The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. (...) The participants believed that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent. (shrink)

This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and (...) overall wellbeing of older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes. (shrink)

How should political theorists go about their work if they are democrats? Given their democratic commitments, should they develop theories that are responsive to the views and concerns of their fellow citizens at large? Is there a balance to be struck, within political theory, between truth seeking and democratic responsiveness? The article addresses this question about the relationship between political theory, public opinion and democracy. I criticize the way in which some political theorists have appealed to the value of democratic (...) legitimacy in an attempt to justify a more opinion-sensitive approach to their work. Specifically, I identify a problematic model in the existing literature, which I term ‘democratic restraint’: an approach on which the theorist moderates her normative principles in response to evidence about public attitudes in order to enhance the legitimacy of her account. This model renders the discipline newly vulnerable to an otherwise misguided objection that political theory seeks to pre-empt democratic politics. I trace the problem with the democratic restraint model to its flawed underlying conception of democratic legitimacy. The article then outlines a more appealing ‘democratic underlabourer’ view of the status of political theory and draws out the implications of this alternative account for the role of public opinion. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working (...) in three neurosurgical departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

Background:The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied.Purpose:This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures.Research design:Using Charles Taylor’s hermeneutic framework, a 2-month focused ethnography with a (...) participatory approach was used.Participants and research context:Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity.Ethical considerations:The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants.Findings:By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures.Discussion:A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability.Conclusion:The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

Public reason liberals disagree about the relationship between public justification and deliberative democracy. My goal is to argue against the recent suggestion that public reason liberals seek a ‘divorce’ from deliberative democracy. Defending this thesis will involve discussing the benefits of deliberation for public justification as well as revisiting public reason’s standard Rawlisan restraint requirement. I criticize Kevin Vallier’s alternative convergence-based principle of restraint and respond to the worry that the standard Rawlsian restraint requirement reduces the likelihood (...) of public justification by limiting the diversity of inputs into the justificatory process. (shrink)

From these elements, however, genealogy retrieves an indispensable restraint: it must record the singularity of events … in the most unpromising places, in what we tend to feel is without history—in sentiments, love, conscience, instincts; it must be sensitive to their recurrence, not in order to trace the gradual curve of their evolution but to isolate the different scenes where they engaged in different roles.In much of what has been called the “affective turn,” Michel Foucault has figured as a (...) paranoid foil where he has been mentioned at all. Both continental feminists—influenced by Gilles Deleuze’s work on Spinoza and Nietzsche—and queer theorists—for whom affect presents an alternative to the normalizing .. (shrink)

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims: to gain access to the bodily phenomenon of being placed in mechanical restraints; to give voice to the intimate experiential (...) understanding of this experience; and through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses and patients we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: context of care, meaning of quality of care, emotional reactions and nurse–patient relationship, meeting the needs and need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice. (shrink)

Freiheitsentziehende Maßnahmen in Altenpflegeheimen sind unter pflegerischen und ethischen, aber auch betreuungsrechtlichen und vor allem strafrechtlichen Gesichtspunkten von besonderer Bedeutung. Häufig sind eingeschränkte Mobilität, Verringerung der kognitiven Funktionen, große Hilfsbedürftigkeit des älteren Menschen der auslösende Faktor für den Einsatz derartiger Einschränkungen. Daneben gibt es jedoch Hinweise, dass die Anwendung freiheitsentziehender Maßnahmen auch mit organisatorischen Abläufen in Altenpflegeeinrichtungen zusammenhängt. Der vorliegende Beitrag diskutiert, wieweit freiheitsentziehende und freiheitsbeschränkende Maßnahmen bei alten Menschen überhaupt zulässig sind und zeigt auf, dass die Entwicklung von alternativen (...) Betreuungs- und Versorgungsansätzen dazu beitragen kann, dass durch weniger freiheitsentziehende Maßnahmen in der stationären Pflege die Würde der alten Menschen gewahrt bleibt. (shrink)

