Suffering is widely assumed to have particular moral significance, and is of special relevance in medicine. There are, however, many theories about the nature of suffering that seem mutually incompatible. I suggest that there are three overall kinds of view about what suffering is: value‐based theories, including the theory famously expounded by Eric Cassell, which as a group suggest that suffering is something like a state of distress related to threats to things that a person cares about; feeling‐based theories, which (...) equate suffering with aversive feelings or sensations like pain; and objective theories, which suggest that suffering is the absence of objective flourishing. Rather than argue that one or another of these kinds of theory most accurately captures the nature of suffering, I allow that the term is ambiguous and thus that it may have at least three different kinds. I further argue, however, that when we think about suffering as potentially justifying end‐of‐life interventions, especially for cognitively typical adults, we are interested mainly in value‐based suffering. This is because the moral significance of value‐based suffering for persons with decision‐making capacity generally outweighs that of the other types; those other types of suffering achieve overriding moral significance only if they also constitute, or contribute to, value‐based suffering. (shrink)

Hastings Center Report, Volume 52, Issue 5, Page 15-23, September–October 2022.

There is currently much concern over the use of pharmaceuticals and other biomedical techniques to enhance athletic performance—a practice we might refer to as doping. Many justifications of anti-doping efforts claim that doping involves a serious moral transgression. In this article, I review a number of arguments in support of that claim, but show that they are not conclusive, suggesting that we do not have good reasons for thinking that doping is wrong.

In a recent article, Tyler Tate argues that the suffering of children — especially children with severe cognitive impairments — should be regarded as the antithesis of flourishing, where flourishing is relative to one’s individual characteristics and essentially involves receiving care from others. Although initially persuasive, Tate’s theory is ambiguous in several ways, leading to significant conceptual problems. By identifying flourishing with receiving care, Tate raises questions about the importance of care that he does not address, giving rise to a (...) bootstrapping problem. By making flourishing relative to an individual’s circumstances, Tate is forced to confront questions about exactly how relative it can be, suggesting the possibility that, on his view, to flourish is simply to be however one is. In an attempt to surmount these problems, I offer a revision and restatement of Tate’s view that defines the relationship between individualized flourishing and the more conventional, species-relative concept, and describe more clearly the role that care should play with respect to flourishing — one that is instrumental and not merely constitutive. Even this restated view, however, fails to answer difficult questions about how one should respond to the medical needs of some children, highlighting the fact that a conceptual analysis of suffering may do little, in the end, to untangle ethical dilemmas in the care of severely ill children. (shrink)

ABSTRACT:Psychedelic substances have great promise for the treatment of many conditions, and they are the subject of intensive research. As with other medical treatments, both research and clinical use of psychedelics depend on our ability to ensure informed consent by patients and research participants. However, some have argued that informed consent for psychedelic use may be impossible, because psychedelic experiences can be transformative in the sense articulated by L. A. Paul (2014). For Paul, transformative experiences involve either the acquisition of (...) knowledge that cannot be obtained in any other way or changes in the self. Either of these characteristics may appear to undermine informed consent. This article argues, however, that there is limited evidence that psychedelic experiences are transformative in Paul's sense, and that they may not differ in their transformative features from other common medical experiences for which informed consent is clearly possible. Further, even if psychedelic experiences can be transformative, informed consent is still possible. Because psychedelic experiences are importantly different in several respects from other medical experiences, this article closes with recommendations for how these differences should be reflected in informed consent processes. (shrink)

There has been much debate about whether the concept of disease articulated in Boorse’s biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. I argue that value-ladenness does not threaten the scientific legitimacy of our disease-concept because the concept makes little difference to the formulation and testing of scientific hypotheses. Likewise, even (...) if our disease-concept is value-laden, this does not show it is morally impermissible. To determine its permissibility, we must regard it as a tool to structure social institutions. Seen in that way, whether our disease-concept is morally permissible is a consequentialist matter and depends exquisitely on unanswered empirical questions. (shrink)

