The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. (...) The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy. (shrink)

The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions to the virtual exclusion of the capacity to execute the treatment plan. However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. The purpose of this (...) article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy. (shrink)

In May of 2006, the Abigail Alliance for Better Access to Development Drugs appeared to have won a victory when a divided panel of the Court of Appeals for the District of Columbia Circuit ruled that “terminally ill, mentally competent adult patients” had a constitutionally protected right to access investigational medications. This victory was short lived, however. On August 7, 2007, the D.C. Circuit sitting en banc reversed this earlier decision, marking a setback in Abigail's campaign for removal of the (...) regulatory barriers that currently prevent terminally ill patients from gaining early access to investigational drugs. This loss represents a big blow for Abigail's cause, because there is no guarantee that they will have another day in court, and attaining their goal through other branches of the government remains uncertain. (shrink)

In May of 2006, the Abigail Alliance for Better Access to Development Drugs appeared to have won a victory when a divided panel of the Court of Appeals for the District of Columbia Circuit ruled that “terminally ill, mentally competent adult patients” had a constitutionally protected right to access investigational medications. This victory was short lived, however. On August 7, 2007, the D.C. Circuit sitting en banc reversed this earlier decision, marking a setback in Abigail's campaign for removal of the (...) regulatory barriers that currently prevent terminally ill patients from gaining early access to investigational drugs. This loss represents a big blow for Abigail's cause, because there is no guarantee that they will have another day in court, and attaining their goal through other branches of the government remains uncertain. (shrink)

Le propos de l’article est l’analyse de la cérémonie de la prise d’habit au sein de l’Ordre Notre-Dame du Mont-Carmel aux xviie et xviiie siècles. À partir des sources normatives, picturales et hagiographiques, cette cérémonie est détaillée, notamment la scénographie de l’avant/après, gommant toute marque féminine. Certaines pratiques témoignent de la mise en impatience de ce passage de la soie au drap, qui se traduit par des prises d’habit clandestines, prématurées ou des portraits de mondaines usurpatrices en habit de (...) carmélites. Il est vrai que le modèle absolu de La Madeleine, compte tenu des origines le plus souvent princières des postulantes, n’est pas étranger au prestige de la métamorphose. Réalité et construction représentative permettent de montrer comment le Carmel s’est approprié une cérémonie, qui, dans le contexte compétitif entre les ordres de la liturgie tridentine, valorise la femme, par le biais de la moniale, affranchie des attributs de son sexe. Mais surtout, la vêture a su rendre spectaculaire et désirable ce qui a priori ne l’est pas, la pauvreté et la pénitence du corps et de ses attributs, dans le but avoué du recrutement de nouvelles postulantes. De la rivalité entre drap et soie, le vainqueur n’est pas forcément celui que l’on croit. (shrink)

Le propos de l’article est l’analyse de la cérémonie de la prise d’habit au sein de l’Ordre Notre-Dame du Mont-Carmel aux xviie et xviiie siècles. À partir des sources normatives, picturales et hagiographiques, cette cérémonie est détaillée, notamment la scénographie de l’avant/après, gommant toute marque féminine (présence de cheveux, soins pour un teint pâle, vêtement ajusté, usage de soieries, de bijoux, etc.). Certaines pratiques témoignent de la mise en impatience de ce passage de la soie au drap, qui se (...) traduit par des prises d’habit clandestines, prématurées ou des portraits de mondaines usurpatrices en habit de carmélites. Il est vrai que le modèle absolu de La Madeleine, compte tenu des origines le plus souvent princières des postulantes, n’est pas étranger au prestige de la métamorphose. Réalité et construction représentative permettent de montrer comment le Carmel s’est approprié une cérémonie, qui, dans le contexte compétitif entre les ordres de la liturgie tridentine, valorise la femme, par le biais de la moniale, affranchie des attributs de son sexe. Mais surtout, la vêture a su rendre spectaculaire et désirable ce qui a priori ne l’est pas, la pauvreté et la pénitence du corps et de ses attributs, dans le but avoué du recrutement de nouvelles postulantes. De la rivalité entre drap et soie, le vainqueur n’est pas forcément celui que l’on croit. (shrink)