The framework of the Israel-Palestinian Arab conflict has evolved over the last half century through an instrumentalization of violence by the parties concerned. Two alternating "structures of violence" have emerged to define this instrumentality: the one Israeli, the other Palestinian. I call these structures of violence "alternating" rather than merely "reciprocating" because the one not only feeds off the other and actually practices on the other that which is merely fancied and projected as the other's intention but also because they (...) have inverse periodicities: The "Great Revolt" of 1936-1939 introduced the principle of "armed struggle" into the practice and lore of a fractured and often factional antiBritish and anti-Zionist insurgency. It was effectively countered by British might coupled with an essentially defensive Jewish posture of consensus and "restraint". By contrast the current Palestinian "Uprising" has the Arab side preaching restraint if not always nonviolence, through a pluralistic consensus on the immediate national ends such practice aims to achieve. Against this is an avowed Israeli policy of "the iron fist" that for the first time since independence has broken the general Zionist consensus with regard not only to the utility and morality of violent means but also to national goals. (shrink)

This book, which inaugurates the Princeton Monographs in Philosophy series, starts from Plato's analogy in the Republic between conflict in the soul and conflict in the city. Plato's solution required reason to impose agreement and harmony on the warring passions, and this search for harmony and agreement constitutes the main tradition in political philosophy up to and including contemporary liberal theory. Hampshire undermines this tradition by developing a distinction between justice in procedures, which demands that both sides in a conflict (...) should be heard, and justice in matters of substance, which will always be disputed. Rationality in private thinking consists in adversary reasoning, and so it does in public affairs. Moral conflict is eternal, and institutionalized argument is its only universally acceptable restraint and the only alternative to tyranny.In the chapter "Against Monotheism," Hampshire argues that monotheistic beliefs are only with difficulty made compatible with pluralism in ethics. In "Conflict and Conflict Resolution," he argues that socialism, seen as the proposal of extended political solutions for natural human ills, is still a relevant, yet strongly contested, ideal. (shrink)

Contrary to the received view, I argue that Kant, in the “Doctrine of Right”, outlines a third, republican alternative to absolutist and voluntarist conceptions of political legitimacy. According to this republican alternative, a state must meet certain institutional requirements before political obligations arise. An important result of this interpretation is not only that there are institutional restraints on a legitimate state's use of coercion, but also that the rights of the state (‘public right’) are not in principle reducible to the (...) rights of individuals (‘private right’). Thus, for Kant, political obligations are intimately linked to the existence of a certain kind of republican institutional framework. (shrink)