In ‘Epistemic injustice, children and mental Illness,’1 Edward Harcourt uses Miranda Fricker’s concept of testimonial injustice 2 to make sense of claims, from mental health service users, that clinicians do not listen to them. Being listened to matters. It is a sign of respect as a person and associated with better clinical outcomes. TI involves suffering an unfair credibility deficit because of prejudice, so seems like a promising way of understanding service users’ complaints. Harcourt quickly concludes, however, that it is (...) inadequate. Since many service users are not wholly rational, the credibility deficits they suffer could be fair, and thus cannot constitute TI. Undaunted, Harcourt tries to reimagine TI so it can help. He observes that many children are also unfairly discredited by clinicians. Perhaps they are victims of TI, too, in a way that could help resurrect the concept? It may at first seem not: although providers who work with children often discredit them, this may result from mere ignorance, not prejudice. We should not let clinicians off the hook so easily, however, since they work with children, and should know their real capacities. Since they still discredit children, they must be prejudiced. And even further kinds of TI could be perpetrated by clinicians. Fricker assumes that …. (shrink)

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending (...) their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering are (...) often getting at something ethically important. But this is where the work of ethics begins, not where it ends. (shrink)

Paternalistic interference in autonomous decisions is typically impermissible. This has several explanations, among which is a view I call theagent-constitution of the good: that the autonomous agent not onlyknowswhat is best for herself, butdetermineswhat is best for herself through her desires, goals and so on (heraims). For instance, it might seem that if an autonomous person does choose not to take insulin for her diabetes, then not only is it inappropriate to force treatment upon her, it is also not in (...) her best interest to take insulin. Here I argue that agent-constitution, though appealing, is false. In fact, autonomous agents can be mistaken about their good, even when it seems to depend only upon their aims. Agent-constitution appears true only because we typically fail to notice constraints on a person's good in private, self-regarding decisions where paternalism might be considered. (shrink)

One of the most widely accepted views in bioethics is that paternalistic interference in others’ self-regarding decisions is justified only if those decisions are not autonomous. Typically, a decision is autonomous if and only if it satisfies certain psychological criteria. Namely, it must be competent and also voluntary. This latter criterion means, roughly, that the agent herself decided without being controlled or unduly influenced by other persons or impersonal forces, in light her own values.The modern locus classicus of this idea (...) is undoubtedly Beauchamp and Childress ; they claim we have a duty to respect autonomous agents. (shrink)

McGregor and MacNamee recently, in this journal, offered several criticisms of an earlier article in which I attempted to refute a number of arguments for the claim that doping in sports is morally wrong. Their criticisms are numerous, but focus on four domains. First, they sketch a view on which the risk profiles of different sports may make doping permissible in some and impermissible in others. Second, they suggest that my criticisms of safety-based arguments assume that doping opponents are bent (...) on harm elimination, rather than harm management. Finally, they offer two methodological criticisms, the first pertaining to my use of analogical arguments, and the second pertaining to the general difficulties of making revisionist arguments in ethics. I defend my criticisms of safety-based arguments by showing that these do not rest on the assumptions McGregor and MacNamee attribute to me and by noting that their own view about the variable relevance of safety considerations is underdeveloped. As for their methodological arguments, I endeavor to show that these are misplaced, in that they either rest on misinterpretations of my earlier article or on an excessively high standard for ethical argumentation. (shrink)

Critics of medical aid in dying (MAID) often argue that it is impermissible because background social conditions are insufficiently good for some persons who would utilize it. I provide a critical evaluation of this view. I suggest that receiving MAID is a sort of “hard choice,” in that death is prima facie bad for the individual and only promotes that person’s interests in special circumstances. Those raising this objection to MAID are, I argue, concerned primarily about the effects of injustice (...) on hard choices. I show, however, that MAID and other hard choices are not always invalidated by injustice and that what matters is whether the injustice can be remediated given certain constraints. Injustice invalidates a hard choice when it can, reasonably, be remedied in a way that makes a person’s life go better. I consider the implications of this view for law and policy regarding MAID. (shrink)

