We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. We explore (...) the legal and clinical consequences of this result. (shrink)

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain (...) can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit (...) and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Thanks to Barton Palmer and John McMillan for these thoughtful commentaries. We found much to agree with and it is striking how so many of the issues relating to decision-making capacity assessment find resonances outside of an English jurisdiction. California and New Zealand are clearly grappling with a very similar set of issues and the commentaries speak to the international nature of these discussions.We will pick up on some main points the commentaries raise.As Palmer notes, DMC law is vulnerable to (...) the criticism that it does not attend to the authenticity of a decision. In ordinary language, this is the idea that someone is deciding while “not their self” or that it is the “illness speaking.” There is a... (shrink)

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...) the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public. Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (shrink)

Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions.

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

ABSTRACTTime-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses (...) regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski and Ludwig Binswanger. We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski... (shrink)

ABSTRACT This article aims to explain the family resemblance between the early socialism that emerged in France from the aftermath of the Revolution and Owenite socialism, which emerged out of the very different political and religious circumstances of late Georgian Britain. While the ‘sciences’ of Henri Saint-Simon and Charles Fourier were conceived to end the crisis produced by the French Revolution, Owen’s newfound principle, what he called the ‘science of the influence of circumstance’, emerged from his A New View (...) of Society and his ideas on formation of character, was directed to the solution of the problems of industrial Britain during the French wars and after. The article shows that, contrary to the arguments of the pathbreaking work of Gregory Claeys, Owen’s ideas had less to do with a Republicanism that, for Claeys in following the work of J.G.A. Pocock, had its roots in the Renaissance, and more to do with the emergence of the science of society whose origins lay in the late Enlightenment and the shared concerns of English, Scottish, and French thinkers on trying to understand an emerging and new social order. (shrink)

This chapter contains sections titled: The Fourfold Classification Tropes Aristotle's Principle In a Subject Owen's Reading Frede's Reading Differentiae Options for “In a Subject” The Tenfold Classification Substance Relatives The Place of the Categories in Aristotle's Thought Being Said in Many Ways Two Systems? The Afterlife of the Doctrine of Categories Notes Bibliography.

The current case study focused on a crucial match in the qualification for the Norwegian Premier League. In the match, the participants of the study experienced a radical change in performance toward the end of the second half, from being behind by several goals to scoring 3 goals in 6 min and winning the qualifying game. The purpose of this study was therefore to examine the perceptions and reflections of players and coaches on what occurred within their own team and (...) within the opposing team. The momentum shift in the opposition team can be described as a collective collapse. In the study, the theoretical collective collapse process model was used as a guide for the design of the interview questions where five semi-structured interviews were conducted with participants involved in the match. The participants watched excerpt clips from the match to recall the main events, which they subsequently reflected on. The results highlighted the importance of the “before-game” aspects, the “during-the-game” behavior and the cognitive and emotional reactions to the match unfolding. In addition, social contagion processes were evident in both teams relating to emotion and behavior. Overall, the data from this study investigated the general structure of the process model of collective sport team collapse and found support for the notion of a temporal cascade of causes for a team collapse. Future research is encouraged to examine this model, to provide guidance to teams, coaches, and sport psychologists in order to make recommendations for dealing with collective collapse in sport teams. (shrink)

For phenomenological psychopathologists an important methodological question is which philosopher, or philosophical corpus, one is going to draw on to help organize and illuminate raw psychopathological data. For the main phenomenological psychopathologists of the past this involved selecting from among phenomenological philosophers and keeping close to them to varying degrees. For Minkowski it was Bergson, for von Gebsattel it was Scheler, and for Binswanger it was Heidegger and then Husserl. A question that arises is what makes the choice of philosopher (...) non-arbitrary?A pragmatist, or pluralist, answer to this question which I tend to favor is that psychopathologists... (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...) to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

Translation with notes of Ammonius' Commentary on Aristotle's Categories.

The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of (...) potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a ‘report’ button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them. (shrink)

French translation of Gareth Evans' paper "Identity and Predication".

We discuss Aristotle's "Categories" as an answer to Plato's One-over-Many argument. For Plato, F-ness is something "over against" particular F things; to predicate "F" of these things is to assert that they all stand in a certain relation to F-ness. Aristotle answers that predication is classification; and there being a classification of a certain sort is a fact correlative with there being things classifiable in the way the classification in question would classify them.

It is often assumed that Fichte's aim in Part I of the System of Ethics is to provide a deduction of the moral law, the very thing that Kant – after years of unsuccessful attempts – deemed impossible. On this familiar reading, what Kant eventually viewed as an underivable 'fact' (Factum), the authority of the moral law, is what Fichte traces to its highest ground in what he calls the principle of the 'I'. However, scholars have largely overlooked a passage (...) in the System of Ethics where Fichte explicitly invokes Kant's doctrine of the fact of reason with approval, claiming that consciousness of the moral law grounds our belief in freedom (GA I/5:65). On the reading I defend, Fichte's invocation of the Factum is consistent with the structure of Part I when we distinguish (a) the feeling of moral compulsion from (b) the moral law itself. (shrink)