On the analogy of the colloquial register in some modern languages, where narrative and argument may be punctuated by oaths and exclamations in order to maintain a high affective level and compel the hearer's attention, it is reasonable to postulate that Attic conversation also was punctuated by oaths, that this ingredient in comic language was drawn from life, and that the comparative frequency of ║ M M Δ in comedy is sufficiently explained thereby. There are obvious affinities between some passages (...) of comedy, relaxed conversation in Plato and Xenophon, and the forceful, man-to-man tone which Demosthenes sometimes adopts to such good effect . Compare, for instance, Ar. V. 133 f. στιν δ' νομα ⋮ τ μν γέροντι ⋮ Φιλοκλέων / να μ Δία, τ δ' υε κτλ., where the oath is a response to imagined incredulity, and X. Smp. 4.27 ατν δ σέ, η, γ εδον να μ τν πόλλω, τε κτλ. . It is also important that the commonest oaths fit, in most of their forms, the end of an iambic trimeter: μ τν Δία, ν Δία,ν τούς θεούς, μ τος θεούς. Add that in Aristophanic dialogue over half the iambic trimeters end with major pause, and half the remainder with minor pause, and we can see why Δ / established itself early as a distinctive comic pattern. Out of 105 examples of M M Δ cited from comedy in Section II above, 59 have the oath at verse-end. In the case of πάνυ, which was almost exclusively Attic and — to judge from its great rarity in tragedy — felt by Athenian poets to be prosaic, we lack evidence on its functions in the colloquial register; it may or may not have served as affective punctuation. In prose, we have to reckon with the fact that π Mπ and Mπ π constituted a genuine stylistic choice as far back as the evidence will take us, since the two earliest instances in prose are [X.] Ath. 2.3 πάνυ δι χρείαν and ibid. 3.5 πολλ τι πάνυ. The oath, as treated by the comic poets on the basis of colloquial usage, is bound to have served as a model for πάνυ, exerting an influence which pulled πάνυ to the end of the verse, but there was also a powerful metrical constraint. As a dibrach ending in a vowel which could not be elided or enter into crasis, πάνυ was especially appropriate for verse-end. That in itself was enough both to establish Mπ π as the dominant pattern in comedy and to promote Mπ … π. Out of the total of 104 examples of Mπ π in comedy, 93 have πάνυ at verse-end, which makes Mπ π / one of the hallmarks of comic style. Mπ … π does not occur in prose in association with any other feature identified as colloquial, but it should be noted that Aiskhines and Demosthenes are much fonder of Mπ π than other prose authors. In some cases one can see that the order Mπ π avoids a succession of short syllables or hiatus or both , but there are other cases in which it has the opposite effect . The possibility of comic influence on oratorical language cannot be dismissed out of hand. It is also possible that someone will find positive determinants which will explain all the cases of Mπ π in prose. σόδρα, which, like πάνυ, is peculiarly Attic, is metrically more tractable than πάνυ, since it can be elided; even so, out of the 80 comic examples of Mσ σ no less than 58 have σόδρα at verse-end, and of those 58 there are 22 at major pause, 8 at presumed major pause and 9 at minor pause. The comic treatment of σόδρα is thus comparable with the treatment of πάνυ, and Timokles 222.4 τηρεν…σόδρα is in fact the closest analogy we have to Ar. Pl. 234 f. χθομαι…πάνυ. δέ and γάρ are a different matter, and in some significant respects different from each other. Postponement of δέ is especially prominent in Aeschylus and then abundant in fourth-century comedy. It is much less common in Euripides , rare in Sophocles and Aristophanes , and virtually limited in prose to the categories which I labelled –. There is as yet no evidence to associate postponement of δέ with colloquial language; on the contrary, it seems to have begun as a feature of poetic language and to have been taken up and exploited by fourth-century comedy. If, in addition to being Aeschylean, it was colloquial in the fourth century, what happened to it afterwards? Except for such an isolated and inexplicable case as Diod. xx85.1 — in a military narrative — it is not a feature of the Koine at literary, documentary or subliterate level. Postponement of γάρ was no doubt encouraged by postponement of δέ, but it is not itself notably poetic ). One can see how it could possibly have developed in the spoken language of the fourth century, extending the function of γάρ as an explanatory particle in a way which makes it comparable with the English ‘you see’ in ‘He didn't dare pick it up. He hurt his back last year, you see’. For an extension of this kind we may compare the current extension of the English genitive affix in ‘Then the girl whose place she was taking's mother turned up’ and ‘The man that Christopher liked's Introduction is much better’. Moreover, postponed γάρ appears in a segment of conversation constructed in indirect speech by Theophrastus in Char. 8.9 τ πργμα βοσθαι γάρ . Again we must ask: what happened to it afterwards? A couple of cases in Theophrastus' botanical works could be a reflex of the influence of comedy on literary language at Athens. The influence was plainly short-lived, since it did not affect the Koine. It is not hard to see why serious poetry in the fifth century and earlier should have experimented occasionally with the postponement of δέ and γάρ: treatment of M M q as a valid alternative to M q M is metrically very convenient. No poet, however, could afford to use common words in a bizarre, un-Greek way merely to save himself time and trouble in constructing a verse. Linguistic innovation is normally analogical, proceeding by extension from a starting-point already there, and the most obvious starting-point for postponement of δέ and γάρ is constituted by my class . This consideration provides comic postponement with a pedigree, but does not deny it individuality. The remarkable scale and frequency with which comedy exploited a phenomenon which tragedy used with restraint and prose hardly at all gives comic postponement the right to be regarded as a quite distinctive artificial feature of comedy. (shrink)

