Response to commentaries on keynote article.

A theory of the neural bases of aesthetic experience across the arts, which draws on the tools of both cognitive neuroscience and traditional humanist inquiry.

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, (...) in itself, a therapeutic intervention. (shrink)

Currently, brain tissue transplantations are being developed as a clinical-therapeutic tool in neurodegenerative diseases such as Parkinson's or Alzheimer's disease. From an ethical point of view, distinguishing between the preservation and an alteration of personal identity seems to be central to determining the scope for further application of brain tissue transplantation therapy. The purpose of this article is to review "standard" arguments which are used on the one hand by proponents to prove preservation of personal identity and by opponents on (...) the other hand to prove that brain tissue transplantation results in an altered personal identity. Proponents and opponents are shown to use the same arguments, albeit with different presuppositions. These presuppositions concern the meaning of the term "identity", either numerical or qualitative, the definition of brain identity, either structurally or functionally, and the relationship between mental states, psychological functions and neurophysiological properties as criteria for personal identity. Furthermore the respective neurophysiological, clinical and philosophical evidence for the different presuppositions are discussed. It is concluded that evaluation of personal identity in brain tissue transplantation should not only rely on the "standard" arguments but, additionally, neurophysiological, clinical and philosophical implications should be discussed. (shrink)

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. (...) In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit. (shrink)

Socrates (in the Meno) denied that virtues like courage could be taught, whereas Protagoras defended this claim. Compassion is discussed below in this context; it is distinguished from related, but different, moral qualities, and the role of imagination is emphasised. 'Sympathy's and role-modelling views of compassion's acquisition are criticised. Compassion can indeed be taught, but neither by the example of a few, isolated physicians nor by creation of Departments of Compassion. In replying to one standard objection to teaching compassion, it (...) is emphasised that scientific competence and compassion aren't mutually exclusive. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)

Following Henkin’s discovery of partially-ordered (branching) quantification (POQ) with standard quantifiers in 1959, philosophers of language have attempted to extend his definition to POQ with generalized quantifiers. In this paper I propose a general definition of POQ with 1-place generalized quantifiers of the simplest kind: namely, predicative, or “cardinality” quantifiers, e.g., “most”, “few”, “finitely many”, “exactly α ”, where α is any cardinal, etc. The definition is obtained in a series of generalizations, extending the original, Henkin definition first to a (...) general definition of monotone-increasing (M↑) POQ and then to a general definition of generalized POQ, regardless of monotonicity. The extension is based on (i) Barwise’s 1979 analysis of the basic case of M↑ POQ and (ii) my 1990 analysis of the basic case of generalized POQ. POQ is a non-compositional 1st-order structure, hence the problem of extending the definition of the basic case to a general definition is not trivial. The paper concludes with a sample of applications to natural and mathematical languages. (shrink)

It is known that the Restricted Predicate Calculus can be embedded in an elementary theory, the signature of which consists of exactly two equivalences. Some special models for the mentioned theory were constructed to prove this fact. Besides formal adequacy of these models, a question may be posed concerning their conceptual simplicity, "transparency" of interpretations they assigned to the two stated equivalences. In works known to us these interpretations are rather complex, and can be called "technical", serving only the purpose (...) of embedding. We propose a conversion method, which transforms an arbitrary model of RPC into some model of the elementary theory TR, which includes three equivalences. RPC is embeddable in TR, and it appears possible to assign some "natural" interpretations to three equivalences using the "Track of Relation " concept. (shrink)

The notion of 'quality of life' frequently features in discussions about how it is appropriate to treat folk at the beginning and at the end of life. It is argued that there is a disjunction between its use in these two areas (1). In the case of disabled babies at the very beginning of life, 'quality of life' considerations are frequently used to justify enforced death on the basis that the babies in question would be better off dead. At times, (...) babies with severe disabilities are thus allowed to die or even killed. In the case of terminally ill people 'quality of life' is also important in guiding the actions of doctors. However, in the case of individuals who do not wish to live any longer because their quality of life is so poor that they would rather be dead, quality of life is likely to be dropped as a guiding principle. Thus patients who wish to die and ask to be killed, will most often be forced to endure enforced life. (shrink)