In this article, cluster analysis is used to explore the conflicting results reported when the Defining Issues Test is used to explain moral reasoning ability in business situations. Using a convenience sample, gender, age, work experience, and ethics training were examined to determine their impact on the level of moral reasoning ability as measured by the Defining Issues Test. Using the whole sample, a significant difference was found for average P scores reported for males and females, but no significant differences (...) were found based on age, work experience, and ethics training. However, the sample fell into distinct clusters that identified distinct male and female groupings. While females naturally fell into two distinct high- and low-moral reasoning ability clusters, male clusters were dominated more by work experience and ethics training. Clearly there are other factors mitigating the level of moral reasoning ability for males which require further exploration. The findings suggest that while the P score provides an initial point of comparison, the real benefit to the test is in exploring what is different for males and females in terms of training needs, and the impact of work experience on the moral reasoning ability, and most importantly, how to make ethics training enticing. Recommendations for future research are also discussed. (shrink)

Anthony Collins is known mostly as an eighteenth-century freethinker who contributed to ideas of rational religion and religious toleration, as a close friend of John Locke, and as a necessitarian and materialist who held a significant correspondence with Samuel Clarke. Yet, his political philosophy has rarely received serious attention, and he remains a neglected figure in the history of political thought. This article attempts to recover Collins as a philosopher who developed a complex political theory, by focusing on his conceptions (...) of liberty and authority. It shows that he conceptualised liberty, and liberty of thought in particular, both as non-interference and non-domination, namely, an absence of censorship as well as an absence of continuous tyranny over the minds of humankind. Then, it shows that Collins also developed a thorough idea of civil authority, according to which even religious liberties may depend in some cases on the discretion of the civil sovereign. Finally, this article suggests that Collins’s multi-layered theory continued to develop after his lifetime, and that he therefore had a prominent place in eighteenth-century debates of liberty and authority. (shrink)

In this Matters Arising article, we outline how the recent article “The impact on patients of objections by institutions to assisted dying: a qualitative study of family caregivers’ perceptions” (White et al., 2023 Mar 13;24(1):22) informed Voluntary Assisted Dying (VAD) implementation in our large Australian public health setting, where objections do not emanate from, but within, the institution. In reporting the harms to patients and caregivers created by institutional objection, White et al. provide an evidenced-based road map for potential potholes (...) or risks associated with VAD implementation. We discuss the complexities emerging from the diverse views of health professionals and the ethical tensions arising from such, especially within certain specialties, and how we developed systemic strategies that support patients, caregivers and staff alike. We highlighted the need to shift from “Do you support VAD?“ to “How can we support you as healthcare professionals to integrate VAD into your practice, in a way that complies with the legislation, meets the needs of patients and caregivers, and feels safe and does not compromise your moral stance?“. (shrink)

Human consciousness is one of the greatest mysteries in the universe. From one point of view this should be surprising, since we know a great deal about consciousness from our own experience. One could say that our own conscious experience is the thing in the world that we know best. Descartes wanted to build the entirety of natural science on the foundation of our understanding of our conscious thought. Yet despite our intimate relationship with our own consciousness experience, from another (...) point of view consciousness is a puzzling phenomenon. We have no idea what it is about us, as physical beings, that makes us conscious, why we have consciousness, or which creatures other than humans have consciousness. Not only is it hard to answer these questions, it is hard to know how to even start to find answers. (shrink)

O artigo pretende aproximar as ideias protofeministas desenvolvidas pelo filósofo e teólogo francês François Poulain de la Barre (1647-1723) das estratégias de escrita formuladas pelas autoras seiscentistas da assim chamada literatura preciosa, tais como Madeleine de Scudéry (1607-1701) e Madame de Lafayette (1634-1693). Critica, para tanto, a divisão proposta por Elsa Dorlin (1974-) entre o feminismo lógico e a préciosité duplamente: através de uma reflexão mais ampla sobre os limites da separação entre filosofia e literatura e, num segundo momento, a (...) partir da análise direta dos argumentos de Poulain. Procura, assim, demonstrar a associação possível entre a confecção de uma ordem fabulada como procedimento filosófico legítimo e o emprego da imaginação como modelo da produção literária. (shrink)

This book presents recent advancements in positive psychology, specifically its application across broad areas of current interest. Chapters include submissions from various international authors in the field and cover discussion and presentation of relevant research, theories, and applications. The volume covers topics such as CBT, Student Resilience, Active Aging, Humour, Mindfulness, Character Strengths, Education, Health, Relationships, Workplaces, Performance, Technology, Design, and Communities. With the growing interest in the applications of positive psychology across diverse fields within psychology and beyond, this book (...) will make a worthwhile contribution to the field. It will also fill the current need for a volume that highlights specifically the various recent advancements in positive psychology into diverse fields and as such will be of benefit to a wide range of professionals, including psychologists, educators, clinicians, therapists, and many others. (shrink)