It is a noteworthy achievement of Western liberal democracies that they have largely relinquished the use of force against citizens whose lifestyles offend their members’ sensibilities, or alternatively which violate their members’ sense of truth. Toleration has become a central virtue in our public institutions. Powerful majorities are given over to restraint. They do not, by and large, expect the state to crush eccentrics, nonconformists, and other uncongenial minorities in their midst. What precipitated this remarkable evolution in our political (...) culture?The road to toleration originates in the debates provoked by religious dissent in the early modem period. This road was paved in part by a grudging appreciation of the necessity for pragmaticaccommodation. The wars of religion that had devastated the Continent educated the political classes about the costs of persecution. A policy of state-imposed religious intolerance was widely understood to be imprudent.In the early modem period there occurs, however, a shift in the arguments adduced in support of the duty of toleration. (shrink)

This book, which inaugurates the Princeton Monographs in Philosophy series, starts from Plato's analogy in the Republic between conflict in the soul and conflict in the city. Plato's solution required reason to impose agreement and harmony on the warring passions, and this search for harmony and agreement constitutes the main tradition in political philosophy up to and including contemporary liberal theory. Hampshire undermines this tradition by developing a distinction between justice in procedures, which demands that both sides in a conflict (...) should be heard, and justice in matters of substance, which will always be disputed. Rationality in private thinking consists in adversary reasoning, and so it does in public affairs. Moral conflict is eternal, and institutionalized argument is its only universally acceptable restraint and the only alternative to tyranny. In the chapter "Against Monotheism," Hampshire argues that monotheistic beliefs are only with difficulty made compatible with pluralism in ethics. In "Conflict and Conflict Resolution," he argues that socialism, seen as the proposal of extended political solutions for natural human ills, is still a relevant, yet strongly contested, ideal. (shrink)

Quine's arguments for the indeterminacy of translation demonstrate the existence and help to explain the rationale of restraints upon what we can say and understand. In particular they show that there are logical truths to which there are no intelligible alternatives. Thus the standard view that the truths of logic and mathematics differ from "synthetic" statements in being true solely by virtue of linguistic convention--Which requires for its plausibility the existence of intelligible alternatives to our present logical truth--Is (...) opposed directly, And not by the espousal of "a more thorough pragmatism". This raises problems about possibility and conceptual novelty. (shrink)

My dissertation comprises three inter-related chapters, all of which explore the nature of work law and critically analyze the prevailing emphasis on matters of contract. The Escape Plans of Mill and Jefferson: I discuss these thinkers’ unsuccessful “escape plans” to minimize wage work. Mill advocated cooperative, worker-owned firms, while Jefferson favored farming the vast American frontier. I explore whether, if realized, either proposal would have satisfied the demands of justice. I argue that such proposals are normatively deficient because they lead (...) us mistakenly to assume that so long as the law provides alternatives to wage labor, it can justly leave work relationships in an unregulated, Dickensian state. In reply, I contend that we have no just alternative to engaging in the messy and difficult task of regulating the workplace. Revising the Roles of Master and Servant: I critically examine the claim that work law is best understood as part of contract law, arguing that this view is neither descriptively nor normatively instructive. Rather than understanding work law as a set of restraints on freedom of contract, we should see it as creating and defining special relationships, much like the codified definitions of marriages and corporations. I trace the development of work relationships through the common law of “master and servant” and more recent statutory modifications. I argue that the history and present form of work law are not consistent with the contract-centered view of work law as “interfering” with an otherwise free labor market. Competing Ideologies and the End of the Lochner Era: I examine Howard Gillman’s critique of the view that early-20th Century Supreme Court Justices sought to advance policy preferences rather than interpret the law. Gillman reconstructs the legal basis for their decisions, thus undermining the claim that they merely pursued laissez faire policies. However, Gillman then claims that the Justices who overruled liberty-of-contract in West Coast Hotel had no principled basis for their decisions. In response, I argue that West Coast Hotel was not only based on a plausible interpretation of constitutional law, but also the best outcome with respect to justice. (shrink)