Background Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups with (...) persons with lived experience of mental illness.Methods We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.Results A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.Conclusions Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rationality, Irrationality, and Depathologizing OCDBrent Kious, MD, PhD (bio)Pablo Hubacher argues that some persons with obsessive-compulsive disorder (OCD) do not, in virtue of OCD itself, exhibit what he calls “epistemic irrationality,” which is a matter of violating rational norms related to belief and inquiry (Hubacher, 2023). The argument is complex and meticulous, but ultimately not persuasive. I outline the argument, show how it is unsound, and articulate its (...) most troubling consequences. I end by inquiring about the goal of projects like this, which, I believe, is to examine the rationality of mental illnesses in order to show that they are or are not illnesses.Hubacher starts by noting that (some) persons with OCD appear “doxastically irrational”: when they exhibit obsessions, they err in how they form beliefs. Specifically, they seem to “jump to conclusions,” inferring that a feared outcome is probable or certain from scant evidence. However, psychological research shows that persons with OCD are not more likely to jump to conclusions than others. Hubacher also observes that jumping to conclusions involves the inference, “possibly P, therefore definitely P.” This inference is irrational but not specific to people with OCD, because many of us do it, and an account of the irrationality of OCD should identify OCD-specific deviations. Hubacher concludes that persons with OCD are not doxastically irrational. He next considers whether they exhibit “zetetic” irrationality, which involves violating epistemic norms of inquiry. This might identify the irrationality of OCD, since compulsions like repeatedly checking the stove are basically ways of getting evidence. But Hubacher introduces the phenomenon of sexually focused OCD, or S-OCD. Persons with S-OCD worry about whether they have sexual desires they regard as inappropriate—for instance, incestuous desires or homosexual desires. Hubacher does not think people with S-OCD are zetetically irrational, however. Their endless doubts are actually reasonable, since it is possible—even common—for people to have repressed sexual desires when those desires are stigmatized. If a person with S-OCD worries about having incestuous desires, the bare fact that he does not feel those desires in the usual way should not be reassuring to him: those desires could simply be repressed. Hubacher adds that [End Page 151] people with OCD have high intolerance of uncertainty, which he takes to mean that they approach inquiries with high standards for confirmation; they are not satisfied with evidence others would see as compelling. He concludes that people with S-OCD are neither zetetically nor doxastically irrational, and so not epistemically irrational.This is a surprising conclusion, but it results from an unsound argument. An initial problem is his assumption that the only way persons with OCD can be doxastically irrational is by jumping to conclusions. This ignores other possible ways of being doxastically irrational. For instance, it would be irrational to retain beliefs that have been disconfirmed by evidence (Hubacher might call this zetetic irrationality, but surely, my beliefs can be disconfirmed without active inquiry). Irrationally retaining disconfirmed beliefs might even capture what happens in OCD: the person with OCD thinks something awful is likely to be true, even though she gets copious disconfirming evidence.A second problem is in Hubacher’s interpretation of the psychological evidence about whether persons with OCD jump to conclusions. He cites two studies involving a very specific psychological test, the bead task, wherein a subject is asked to determine whether a random sequence of colored beads have been drawn from a jar with a preponderance of one color or another. A “jumping to conclusions bias” is taken to be an inclination to guess the jar after no more than two beads are revealed (Huq & Garety et al., 1988). Although a few studies have shown that persons with OCD do not have this jumping to conclusions bias, we cannot conclude that they do not often jump to conclusions in real life. One might imagine, for instance, that people with OCD are still quite likely to jump to conclusions with respect to their obsessions (i.e., things that are highly anxiety-provoking, where the anxiety affects the conclusions drawn). And most people with OCD are not obsessed about the colors of beads.A third... (shrink)

I am grateful for the insightful comments that have been furnished by Drs. Gala, Moseley, and Perring following their reading of my paper. Happily, I find myself in the position of being able to accept many of their criticisms, which identify many of the limitations of my argument as I see them. In only a few cases do I feel that their remarks are misplaced.The first concern raised by Moseley and Gala is that the paper gives the regrettable impression that (...) persons with anorexia nervosa generally have few cognitive deficits and primarily experience problems in valuing. But as is widely known, this is false: many persons with AN reason poorly and suffer perceptual distortions. I did not. (shrink)

