The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis (...) of the ethical concepts associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

IntroductionIn the coronavirus disease 2019 pandemic, Romanian universities switched to emergency relocation and online education, with students experiencing a sense of isolation, which affected their well-being, pace and normal learning style, relationships with other colleagues, and Professors. Beyond the technological obstacles that have arisen in learning, the aim of this study is to highlight the psychological variables that are associated and that explain the self-perceived well-being of students, in university, in the pandemic. The psychological variables studied were the following: the (...) level of openness and personal autonomy, as personality traits of students but also the mechanisms for regulating their academic motivation.MethodWe used a questionnaire-based survey, wherein all four research instruments had been validated and adapted to the investigated population. The subjects were BA and MA students at the University of Oradea, Romania, the majority being females with the age range of 27 years old. Pearson Correlation and Multiple Linear Regression were used to test the two hypotheses.ResultsResearch data obtained in the correlation analysis, point out association relationships with moderate and high effects size, between positive attitude toward self, others and student life and: openness to learning, openness to aesthetics, behavioral autonomy, cognitive autonomy, intrinsic motivation, and identification motivation. Furthermore, in regression analysis, it was revealed that regarding the variance of results concerning students’ self-perceived well-being in university, it contributes both of students’ personality traits and their intrinsic motivation and identification motivation.ConclusionThe fundamental conclusion of the research is that, although the personality traits of students explain in a higher percentage the variability of results in students’ self-perceived well-being, motivation regulation mechanisms play an important role, especially in the conditions of online activities. The results have direct implications for the work carried out in universities. The educational policies developed by specialists and government will have to emphasize the ways of forming resilient student communities in periods of sudden transition and adaptation to change which take place in education and society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Well-Being, Disease, and DisabilityJulian Savulescu (bio)Keywordsautonomy, well-being, mental disorder, psychiatric disease, disability, welfare, body integrity identity disorderVarelius seeks to redefine what constitutes mental disorder or mental illness. (I use these terms interchangeably.) "According to this account, 'a person is mentally disordered when her psychological capacity for autonomy is diminished as compared with that of a typical member of our species of her age-group" (Varelius 2009). This (...) is a stimulating and important paper. Varelius describes fruitfully the relationship between mental illness and autonomy, specifically the ways in which mental disorder can undermine autonomy. This is valuable in understanding the impact of mental illness on the lives of people who suffer from it, which is a serious issue in practical ethics. But is it what constitutes mental disorder or illness? There are logical, conceptual reasons why we should not redefine mental illness in this way.Incomplete Account of Mental DisorderThere are a family of related concepts: disease, injury, disorder, illness, disability. There are old and entrenched disputes about how we should define these concepts. Varelius' paper is a contribution to the definition of mental disorder and illness.The primary classificatory category that defines medical practice is that of health and disease. Disease, broadly construed, involves the presence of pathology. Pathology can result from processes primarily or predominantly internal to the organism, such as genetic disease (although external factors affect their expression), or from processes primarily or predominantly external to the organism, such as injuries.The concepts of disorder and illness relate to the concept of disease. Disorder could be defined in terms of the functional effect of pathology. Illness could be defined in terms of the experiential impact of disease.1 How these terms are precisely defined and related need not concern us at the present. What matters is that the primary category is disease.Psychiatry has evolved in its use of terminology. What used to be called psychiatric diseases are now often called mental disorders. I now claim, for the purposes of illustration of the argument (though it does not require this claim), that the dominant category is disease. Indeed, what are called mental disorders appear in the International Classification of Diseases.Disease can be divided into the mental and physical. I believe that the mental will one day be [End Page 59] shown to be shown to be entirely a subset of the physical. That is, that brain pathology will be a cause, if not the only cause, of mental disease. But others may believe the sets of mental and physical disease are intersecting but not coextensive.What matters is that mental disease is a subcategory of the more general category of disease. It must have the same definitional features as "disease" plus some extra ones specific to the "mental," or mind. (The same points apply if you use "disorder" as the dominant category rather than "disease.")One problem for Varelius is this: how does this autonomy account of "mental disease" relate to an account of "physical disease," and "disease" in general? If mental disease is defined in terms of its impact on the psychological capacities necessary for autonomy, how is "disease" in general, or physical disease, to be defined? One obvious response is to define these related concepts in a similar way:Disease: "a person is diseased when her capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group." Physical disease: "a person is physically disordered when her physical capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group."This interpretation is suggested by the following passage from Varelius:As contrasted with the actual condition of being autonomous, as a capacity of an individual autonomy means that a person has the psychological and bodily abilities that being autonomous... requires.(2009)It would be radical to define disease in general in terms of capacity for autonomy. There is no doubt that disease affects our autonomy, and that is morally significant, but these seem clearly separable concepts. Varelius could respond that he is not defining mental disease but rather the mental component... (shrink)