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

A problem for dialogue models of argumentation is to specify a set of conditions under which an opponent’s claims, offered in support of a standpoint under dispute, ought to be challenged. This project is related to the issue of providing a set of acceptability conditions for claims made in a dialogue. In this paper, we consider the conditions of suspicion and trust articulated by Jacobs (Alta, 2003), arguing that neither are acceptable as general conditions for challenge. We propose a third (...) condition that attempts to mark a middle ground between suspicion and trust. (shrink)

The essays in this provocative collection survey and assess institutional arrangements that offer possible alternatives to capitalism as it exists today. The point of departure agreed upon by the contributors is that on the one hand, capitalism produces unemployment, a lack of autonomy in the workplace, and massive income inequalities; while on the other, central socialist planning is characterized by underemployment, inefficiency, and bureaucracy. In Part I of the volume, various alternatives are proposed: profit-sharing systems, capitalism combined with (...) some central planning, worker-owned firms in a market economy into a centrally planned economy, as has occurred recently in Hungary. Part II provides a theoretical analysis and assessment of these systems. This book is the first to cover such a wide range of subjects as central planning, market socialism, and profit sharing. It will prove indispensable to political and social scientists, and economists. (shrink)

Medical assistance in dying (MAiD) has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary (...) stopping eating and drinking (VSED) as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive? (shrink)

Medical assistance in dying has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary stopping (...) eating and drinking as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive? (shrink)

This paper extends three decades of work arguing that researchers who discuss consciousness should not restrict themselves only to (adult) human minds, but should study (and attempt to model) many kinds of minds, natural and artificial, thereby contributing to our understanding of the space containing all of them. We need to study what they do or can do, how they can do it, and how the natural ones can be emulated in synthetic minds. That requires: (a) understanding sets of requirements (...) that are met by different sorts of minds, i.e. the niches that they occupy, (b) understanding the space of possible designs, and (c) understanding complex and varied relationships between requirements and designs. Attempts to model or explain any particular phenomenon, such as vision, emotion, learning, language use, or consciousness lead to muddle and confusion unless they are placed in that broader context. A methodology for making progress is summarised and a novel requirement proposed for a theory of how human minds work: the theory should support a single generic design for a learning, developing system that, in addition to meeting familiar requirements, should be capable of developing different and opposed philosophical viewpoints about consciousness, and the so-called hard problem. In other words, we need a common explanation for the mental machinations of mysterians, materialists, functionalists, identity theorists, and those who regard all such theories as attempting to answer incoherent questions. No designs proposed so far come close. (shrink)

Philosophers, and students of philosophy, are often advised to interpret other philosophers charitably. In this paper, I present an alternative to interpreting charitably. I call it “the simple-model technique” and use H.L.A. Hart responding to John Rawls to illustrate it.

Most contemporary variants of virtue ethics have a neo-Aristotelian timbre. However, standing alongside the neo-Aristotelians are a number of others playing similar tunes on different instruments. This chapter highlights the four most important virtue ethical alternatives to the dominant neo-Aristotelian chorus. These are Michael Slote’s agent-based approach, Linda Zagzebski’s exemplarism, Christine Swanton’s target-centered theory, and Robert Merrihew Adams’s neo-Platonic account. What these four approaches showcase is the range of possible theoretical structures available to virtue ethicists. A virtue ethicist might (...) attempt to define other normative qualities like goodness or rightness in terms of virtuous traits. But she need not. Instead, she might develop a theory in which virtue is fundamental but other normative qualities obey a logic that is at least partially independent of virtue. This chapter draws attention to an exciting range of possibilities for virtue ethics that both critics and advocates alike will want to explore. (shrink)

Branching theories are popular frameworks for modeling objective indeterminism in the form of a future of open possibilities. In such theories, the notion of a history plays a crucial role: it is both a basic ingredient in the axiomatic definition of the framework, and it is used as a parameter of truth in semantics for languages with a future tense. Furthermore, histories—complete possible courses of events—ground the notion of modal consistency: a set of events is modally consistent iff there is (...) a history containing that set. We will explain these roles of histories and highlight some critical aspects having to do with the fact that histories are global and, in a relevant sense, “big” objects. The notion of modal consistency, on the other hand, has both local and global aspects. We ask in how far a local notion of modal consistency can serve as an alternative to the common uses of histories, and work out two recent approaches to alternatives to histories. Combining these approaches, we develop a novel semantics for branching time. (shrink)