Clinical research is difficult. It confronts massive heterogeneity in its participants, who are real people bumping around the world in complex ways. Clinical research in psychology is doubly difficult, since it tries systematically to study conditions that are inherently difficult to systematize. In their thoughtful and closely argued article, Truijens et al. emphasize these difficulties, and describe a novel challenge to psychotherapy research: that the support for many evidence-based therapies is weaker than previously recognized because it relies on patient-reported outcome (...) measures that often yield invalid results. Despite the initial plausibility of their position, however, their... (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 21-22, August 2011.

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of (...) patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. (shrink)

In his carefully documented article, “From reciprocity to autonomy in physician-assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert Heringa case,” Berand Florijn (20...

Volume 19, Issue 10, October 2019, Page W14-W17.

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

Mandatory vaccination against COVID-19 is a highly controversial issue, and many members of the public oppose it on the grounds that they should be free to determine what happens to their own body. Opinion has generally favored parental authority with respect to vaccination of children, but less attention has been paid to the ethical complexities of how to respond when mature minors refuse vaccination that is requested by their parents. We present a case in which a mature minor, who was (...) psychiatrically hospitalized, refused vaccination that had been requested by her parents, which led to significant moral distress for her caregivers. (shrink)

Brent Kious has objected to our previous criticism of his views on doping, maintaining that we, by and large, misrepresented his position. In this response, we strengthen our original misgivings, arguing that (1) his views on risk of harm in sport are either uncontroversially true (not inconsistent with the views of many doping opponents) or demonstrably false (attribute to doping opponents an overly simplistic view), (2) his use of analogies (still) indicates an oversimplification of many issues surrounding the (...) question of doping in sports, and (3) his doping analogies are insufficiently precise to support his conclusions. (shrink)

The work reported in this monograph was begun in the winter of 1967 in a graduate seminar at Berkeley. Many of the basic data were gathered by members of the seminar and the theoretical framework presented here was initially developed in the context of the seminar discussions. Much has been discovered since1969, the date of original publication, regarding the psychophysical and neurophysical determinants of universal, cross-linguistic constraints on the shape of basic color lexicons, and something, albeit less, can now also (...) be said with some confidence regarding the constraining effects of these language-independent processes of color perception and conceptualization on the direction of evolution of basic color term lexicons. (shrink)

In information societies, operations, decisions and choices previously left to humans are increasingly delegated to algorithms, which may advise, if not decide, about how data should be interpreted and what actions should be taken as a result. More and more often, algorithms mediate social processes, business transactions, governmental decisions, and how we perceive, understand, and interact among ourselves and with the environment. Gaps between the design and operation of algorithms and our understanding of their ethical implications can have severe consequences (...) affecting individuals as well as groups and whole societies. This paper makes three contributions to clarify the ethical importance of algorithmic mediation. It provides a prescriptive map to organise the debate. It reviews the current discussion of ethical aspects of algorithms. And it assesses the available literature in order to identify areas requiring further work to develop the ethics of algorithms. (shrink)

For much of the past two centuries, religion has been understood as a universal phenomenon, a part of the “natural” human experience that is essentially the same across cultures and throughout history. Individual religions may vary through time and geographically, but there is an element, religion, that is to be found in all cultures during all time periods. Taking apart this assumption, Brent Nongbri shows that the idea of religion as a sphere of life distinct from politics, economics, or (...) science is a recent development in European history—a development that has been projected outward in space and backward in time with the result that religion now appears to be a natural and necessary part of our world. Examining a wide array of ancient writings, Nongbri demonstrates that in antiquity, there was no conceptual arena that could be designated as “religious” as opposed to “secular.” Surveying representative episodes from a two-thousand-year period, while constantly attending to the concrete social, political, and colonial contexts that shaped relevant works of philosophers, legal theorists, missionaries, and others, Nongbri offers a concise and readable account of the emergence of the concept of religion. (shrink)