BACKGROUND: There is relatively little research concerning the processes whereby Local Research Ethics Committees discharge their responsibilities towards society, potential participants and investigators. OBJECTIVES: To examine the criteria used by LRECs in arriving at their decisions concerning approval of research protocols through an analysis of letters sent to investigators. DESIGN: Four LRECs each provided copies of 50 letters sent to investigators after their submitted proposals had been considered by the committees. These letters were subjected to a content analysis, in which (...) specific comments and requests for additional information and changes in the protocols were recorded and compared. FINDINGS: Overall 24% of proposals were approved without request for changes or clarifications, but this varied by committee: one committee approved only 6% of proposals without change or clarification while the others ranged from 26% to 32%. The content analyses of responses indicated that they could be placed into four categories: (i) further information for the committee to aid in their deliberations; (ii) requests for changes to the design or justification for the design used; (iii) changes to the information sheets provided to potential participants; and (iv) changes to consent procedures. Of these, alterations to information sheets were the most common type of request. These four types of response could be seen as safeguarding the wellbeing of potential participants (the principle of non-maleficence), of promoting the scientific validity of the research (the principle of beneficence), and of enhancing the rights of potential participants (the principle of autonomy). CONCLUSIONS: The committees were consistent in the types of requests they made of investigators, which can be seen as attempts to protect participants' rights and ensure the scientific validity of studies. Without an analysis of the proposals sent to the committees, however, it is difficult to account for the variation in the requirements set by the committees before approval was given. (shrink)

Suppose COVID-19 is the runaway tram in the famous moral thought experiment, known as the “Bystander at the Switch.” Consider the two differentiated responses of governments around the world to this new threat, namely the option of quarantine/lockdown and herd immunity. Can we contrast the hypothetical with the real scenario? What do the institutional decisions and strategies for dealing with the virus, in the beginning of 2020, signify in a normative moral framework? This paper investigates these possibilities in order to (...) highlight the similarities and, more importantly, the differences that exist between utilitarianism and Kantian ethics. Analysis shows that the hypothetical scenario can never be fully compared to the complex multifactorial nature of the real world. But if a comparison is attempted, the most obvious difference between the two governmental strategies is the concept of duty within the Kantian perspective. Ultimately, it is a matter of comparing freedom and life. Attributing a moral “priority ticket” to one or the other can be analysed through interpersonal aggregation. (shrink)

Materialism in the philosophy of mind — materialismPM — is the view that everything mental is material (or, equivalently, physical). Consciousness — pain, emotional feeling, sensory experience, and so on — certainly exists. So materialismPM is the view that consciousness is wholly material. It has, historically, nothing to do with denial of the existence of consciousness. Its heart is precisely the claim that consciousness — consciousness! — is wholly material. [2] ‘Physicalism’, the view introduced by members of the Vienna Circle (...) in the late 1920s, also has nothing to do with denial of the existence of consciousness. [3] Recently the words ‘materialism’ and ‘physicalism’ have come to be treated as synonymous, and as names for a position in the philosophy of mind that does involve denial of the existence of consciousness. They’ve been used to name a position that (i) directly rejects the heart of materialism (materialismPM) and (ii) is certainly false. This is a pity, because they’re good terms for a view that is very likely true. (shrink)

In this paper we consider the classes of all continuous $\mathcal {L}$ -(pre-)structures for a continuous first-order signature $\mathcal {L}$. We characterize the moduli of continuity for which the classes of finite, countable, or all continuous $\mathcal {L}$ -(pre-)structures have the amalgamation property. We also characterize when Urysohn continuous $\mathcal {L}$ -(pre)-structures exist, establish that certain classes of finite continuous $\mathcal {L}$ -structures are countable Fraïssé classes, prove the coherent EPPA for these classes of finite continuous $\mathcal {L}$ -structures, and (...) show that actions by automorphisms on finite $\mathcal {L}$ -structures also form a Fraïssé class. As consequences, we have that the automorphism group of the Urysohn continuous $\mathcal {L}$ -structure is a universal Polish group and that Hall’s universal locally finite group is contained in the automorphism group of the Urysohn continuous $\mathcal {L}$ -structure as a dense subgroup. (shrink)

It is commonplace to observe that digital technologies facilitate our access to information on a scale unimaginable in previous eras, leading many to call this the “Information Age.” The vaunted advantages of unprecedented data flow obscure a dark corollary: the more modes of engaging with data are available to a people, the more modes are available for manipulating them. Whether through social media, blogs, email, newspaper headlines, or doctored images and videos, the public is indeed bombarded by information, and much (...) of it is misleading or outright false. Much of it, in fact, is propaganda. As the methods for manipulating mass audiences continue to multiply, a clear understanding of the concept of propaganda has never been more relevant. -/- This Article constructs a precise, novel account of propaganda, incorporating notable scholarly insights into the concept as well as the overlooked lessons of the law’s fragmented efforts to regulate it. To bring this new theoretical framework into focus and demonstrate its importance in the Information Age, the Article connects the underlying theory to contemporary communications practices, many of which are enhanced by the availability of new technology. Notably, in doing so, the Article also develops the first systematic account of political gaslighting, which properly understood (and counterintuitively, perhaps) constitutes a form of propaganda. (shrink)