While some countries are moving toward legalization, euthanasia is still criticized on various fronts. Most importantly, it is considered a violation of the medical ethics principle of non-maleficence, because it actively seeks a patient’s death. But, medical ethicists should consider an ethical alternative to euthanasia. In this article, we defend cryocide as one such alternative. Under this procedure, with the consent of terminally-ill patients, their clinical death is induced, in order to prevent the further advance of their brain’s deterioration. Their (...) body is then cryogenically preserved, in the hope that in the future, there will be a technology to reanimate it. This prospect is ethically distinct from euthanasia if a different criterion of death is assumed. In the information-theoretic criterion of death, a person is not considered dead when brain and cardiopulmonary functions cease, but rather, when information constituting psychology and memory is lost. (shrink)

_Idealist Alternatives to Materialist Philosophies of Science_ (ed. Philip MacEwen) presents some of the major challenges to materialist interpretations of science while also giving materialism a full hearing.

Proponents of the causal theory of perception have applied the theory to questions about which particular objects or events are perceived, which parts are perceived, and which properties are perceived. In each case they insist that successful perception is causally dependent on what is perceived. The causal theory rests on an important insight regarding the information-carrying role of perception. In order to succeed in this role, perception cannot be grounded in spurious correlations. But we can respect this insight without embracing (...) the idea that a successful percept must be causally dependent on what is perceived. A correlation in nature can also be genuine or lawful when it arises from a common cause. I show how successful perception is frequently achieved through correlation via a common cause. (shrink)

Most contributors to the debate about brain death, including Dr. James Bernat, share certain assumptions. They believe that the concept of death is univocal, that death is a biological phenomenon, that it is necessarily irreversible, that it is paradigmatically something that happens to organisms, that we are human organisms, and therefore that our deaths will be deaths of organisms. These claims are supposed to have moral significance. It is, for example, only when a person dies that it is permissible to (...) extract her organs for transplantation.It is also commonly held that our univocal notion of death is the permanent cessation of integrated functioning in an organism and that the criterion for determining when this has occurred in animals with brains is the death of the brain as a whole – that is, brain death. The reason most commonly given for this is that the brain is the irreplaceable master control of the organism's integration. (shrink)

Philosophical interest in the biological concept of function stems largely from concerns about its teleological associations. Assigning something a function seems akin to assigning it a purpose, and discussion of the purpose of items has long been off-limits to science. Analytic philosophers have attempted to defend ‘function’ by showing that claims about functions do not involve any reference to a problematic notion of purpose. To do this, philosophers offer short lists of necessary and sufficient conditions for the application of the (...) concept—where the conditions involve only acceptable physical or biological notions—and claim that the set of conditions captures the import of function statements. (shrink)

ABSTRACT Proponents of the causal theory of perception have applied the theory to questions about which particular objects or events are perceived, which parts are perceived, and which properties are perceived. In each case, they insist that successful perception is causally dependent on what is perceived. The causal theory rests on an important insight regarding the information-carrying role of perception. In order to succeed in this role, perception cannot be grounded in spurious correlations. But we can respect this insight without (...) embracing the idea that a successful percept must be causally dependent on what is perceived. A correlation in nature can also be genuine or lawful when it arises from a common cause. I show how successful perception is frequently achieved through correlation via a common cause. (shrink)

Koriat and Goldsmith clearly show the need for an alternative to the storehouse metaphor; however, the alternative metaphor they choose – the correspondence metaphor – is problematic. A more suitable one is the capacity metaphor.