For much of the past two centuries, religion has been understood as a universal phenomenon, a part of the “natural” human experience that is essentially the same across cultures and throughout history. Individual religions may vary through time and geographically, but there is an element, religion, that is to be found in all cultures during all time periods. Taking apart this assumption, Brent Nongbri shows that the idea of religion as a sphere of life distinct from politics, economics, or (...) science is a recent development in European history—a development that has been projected outward in space and backward in time with the result that religion now appears to be a natural and necessary part of our world. Examining a wide array of ancient writings, Nongbri demonstrates that in antiquity, there was no conceptual arena that could be designated as “religious” as opposed to “secular.” Surveying representative episodes from a two-thousand-year period, while constantly attending to the concrete social, political, and colonial contexts that shaped relevant works of philosophers, legal theorists, missionaries, and others, Nongbri offers a concise and readable account of the emergence of the concept of religion. (shrink)

Recent work on interpretability in machine learning and AI has focused on the building of simplified models that approximate the true criteria used to make decisions. These models are a useful pedagogical device for teaching trained professionals how to predict what decisions will be made by the complex system, and most importantly how the system might break. However, when considering any such model it’s important to remember Box’s maxim that "All models are wrong but some are useful." We focus on (...) the distinction between these models and explanations in philosophy and sociology. These models can be understood as a "do it yourself kit" for explanations, allowing a practitioner to directly answer "what if questions" or generate contrastive explanations without external assistance. Although a valuable ability, giving these models as explanations appears more difficult than necessary, and other forms of explanation may not have the same trade-offs. We contrast the different schools of thought on what makes an explanation, and suggest that machine learning might benefit from viewing the problem more broadly. (shrink)

The capacity to collect and analyse data is growing exponentially. Referred to as ‘Big Data’, this scientific, social and technological trend has helped create destabilising amounts of information, which can challenge accepted social and ethical norms. Big Data remains a fuzzy idea, emerging across social, scientific, and business contexts sometimes seemingly related only by the gigantic size of the datasets being considered. As is often the case with the cutting edge of scientific and technological progress, understanding of the ethical implications (...) of Big Data lags behind. In order to bridge such a gap, this article systematically and comprehensively analyses academic literature concerning the ethical implications of Big Data, providing a watershed for future ethical investigations and regulations. Particular attention is paid to biomedical Big Data due to the inherent sensitivity of medical information. By means of a meta-analysis of the literature, a thematic narrative is provided to guide ethicists, data scientists, regulators and other stakeholders through what is already known or hypothesised about the ethical risks of this emerging and innovative phenomenon. Five key areas of concern are identified: informed consent, privacy, ownership, epistemology and objectivity, and ‘Big Data Divides’ created between those who have or lack the necessary resources to analyse increasingly large datasets. Critical gaps in the treatment of these themes are identified with suggestions for future research. Six additional areas of concern are then suggested which, although related have not yet attracted extensive debate in the existing literature. It is argued that they will require much closer scrutiny in the immediate future: the dangers of ignoring group-level ethical harms; the importance of epistemology in assessing the ethics of Big Data; the changing nature of fiduciary relationships that become increasingly data saturated; the need to distinguish between ‘academic’ and ‘commercial’ Big Data practices in terms of potential harm to data subjects; future problems with ownership of intellectual property generated from analysis of aggregated datasets; and the difficulty of providing meaningful access rights to individual data subjects that lack necessary resources. Considered together, these eleven themes provide a thorough critical framework to guide ethical assessment and governance of emerging Big Data practices. (shrink)

We all experience loneliness at some time in our lives and it often motivates people, consciously or otherwise, to enter treatment. Yet it is rarely explicitly addressed in psychoanalytic literature. Loneliness and Longing rectifies this oversight by thoroughly exploring this painful psychological state. In this book contributors address the inner sense of loneliness âe" that is feeling alone even in the company of others âe" by drawing on different aspects of loneliness and longing. Topics covered include: loneliness in the consulting (...) room the relationship between loneliness and love the effects of social networking and the internet how loneliness changes throughout the life-cycle healing the analystâe(tm)s loneliness. Loneliness and Longing draws on both theory and practice to discuss ways to help people to understand and cope with this important emotional state, encouraging them to make loneliness and longing less pervasive in their lives. This will be ideal reading for analysts, psychotherapists, and related practitioners facing the challenges of loneliness in their consulting rooms. (shrink)

Using clear language and numerous examples, each chapter of this guide analyses an individual plateau from Deleuze and Guattari's A Thousand Plateaus, interpreting the work for students and scholars.