A rapidly growing body of scholarship embraces virtue jurisprudence, a series of (often ad hoc) attempts to incorporate the philosophical tradition of virtue ethics into legal theory. Broadly understood, virtue ethics describes an approach to moral questions that emphasizes the importance of developing and embodying various virtues, often as manifestations of human flourishing. Scholars typically contrast virtue ethics with deontological and consequentialist moral theories, tracing virtue-centered analysis to ancient Greek philosophers, and in particular to Aristotle. Virtue ethics has experienced a (...) revival over the past 65 years; but, long before that, it proved especially influential in Catholic moral thought, particularly through the work of Aquinas. Perhaps relatedly, scholars have seized on virtue jurisprudence to defend a range of politically conservative positions, such as originalist constitutional interpretation and the propriety of utilizing the law to regulate ostensibly “private” immoralities. This Article reveals the radically underappreciated progressive promise of virtue jurisprudence. Virtue jurisprudence requires no religious commitments whatsoever, but a strong version entails acceptance of the moral significance of developing one’s character—both within and without the law. On a compelling understanding of the virtues, rejecting a state of perpetual disadvantage under the law is a meaningful marker of the virtue of self-respect, and a repudiation of the vice of servility that would otherwise be imposed by the legal system itself. Thus, contrary to the predominant tenor of research on the subject, virtue jurisprudence can ground significant resistance to—and even defiance of—the law. In making this argument, the Article also draws novel connections between virtue jurisprudence and literature on (inter alia) race, feminism, and sexual orientation to reveal the unnoticed potential of virtue jurisprudence to push forward work in those and related areas. At a time when massive and widespread protests across the United States reflect a groundswell of support for overturning certain long-standing, legally-ingrained, systemic disadvantages of people of color, many might be surprised to learn that virtue jurisprudence can serve as a potent theoretical ally. (shrink)

For decades questionnaires have been used to measure the cognitive and psychological effects of prenatal genetic testing, but little is known about why some women undergo testing and others decline. Research indicates that many factors influence decision making, including values and beliefs. What is often denied rather than recognized is that the professional and personal values and beliefs held by the health care provider influence the patient’s decision. It is assumed that, if genetic services are delivered in a nondirective manner, (...) patients will not be affected by the provider’s personal and professional standpoint. The qualitative research data reported here challenge this assumption. Getting to know patients’ moral understanding and patterns of ethical reasoning by listening to their personal stories is recommended as a better way for nurses to help patients to make informed and autonomous decisions about prenatal genetic screening or diagnostic tests. (shrink)

Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is (...) performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions. (shrink)

What ethical justification can be found for informing a person that he or she will later develop a lethal disease for which no therapy is available? This question has been discussed during the past twenty years by specialists concerned with the prevention of Huntington's Disease, an incurable late-onset hereditary disorder. Many of them have played an active role in developing experimental testing programmes for at-risk persons. This paper is based on a corpus of 119 articles; it reviews the development of (...) their reflection and includes an outline of the ethical problems identified and the solutions adopted in pre-clinical protocols. Seen in a broader perspective, the experience of presymptomatic testing for Huntington's Disease has given medical geneticists the opportunity to clarify their ethical position in the as yet little explored field of predictive medicine. (shrink)

Berkeley held that the moral duty of mankind was to obey God's laws; that--since God was a benevolent Creator--the object of His laws must be to promote the welfare and flourishing of mankind; and that, accordingly, humans could identify their moral duties by asking what system of laws for conduct would in fact tend to promote that object. This position--which is akin to that of 'rule' Utilitarianism--is neither unfamiliar nor manifestly untenable. He was surely mistaken, however, in his further supposition (...) that, if this theory were accepted, the resolution of all (or most) particular moral dilemmas would be simple and straightforward. (shrink)

The paper offers an account of consciousness as a biological process. All its theoretical concepts are derived from the biological context and accurately defined in causal and functional terms. To cover the essence of what is commonly meant by the word ‘consciousness’, and to avoid confusion through a selective or theoretically biased interpretation of that word, the paper addresses the dimensions of awareness which the word denotes according to the dictionaries of the English language, viz., an awareness of the surrounding (...) world, of the self, and of one's thoughts and feelings. These are examined at the primary levels at which they might exist also in nonhuman species. (shrink)

There is a marked disparity between medical intuitions and philosophical argument about euthanasia. In this paper I argue that the following objections can be raised. First, medical intuitions are against it and this is an area in which judgement and sensitivity are required in that death is a unique and complex process and the patient has many needs including the need to know that others have not discounted his or her worth. Also, part of the moral constitution of a good (...) doctor is a devotion to the protection and preservation of life whatever reasons are produced to dissuade her. Finally, we do not know what the final events of a person's life might hold. (shrink)