Anthony Kenny says it is impossible to want what one already has and knows one has. We present a counter-example and then suggest that Kenny may have been misled by the fact that wanting expresses itself in goal-directed behavior. From the truism that one's behavior cannot be directed toward a goal that one knows one has already attained, Kenny may have been led to suppose that behavior directed toward an as yet unattained goal cannot express one's desire for what one (...) has and knows one has. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Context The attitudes of medical professionals towards physician assisted dying have been widely discussed. Less explored is the level of agreement among physicians on the possibility of ‘rational suicide’—a considered suicide act made by a sound mind and a precondition of assisted dying legislation. Objective To assess attitudes towards rational suicide in a representative sample of senior doctors in England and Wales. Methods A postal survey was conducted of 1000 consultants and general practitioners randomly selected from a commercially available database. (...) The main outcome of interest was level of agreement with a statement about rational suicide. Results The corrected participation rate was 50%; 363 questionnaires were analysed. Overall 72% of doctors agreed with the possibility of rational suicide, 17% disagreed, and 11% were neutral. Doctors who identified themselves as being more religious were more likely to disagree. Some doctors who disagreed with legalisation of physician assisted suicide nevertheless agreed with the concept of rational suicide. Conclusions Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients. (shrink)

This paper examines the distinction between self-love and self-conceit in Kant's moral psychology. It motivates an alternative account of the origin of self-conceit by drawing a parallel to what Kant calls transcendental illusion.

The acceptability of sentences in natural language is constrained not only grammaticality, but also by the relationship between what is being conveyed and such factors as context and the beliefs of interlocutors. In many languages the critical element in a sentence (its focus) must be given grammatical prominence. There are different accounts of the nature of focus marking. Some researchers treat it as the grammatical realization of a potentially arbitrary feature of universal grammar and do not provide an explicit account (...) of its origins; others have argued, however, that focus marking is a (grammaticalized) functional solution to the problem of efficiently transmitting information via a noisy channel. By adding redundancy to highlight critical elements in particular, focus protects key parts of the message from noise. If this information‐theoretic account is true, then we should expect focus‐like behavior to emerge even in non‐linguistic communication systems given sufficient noise and pressures for efficiency. We tested this in an experiment in which participants played a simple communication game in which they had to click cells on a grid to communicate one of two line figures drawn across the grid. We manipulated the noise, available time, and required effort, and measured patterns of redundancy. Because the lines in many cases overlapped, meaning that only some parts of each line could be used to distinguish it from the other, we were able to compare the extent to which effort was expended on adding redundancy to critical (non‐overlapping) and non‐critical (overlapping) parts of the message. The results supported the information‐theoretic account of focus and shed light on the emergence of information structure in language. (shrink)

Just as humans can draw conclusions responsibly or irresponsibly, so too can computers. Machine learning systems that have been trained on data sets that include irresponsible judgments are likely to yield irresponsible predictions as outputs. In this paper I focus on a particular kind of inference a computer system might make: identification of the intentions with which a person acted on the basis of photographic evidence. Such inferences are liable to be morally objectionable, because of a way in which they (...) are presumptuous. After elaborating this moral concern, I explore the possibility that carefully procuring the training data for image recognition systems could ensure that the systems avoid the problem. The lesson of this paper extends beyond just the particular case of image recognition systems and the challenge of responsibly identifying a person’s intentions. Reflection on this particular case demonstrates the importance (as well as the difficulty) of evaluating machine learning systems and their training data from the standpoint of moral considerations that are not encompassed by ordinary assessments of predictive accuracy. (shrink)

Owen Flanagan is a highly prolific writer and speaker whose work brings together results of research in several empirical disciplines overlapping with philosophy, particularly neuroscience and other areas of psychology. This book of thirteen essays, most of them revisions of work published elsewhere, exhibits both his intellectual and his stylistic range. Many of the essays are light and chatty, others analytical and slower-going.

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...) the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm. (shrink)

The idea that the self is inextricably intertwined with the rest of the world—the “oneness hypothesis”—can be found in many of the world’s philosophical and religious traditions. Oneness provides ways to imagine and achieve a more expansive conception of the self as fundamentally connected with other people, creatures, and things. Such views present profound challenges to Western hyperindividualism and its excessive concern with self-interest and tendency toward self-centered behavior. This anthology presents a wide-ranging, interdisciplinary exploration of the nature and implications (...) of the oneness hypothesis. While fundamentally inspired by East and South Asian traditions, in which such a view often is critical to philosophical approach, this collection draws upon religion, psychology, and Western philosophy, as well as sociology, evolutionary theory, and cognitive neuroscience. Contributors trace the oneness hypothesis through the works of East Asian and Western thinkers and traditions, including Confucianism. Mohism, Daoism, Buddhism, Platonism, Zhuangzi, Kant, James, and Dewey. They intervene in debates over ethics, cultural difference, identity, group solidarity, and the positive and negative implications of metaphors of organic unity. Challenging dominant traditional views that presume the proper scope of the mind stops at the boundaries of the skin and skull, The Oneness Hypothesis shows that a more relational conception of the self is not only consistent with contemporary science but has the potential to lead to greater happiness and well-being for both individuals and the larger wholes of which they are parts. (shrink)

In this article I argue that a critical theory of whiteness is necessary, though not sufficient, to the formulation of an adequate explanatory account of the mechanisms of racial oppression in the modern world. In order to explain how whiteness underwrites systems of racial oppression and how it is reproduced, the central functional properties of whiteness are identified. I propose that understanding whiteness as a structuring property of racialized social systems best explains these functional properties. Given the variety of conceptions (...) of whiteness in the literature, the several uses of the term are analysed and it is shown that there is a unifying concept underlying these various senses of whiteness. Lastly, some of the implications of this account of whiteness for anti-racist engagement are considered. Key Words: critical theory • Anthony Giddens • Jürgen Habermas • race • racial contract • racism • social structure • white supremacy • whiteness. (shrink)

The first book-length treatment in English of Habermas’s theory of social evolution and progress.