Two studies tested the relationship between three facets of personality—conscientiousness, agreeableness, and openness to experience—as well as moral identity, on individuals’ ethical ideology. Study 1 showed that moral personality and the centralityof moral identity to the self were associated with a more principled (versus expedient) ethical ideology in a sample of female speech therapists. Study 2 replicated these findings in a sample of male and female college students, and showed that ideology mediated therelationship between personality, moral identity, and two organizationally (...) relevant outcomes: organizational citizenship behavior and the propensity to morally disengage. Implications for business ethics are discussed. (shrink)

Two studies tested the relationship between three facets of personality—conscientiousness, agreeableness, and openness to experience—as well as moral identity, on individuals’ ethical ideology. Study 1 showed that moral personality and the centralityof moral identity to the self were associated with a more principled (versus expedient) ethical ideology in a sample of female speech therapists. Study 2 replicated these findings in a sample of male and female college students, and showed that ideology mediated therelationship between personality, moral identity, and two organizationally (...) relevant outcomes: organizational citizenship behavior and the propensity to morally disengage. Implications for business ethics are discussed. (shrink)

Ethicists are typically willing to grant that thick terms (e.g. ‘courageous’ and ‘murder’) are somehow associated with evaluations. But they tend to disagree about what exactly this relationship is. Does a thick term’s evaluation come by way of its semantic content? Or is the evaluation pragmatically associated with the thick term (e.g. via conversational implicature)? In this paper, I argue that thick terms are semantically associated with evaluations. In particular, I argue that many thick concepts (if not all) conceptually entail (...) evaluative contents. The Semantic View has a number of outspoken critics, but I shall limit discussion to the most recent--Pekka Väyrynen--who believes that objectionable thick concepts present a problem for the Semantic View. After advancing my positive argument in favor of the Semantic View (section II), I argue that Väyrynen’s attack is unsuccessful (section III). One reason ethicists cite for not focusing on thick concepts is that such concepts are supposedly not semantically evaluative whereas traditional thin concepts (e.g. good and wrong) are. But if my view is correct, then this reason must be rejected. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The system (...) / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

The concept of individuality as applied to species, an important advance in the philosophy of evolutionary biology, is nevertheless in need of refinement. Four important subparts of this concept must be recognized: spatial boundaries, temporal boundaries, integration, and cohesion. Not all species necessarily meet all of these. Two very different types of pluralism have been advocated with respect to species, only one of which is satisfactory. An often unrecognized distinction between grouping and ranking components of any species concept is necessary. (...) A phylogenetic species concept is advocated that uses a grouping criterion of monophyly in a cladistic sense, and a ranking criterion based on those causal processes that are most important in producing and maintaining lineages in a particular case. Such causal processes can include actual interbreeding, selective constraints, and developmental canalization. The widespread use of the biological species concept is flawed for two reasons: because of a failure to distinguish grouping from ranking criteria and because of an unwarranted emphasis on the importance of interbreeding as a universal causal factor controlling evolutionary diversification. The potential to interbreed is not in itself a process; it is instead a result of a diversity of processes which result in shared selective environments and common developmental programs. These types of processes act in both sexual and asexual organisms, thus the phylogenetic species concept can reflect an underlying unity that the biological species concept can not. (shrink)