A radical crítica à linguagem efetuada por Spinoza, que insiste em seu necessário potencial falsificador, parece equipará-lo aos seus contemporâneos. Mais do que isso, parece introduzir um problema insolúvel para a possibilidade de comunicação unívoca da verdade – incluindo a expressão dA radical crítica à linguagem efetuada por Spinoza, que insisteem seu necessário potencial falsificador, parece equipará-lo aos seus contemporâneos. Mais do que isso, parece introduzir um problema insolúvel para a possibilidade de comunicação unívoca da verdade — incluindo a expressão (...) de sua própria filosofia. Neste artigo, procuro refletir sobre esta crítica e propor uma alternativa ao caráter imaginativo das palavras, apostando na distinção entre linguagem e método. Esta propostainterpretativa permitirá reclassificar a posição spinozista e manter sua originalidade frente às demais concepções de seu período histórico.e sua própria filosofia. Neste artigo, procuro refletir sobre esta crítica e propor uma alternativa ao caráter imaginativo das palavras, apostando na distinção entre linguagem e método. Esta proposta interpretativa permitirá reclassificar a posição spinozista e manter sua originalidade frente às demais concepções de seu período histórico. (shrink)

Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid‐19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid‐19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. (...) While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance. (shrink)

Traditionally, heated philosophical debates regarding the status of categories have turned on questions of "nominal" vs "real" existence, where the role and significance of rhetoric and politics is obscured. Feminists in the late 20th century acknowledge a variety of elements involved in the construction of categories such as "human," "nature," rhetoric and logic. I argue for a position which undercuts the traditional debates between nominalism and realism, and using "wo men" as a case study, demonstrate the intricacies of the relationship (...) of logic and rhetoric in category construction. (shrink)

This dissertation is comprised of three parts. The first part is an intellectual historical thesis, regarding the place of Jean Piaget in philosophic thought. In Chapter One I outline the differences between my thesis and Piaget's position on the development of spatial concepts. My second chapter places his theory within the context of congruent accounts from the philosophy of nature, neurophysiology, and philosophy of psychology. Chapter Three situates him in relation to a selection of philosophers in the history of western (...) philosophy, through a metapsychology. ;In Part II I provide a dynamic account of the order of conceptual development, and clarification of the concepts of topological space, projective space, and euclidean or metric space.$\sp1$ In three chapters I outline a systematic analysis of the genetic development of the concepts based on an analysis and critique of Piaget's observations. The emergence of each concept is shown to be a result of the experience of some incongruity between the concept immediately preceding, and experience. The order I outline differs in some specifics from that suggested by Piaget's broad outline, and I explain the differences as they occur. ;The third part of this dissertation is the most tentative. Chapter Nine discusses the kind of testing I will employ when I test the logical order of concepts. There are four kinds of modes which I use to test each concept. This is followed by Chapter Ten, which tests the dynamic development of concepts of space. In this I attempt to confirm those changes in the development of the concepts, as well as Piaget's overall framework, through the use of Piaget's pre-logical modes as well as others I have extracted from the dynamic development of concepts. ftn $\sp1$ I note here that Piaget means, by euclidean geometry, metric geometry. The distinction between geometry with a euclidean and a non-euclidean metric is not crucial for the purpose of this thesis. (shrink)

Pilcher, Carmel Review(s) of: Aboriginal church paintings: Reflecting on our faith, by Eugene Stockton Editor with Terence O'Donnell (Lawson: Blue Mountain Education and Research Trust Publishers, 2010), pp.45, $20.00.

Pilcher, Carmel Review of: Earth unites with heaven: An introduction to the liturgical year, by Gerard More, Northcote, VIC: Morning Star, 2014, pp. 75, $12.95.

In the latter half of the 20th century, Western medicine moved death from the home to the hospital. As a result, the process of dying seems to have lost its spiritual dimension, and become a matter of prolonging material life by means of medical technology. The novel quandaries that arose led in turn to medico-legal regulation. This paper describes the recent regulation of dying in Israel under its Dying Patient Law, 2005. The Law recognizes advance directives in principle, but limits (...) their effect and form through complex medico-legal artifices. It reflects a culture that places high value on both scientific medicine and the sanctity of life as such, and illustrates a medical culture that pitches battle against death. At the same time, the Law constructs the will of the individual in a medico-legal language that is alien to the lay person. The paper suggests an alternative approach to advance care planning that is patient-centred and addresses the psycho-social needs of the individual in terms of her relational autonomy. From this perspective, advance care planning becomes an opportunity to extract the patient from the medical context and allow her to speak about her approaching death with close ones in her own terms of reference. To this end, there is a need for facilitation of an intimate encounter where patients can speak about their concerns with their loved ones. The paper also presents a methodological approach of attentive listening, which can be applied across diverse cultures and circumstances. (shrink)