The original evidence advanced to support the Tensed S Condition (TSC) and the Specified Subject Condition (SSC) in Chomsky's Conditions on Transformations is reconsidered and viable alternatives to these constraints are provided. It is shown that TSC and SSC, in some instances, lead to a loss of linguistically significant generalization. Satisfactory alternatives can account for the relevant range of data and provide a more general account of additional data. Finally, counterevidence to Subjacency and Superiority is adduced, but explicit (...) alternatives to these conditions are not offered. (shrink)

They are correct that punctuated equilibria apply to sexually reproducing organisms and that morphological evolutionary change is regarded as largely (if not exclusively) correlated with speciation events. However, they err in suggesting that we attribute stasis strictly to "developmental constraints," which represent only one of a set of possible mechanisms that we have suggested for the causes of stasis. Others include habitat tracking and the internal structure of species themselves [for example, (2)].

This book examines the ethics of the alternatives to war. It assesses the moral case for each of the alternative in their own right, and provides an overall assessment of the alternatives to war.

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

The Schwarzschild solution (Schwarzschild, 1915/16) to Einstein’s General Theory of Relativity (GTR) is accepted in theoretical physics as the unique solution to GTR for a central-mass system. In this paper I propose an alternative solution to GTR, and argue it is both logically consistent and empirically realistic as a theory of gravity. This solution is here called K-gravity. The introduction explains the basic concept. The central sections go through the technical detail, defining the basic solution for the geometric tensor, the (...) Christoffel symbols, Ricci tensor, Ricci scalar, Einstein tensor, stress-energy tensor and density-pressure for the system. The density is integrated, and some consistency properties are demonstrated. A notable feature is the disappearance of the event horizon singularity, i.e. there are no black holes. So far this is for a single central mass. A generalization of the solution for multiple masses is then proposed. This is required to support K-gravity as a viable general interpretation of gravity. Then the question of empirical tests is discussed. It is argued that current observational data is almost but not quite sufficient to verify or falsify K-gravity. The Pioneer spacecraft trajectory data is of particular interest, as this is capable of providing a test; but the data (which originally showed anomalies that match K-gravity) is now uncertain. A new and very practical experiment is proposed to settle the matter. This would provide a novel test of GTR, and a novel test of the cause of the Pioneer anomalies. In conclusion, K-gravity has extensive ramifications for gravitational physics and for the philosophy of GTR and space-time. (shrink)

The Handicap Principle represents a central theory in the biological understanding of signaling. This paper presents a number of alternative theories to the Handicap Principle and argues that some of these theories may provide a better explanation for the evolution and stability of honest communication.

In this paper, we analyse the Wittgensteinian critique of the orthodoxy in animal ethics that has been championed by Cora Diamond and Alice Crary. While Crary frames it as a critique of “moral individualism”, we show that their criticism applies most prominently to certain forms of moral individualism (namely, those that follow hedonistic or preference-satisfaction axiologies), and not to moral individualism in itself. Indeed, there is a concrete sense in which the moral individualistic stance cannot be escaped, and we believe (...) that it is this particular limitation that justified Crary’s later move to a qualified version of moral individualism. At the same time, we also argue that there are significant merits to the Wittgensteinian critique of moral individualism, which pertain to its attack on the rationalism, naturalism, and reductionism that characterise orthodox approaches to animal ethics. We show that there is much of value in the Wittgensteinians’ call for an ethics that is more human; an ethics that fully embraces the capacities we are endowed with and one that pays heed to the richness and complexity of our moral lives. (shrink)

This article argues that the Phaedo is written as a new sort of story of how a hero faces death; this story provides an alternative to existing tragedy, as understood by Plato. The opening of the Phaedo makes clear that two features that Plato closely associates with tragedy, pity and lamentation, are inappropriate responses to Socrates’ impending death, and that tuchē (chance) did not affect his happiness. This is the first step in the dialogue’s sustained engagement with tragedy. Tragedy for (...) Plato falls under the category of stories about heroes and gods. Plato wrote the Phaedo so that we would see Socrates as a philosophical hero, a replacement for traditional heroes such as Theseus or Heracles. I argue that in fact the Phaedo meets every requirement in Republic Books 2–3 for how to tell stories about heroes and gods and so belongs to the same broad category as tragedy. Within this framework, it tells its new story of how the true hero faces death. (shrink)

This volume contains eighteen essays by established and younger historians that examine non-democratic alternative political systems and ideologies--oligarchies, monarchies, mixed constitutions--along with diverse forms of communal and regional associations such as ethnoi, amphiktyonies, and confederacies. The papers, which span the length and breadth of the Hellenic world highlight the immense political flexibility and diversity of ancient Greek civilization.