Inventions of Teaching: A Genealogy is a powerful examination of current metaphors for and synonyms of teaching. It offers an account of the varied and conflicting influences and conceptual commitments that have contributed to contemporary vocabularies--and that are in some ways maintained by those vocabularies, in spite of inconsistencies and incompatibilities among popular terms. The concern that frames the book is how speakers of English invented (in the original sense of the word, "came upon") our current vocabularies for teaching. Conceptually, (...) this book is unique in the educational literature. As a whole, it presents an overview of the major underlying philosophical and ideological concepts and traditions related to knowledge, learning, and teaching in the Western world, concisely introducing readers to the central historical and contemporary discourses that shape current discussions and beliefs in the field. Because the organization of historical, philosophical, theoretical, and etymological information is around key conceptual divergences in Western thought rather than any sort of chronology, this text is not a linear history, but several histories--or, more precisely, it is a genealogy. Specifically, it is developed around breaks in opinion that gave or are giving rise to diverse interpretations of knowledge, learning, and teaching--highlighting historical moments in which vibrant new figurative understandings of teaching emerged and moments at which they froze into literalness. The book is composed of two sorts of chapters, "branching" and "teaching." Branching chapters include an opening treatment of the break in opinion, separate discussions of each branch, and a summary of the common assumptions and shared histories of the two branches. Teaching chapters offer brief etymological histories and some of the practical implications of the terms for teaching that were coined, co-opted, or redefined within the various traditions. Inventions of Teaching: A Genealogy is an essential text for senior undergraduate and graduate courses in curriculum studies and foundations of teaching and is highly relevant as well for students, faculty, and researchers across the field of education. (shrink)

What is Christian about Christian bioethics? The short answer to this question is that the Incarnation should shape the form and content of Christian bioethics. In explicating this answer it is argued that contemporary medicine is unwittingly embracing and implementing the transhumanist dream of transforming humans into posthumans. Contemporary medicine does not admit that there are any limits in principle to the extent to which it should intervene to improve the quality of human life. This largely inarticulate, yet ambitious, agenda (...) is derived first in late modernity's failed, but nonetheless ongoing, attempt to transform necessity into goodness, and second the loss of any viable concept of eternity, thereby stripping temporal existence of any normative significance. In short, medicine has become the vanguard of a profane attempt to save humankind by extracting data from flesh. In response, it is contended that an alternative Christian bioethics must be shaped by the Incarnation, the Word made flesh. This assertion does not entitle Christians to oppose the posthuman trajectory of contemporary medicine on the basis of any natural or biological essentialism. Rather, it is an evangelical witness to the grace of Christ's redemption instead of the work of self-transformation. It is Christ alone who thereby makes the vulnerability and mortality of finitude a gift and blessing. Specifically, it is maintained that the chasm separating necessity and goodness cannot be filled but only bridged through the suffering entailed in Christ's cross, and through Christ's resurrection eternity becomes the standard against which the temporal lives of human creatures are properly formed and measured. Consequently, Christian bioethics should help us become conformed to Christ rather than enabling selftransformation. (shrink)

The Ecole Supérieure de Commerce de Rennes has recently introduced a final year group‐taught compulsory course in Business Ethics. Its organisers here describe and discuss their aims, methods and results. Michael Brent is Head of the Human Resources Department at Groupe ESC Rennes, 2 rue Robert‐d’Arbrissel, 35065 Rennes, and has an MA in Philosophy and diplomas in business and marketing, as well as several years European consultancy experience. Susan Grinsted teaches production management and related subjects at Rennes, with a (...) first degree in Metallurgy and a PhD in Engineering as well as several years UK industrial experience and a previous appointment at Warwick University, England. (shrink)

This paper proposes a new Separabilist account of thick concepts, called the Expansion View (or EV). According to EV, thick concepts are expanded contents of thin terms. An expanded content is, roughly, the semantic content of a predicate along with modifiers. Although EV is a form of Separabilism, it is distinct from the only kind of Separabilism discussed in the literature, and it has many features that Inseparabilists want from an account of thick concepts. EV can also give non-cognitivists a (...) novel escape from the Anti-Disentangling Argument. §I explains the approach of all previous Separabilists, and argues that there’s no reason for Separabilists to take this approach. §II explains EV. §III fends off objections. And §IV explains how non-cognitivist proponents of EV can escape the Anti-Disentangling Argument. (shrink)