Robert Wallace (1697–1771) was a leading minister of the Church of Scotland, but he remains a largely overlooked figure in the literature. Nevertheless, his participation in philosophical and theological debates offers a glimpse of the complex positions of the Scottish clergy – and of Scottish moderation on its own terms. Wallace’s moderation was evident, for example, in his opposition both to radical deism and orthodox dogmatism. Yet what makes Wallace’s case particularly interesting is that he described himself as a ‘moderate (...) freethinker’ in a letter to David Hume, while distinguishing elsewhere the ‘moderate’ and ‘sober’ freethinkers from the dangerously sceptical ones. Exploring his consistent statements on this issue in various writings throughout his career, this article investigates the self-identified moderation of Wallace – in opposition, for example, to his rival freethinker William Dudgeon – and thus the clergy’s attempt to use this category in the shaping of their vision of the Scottish Enlightenment. (shrink)

Hobbes left a complicated legacy for the English Whigs. They thought that his Leviathan was all too powerful, but they found other elements in his thought more appealing – mostly his anticlericalism. Still, the precise relationship between Hobbes and the Whigs has remained underexplored, while some still argue that Hobbes was simply too much of an absolutist for the Whigs to rely on his political ideas. This article attempts to show that Hobbes was, in fact, recruited by proto- and early (...) Whigs for their causes. It shows how Hobbesian ideas were used in the toleration debates of the 1660s and 1670s, and even in debates on human reason and liberty of conscience. Then it demonstrates how similar Hobbesian principles, and even phrases, were used subsequently in the formative years of Whiggism from the 1680s to the 1720s, by thinkers who were worried, as Hobbes was, about the political aspirations of the Church. By collecting a series of prominent thinkers who are associated with Whiggism and who engaged with Hobbes in various ways – including Buckingham, Marvell, Cavendish, Warren, Blount, Tindal, Trenchard and Gordon – this article shows that Hobbes was employed systematically in the service of Whig causes, such as limited toleration, civil religion and an opposition to religious persecution. (shrink)

This paper invites us to reimagine parents as history makers and parenthood as a political space where parents and adult educators collaborate in reading and acting on the world that is, with a view to achieving a world that is not. The pandemic provides a backdrop to a fundamental understanding that while the virus may claim to be entirely democratic, the pandemic has failed the equity test. The asymmetrical world that is calls for a reinvention of adult education as a (...) space in which the excesses of neoliberalism are resisted in preparation for a shift in consciousness that might promote collective action against today’s far-from-equitable reality. Parents as ‘Subjects’ is a cris de coeur for a liberatory parent-focused education that rehumanizes parents in a world that will be. (shrink)

The rapid development of assisted reproduction technologies for the treatment of infertility appears to empower women through expanding their individual choice, but it is also creating new forms of suffering for them and their collaborators, especially in the context of transnational third-party reproduction. This paper explores the possibility of framing the ethical discourse around third-party reproduction by bringing attention to concerns of altruistic empathy for women who collaborate in the reproductive process, in addition to those of individualistic choice. This would (...) entail moving beyond an ethic of liberty that is based on self-interest and the language of rights, to an alternative ethic of care that is based on self-restraint and the language of responsibilities. An ethic of care and responsibility would cultivate the empathetic self-reflection of the autonomous actor in relation to those others who are part of the enterprise of bringing a child into the world. (shrink)

A Hobbesian utopia might sound paradoxical. Hobbes never prescribed a utopia per se, and he is well-known for his practical and pragmatic approach to human nature and to politics. Yet, this article identifies several utopian elements in Hobbes, starting with the ways in which his contemporaries thought of his work as utopian. Following Galileo and others, Hobbes might have been part of a utopian moment, or at least believed that he was, especially due to his novel and historic philosophy. Behind (...) his dystopian description of the state of nature there is a utopian vision of a civilized, peaceful, and industrious society, the result of true moral philosophy. Finally, the differences between Hobbes and Plato notwithstanding, there might be one overlooked similarity: if Plato designed a republic where Socrates would not have been persecuted, Hobbes might have designed a commonwealth that would produce and allow future Galileos to work without hindrance. (shrink)