsible. I argue that a particular Motivationist account, the Desire to (...) Believe account, together with other resources, best explains how there can be culpable self-deception. In the process, I also show how self-deception is a good test case for deciding important questions about the nature of moral responsibility. (shrink)

ABSTRACTDiagnostic self‐testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point‐of‐care facilities and at home. Designed to allow earlier detection of diseases, self‐testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping (...) society improve health and reduce health costs. However, the full implications of future home‐based diagnostic technology for individuals and society remain unclear due to their novelty.We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home‐based self‐testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation.While the ethical issues are not necessarily new, the development of home‐based self‐testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

This paper raises a slightly uncomfortable question: are some delusional subjects responsible for their delusions? This question is uncomfortable because we typically think that the answer is pretty clearly just ‘no’. However, we also accept that self-deception is paradigmatically intentional behavior for which the self-deceiver is prima facie blameworthy. Thus, if there is overlap between self-deception and delusion, this will put pressure on our initial answer. This paper argues that there is indeed such overlap by offering a (...) novel philosophical account of self-deception. The account offered is independently plausible and avoids the main problems that plague other views. It also yields the result that some delusional subjects are self-deceived. The conclusion is not, however, that those subjects are blameworthy. Rather, a distinction is made between blameworthiness and ‘attributability’. States or actions can be significantly attributable to a subject—in the sense that they are expressions of their wills—without it being the case that the subject is blameworthy, if the subject has an appropriate excuse. Understanding delusions within this framework of responsibility and excuses not only illuminates the ways in which the processes of delusional belief formation and maintenance are continuous with ‘ordinary’ processes of belief formation and maintenance, it also provides a way of understanding the innocence of the delusional subject that does not involve the denial of agency. (shrink)

In this paper, I first argue that sometimes freely and knowingly manipulating oneself does not fully preserve moral responsibility – namely, in cases of practically distinct self-manipulation. However, I argue that practically distinct self-manipulation preserves moral responsibility to some extent because such a self-manipulated person is more morally responsibility than an other-manipulated person. This is an important result: manipulating oneself doesn’t always fully preserve one’s moral responsibility for one’s actions. But in what sense (...) is the self-manipulated person more morally responsible? I argue the self-manipulated person is not a fitting target of the reactive attitudes but continues to have wrongdoing-incurred reparative obligations. This explains the intuitive judgement about the self-manipulated person, provides a better explanation of “tracing” cases, and reveals important requirements for a plausible theory of moral responsibility. (shrink)

The self is not a metaphysical object but a mode of temporal organization unified by responsibility. Learning to be responsible constitutes the self as a self-identical entity over time. Responsibility depends on the current self interpreting previous events, attributing them to itself and thereby committing itself for the future. (2004) .

Statements of the core ethical and professional responsibilities of medical professionals are incomplete in ways that threaten fundamental goals of medicine. First, in the absence of explicit guida...

This paper discusses two features of the "morally responsible self." The first has to do with the preconditions of personal identity assumed to inhere in a morally responsible self. The paper argues that it is not a requirement of moral responsibility that the self held responsible for some action is one and the same individual as the self that performed it. the second feature involves what's known as the "deep self" theory of responsibility. (...) The paper discusses the history of the theory, as well as some critical contemporary exchanges about it. (shrink)

ABSTRACT Patient self‐management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified: 1) insufficient patient/family access to preparation that will optimize their competence to SM without (...) harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled. (shrink)

It is often emphasised that persons diagnosed with borderline personality disorder show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person’s own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the (...) idea that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern ‘from behind’. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD, particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame. (shrink)

He finds the key in the concept of responsibility, which implies not only the freedom and flexibility of responsiveness to others but also a guiding ideal of ...

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. (...) Regarding (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

Robert Kane has for many years claimed that in our underivatively free actions, what he calls “self-forming acts”, we actually try to do both of the two acts we are contemplating doing and then we ultimately end up doing only one of them. This idea of dual willings/efforts was put forward in an attempt to solve luck problems, but Randolph Clarke and Alfred Mele argue that for this to work agents must, then, freely engage in the dual efforts leading (...) up to their SFAs. In response, Kane has said they do so freely by meeting compatibilist criteria of freedom. In Free Will and Luck , Mele argues that this move is deeply problematic. In this essay, I defend Kane's position. In doing so, I clarify important differences between the SFAs of adults and those of young children, making more clear the connections between SFAs, character, and responsibility. (shrink)

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping (...) society improve health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

The Responsible Self was H. Richard Niebuhr's most important work in Christian ethics. In it he probes the most fundamental character of the moral life and it stands today as a landmark contribution to the field. The Library of Theological Ethics series focuses on what it means to think theologically and ethically. It presents a selection of important and otherwise unavailable texts in easily accessible form. Volumes in this series will enable sustained dialogue with predecessors though reflection on classic (...) works in the field. (shrink)