The standard formulation of quantum gauge theories results from the Lagrangian (functional integral) quantization of classical gauge theories. A more intrinsic quantum theoretical access in the spirit of Wigner’s representation theory shows that there is a fundamental clash between the pointlike localization of zero mass (vector, tensor) potentials and the Hilbert space (positivity, unitarity) structure of QT. The quantization approach has no other way than to stay with pointlike localization and sacrifice the Hilbert space whereas the approach built on the (...) intrinsic quantum concept of modular localization keeps the Hilbert space and trades the conflict creating pointlike generation with the tightest consistent localization: semiinfinite spacelike string localization. Whereas these potentials in the presence of interactions stay quite close to associated pointlike field strengths, the interacting matter fields to which they are coupled bear the brunt of the nonlocal aspect in that they are string-generated in a way which cannot be undone by any differentiation.The new stringlike approach to gauge theory also revives the idea of a Schwinger-Higgs screening mechanism as a deeper and less metaphoric description of the Higgs spontaneous symmetry breaking and its accompanying tale about “God’s particle” and its mass generation for all the other particles. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

In this chapter I argue that the old common law concept of the commons can make a major contribution to how we regulate human tissue and genetic information in the twenty-first century. But if we want to use this concept, we will have to act fast, because private corporate interests have already realised the relevance of the commons for holdings in human tissue and genetic information. Instead of a commonly created and held resource, however, they have sought to create one (...) derived from many persons' mutual labour but owned privately: what I call, with deliberate irony, a 'corporate commons'. (shrink)

When the only advice on offer is unhelpful, a potential missionary might need to be advised to seek an alternative. Jesus, we take it, was not building a worldly empire. Christian mission has become associated with colonialism. Dominant advice often pushes Western missionaries to positions of strength. In order to be vulnerable, one needs an alternative to such advice. Economic domination of Africa by the West makes it hard to know when Africa’s people, long engrossed in patron/client relationships, are not (...) talking for power. Use of English to describe Africa leads to massive false imputing of Western histories onto African societies. A little linguistic wisdom exposes the naivety of many contemporary understandings of the acumen of translation. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

FROM VARIOUS THINKERS and in different languages we have been receiving an identical message: the philosophy of the subject initiated by Descartes' cogito has reached a definitive impasse. Critical reactions range from attempts to dispose of the subject altogether to efforts to restore pre-Cartesian theories. The authors here presented adopt positions different from either of those extremes. Fully aware of the modern predicament they advocate neither a return to a pre-Cartesian past nor do they dismiss outright the post-Cartesian subjective starting (...) point. Theoretical attitudes once adopted cannot simply be discarded: philosophy has to work its way through them. Still, the proposed answers vary substantially. In Philosophy and the Mirror of Nature, Richard Rorty advocates abandoning traditional truth claims in favor of a rational "conversation" carried on between incommensurable positions. Francis Jacques's Différence et subjectivité reverses the traditional priority of subject to relation. In Généalogie de la psychanalyse Michel Henry attempts to reclaim a theory of "pure" subjectivity from the wild growth of its objectivist deviations. Alasdair MacIntyre exposes the disastrous moral consequences that have resulted from the primacy of an autonomous, isolated subject and proposes a program for a socially and historically more integrated ethical reconstruction. No idea has of late more consistently come under fire than that of the subject as sole source of meaning and value. Heidegger attributed it to Descartes, and three of the studies show the direct impact of his reading. Yet similar tendencies had been at work in analytic philosophy. Rorty presents pragmatic anti-subjective interpretations of language going back to Wittgenstein; Francis Jacques supports his attack by Russell's theory of relations. (shrink)