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has (...) not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years at baseline. Study participants provided up to 16 measurement occasions between 2009 and 2016. Dates of death were available for 118 individuals who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic and four indicators of eudaimonic wellbeing as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction:The Heat of Mild Cognitive ImpairmentJulian C. Hughes (bio)Keywordsaging, explanation, mild cognitive impairment, understanding, valuesDebates about mild cognitive impairment (MCI) are generating heat, albeit civilized heat. But under the surface, as I think the papers in this special issue demonstrate, the civilized heat comes from a good deal of passion. One way in which philosophy can contribute to the debate is by making plain the sources of this passion, (...) so that the motivating forces are clearer.One motivating force is this: There will be people who do not have dementia but who have symptoms or signs that might predict dementia, which cause them concern, whom we might help by early intervention. The intervention might involve advice and support, or it might involve some form of drug treatment; and in the utopia of our dreams, it might involve prevention. All of this is very motivating for clinical scientists. It also offers a laudable motivation to pharmaceutical companies, who simultaneously must have regard to the possibility of profits for their shareholders.Here, however, is an alternative motivation: The effects of aging must not be ignored if help can be given, but older people must not be stigmatized by a medical process that thrusts disabling labels on them. People age, but they age differently, and it is better to recognize difference, both from a biological and from a philosophical perspective. Thus, a passionate commitment to the cause of individual agency in old age and a desire for authentic autonomy for older people provide strong motivation too.At root, then, the conflicting passions over MCI reflect the age-old struggle in the philosophy of psychiatry between the natural sciences (Naturwissenschaften) and the human or cultural sciences (Geisteswissenschaften): the tension is between a tendency to approach the problem with the aim of eliciting a scientific explanation and a tendency to try to achieve a human and cultural understanding of the phenomena (Phillips 2004). So, although MCI can be regarded as an explanatory diagnostic entity with some predictive value, it can also be regarded as a label that might cause harm or as a human phenomenon that requires understanding. Furthermore, MCI raises ontological questions about the nature of disease entities. And there is a wider issue as well about how aging itself should be regarded.From a biological perspective, it turns out there is no clear cutoff between what is normal and what [End Page 1] is not. Hence, in a number of ways, values seem to be as important as facts (Sadler 2005). Perhaps philosophy should content itself with saying no more than this: MCI ought not to be considered or debated as if it lies outside the realm of evaluative judgment. The very possibility of its existence as a clinical entity is a matter worthy of moral and social discourse.The direction of thought indicated here and in the papers that follow, however, is more radical than the easily won point that the "diagnosis" of MCI is not value free. On the back of the biological point, that there is a continuum between physiological and pathological aging, is the broader philosophical point that aging can neither be understood solely in terms of physiology nor in terms of pathology, nor even in terms of both. Ageing represents, inter alia, a social and cultural phenomenon manifest in the context of particular psychological and spiritual responses to a mixture of physiological adaptations and pathological predispositions. Without the broader picture, we tend to characterize old age, as Michael Bavidge has suggested elsewhere, in terms of deteriorations: "We should think of old age as offering alternative rather than impaired ways of experiencing life" (2006, 49). The difficulty is that any diagnosis seems to suggest impairment in one form or another. The radical suggestion, therefore, might be to commend descriptions that encourage shared understanding over and above the giving of names and labels.In a brief critique of the scientific approach to "banal memory disorders and MCI", Jean-Marie Léger, like Bavidge, regrets the extent to which people with cognitive impairment "are described in terms of what they have lost, with no regard for the wealth of faculties which are still present." Léger... (shrink)

Evidence-based recommendations for lifestyles to promote healthy cognitive aging root in reductionistic studies of mostly physical measurable factors with large effect sizes. In contrast, most people consider factors like autonomy, purpose, social participation and engagement, etc. as central to a high quality of life in old age. Evidence for a direct causal impact of these factors on healthy cognitive aging is still limited, albeit not absent. Ultimately, however, individual lifestyle is a complex composite of variables relating to both body (...) and mind as well as to receiving input and generating output. The physical interventions are tied to the more subjective and mind-related aspects of lifestyle and wellbeing in the idea of the “embodied mind,” which states that the mind is shaped by and requires the body. The causality is reciprocal and the process is dynamic, critically requiring movement: the “embodied mind” is a “embodied mind in motion.” Hiking, playing musical instruments, dancing and yoga are examples of body–mind activities that assign depth, purpose, meaning, social embedding, etc. to long-term beneficial physical “activities” and increase quality of life not only as delayed gratification. The present motivational power of embodied activities allows benefiting from the side-effects of late-life resilience. The concept offers an access point for unraveling the mechanistic complexity of lifestyle-based prevention, including their neurobiological foundations. (shrink)

Late in life, Józef Maria Bocheński set out to examine the age-old preoccupation with the question “how to live as well and as long as possible?” A traditional answer has been, “live wisely.” In his Handbook of Worldly Wisdom (2020), Bocheński analyzes this answer arguing that, conceptually, living wisely is distinct from obeying moral commandments, prescribing ethical rules, and recognizing authority (e.g., piety, free submission to divine authority). He claims that ethics consists solely in what moral philosophers label as “metaethics” (...) — a theoretical discipline interested in the conceptual status of moral discourse qua discourse. However, Bocheński remains silent about a substantive ethics — that is, how a life led one way or another subscribes to some guiding value-set. As regards wisdom, therefore, the consequence of this position is that Bocheński’s account is ethically neutral. I argue that such a position entails a tension and dichotomy between, on the one hand, prudential rationality concerned with getting on in the moment — that is, wisdom — and, on the other hand, unconditional moral commandments. For his part, Bocheński does not recommend living according to wisdom’s precepts as he analyses them; his own path through life, he tells us, has been a commitment to Christian values, piety abetted by observance of moral commandments, a perspective that, I submit, is not ethically neutral: on the contrary, it entails thick, substantive value-choice. Bocheński’s avowal suggests a second dichotomy and tension, that between the worldly conduct of life, with moderate acknowledgment of moral principles, and an extra-worldly perspective (the “folly of the Cross”). Bocheński does not attempt to resolve either dichotomy, to seek a possible point of their convergence and integration, for instance by inquiring into moral psychology (i.e., the construction of self, the nature of the will, etc.). I believe that this set of views stems from conclusions Bocheński reached in advance of producing the Handbook that bear on, first, how philosophy should be conducted — as logical analysis hostile to grandiloquent speculation and synthesis (“worldviews”); and second, his utter dismissal as nefarious of anthropocentric views. Indeed, Bocheński asserts, without a blush, that almost everything “we” have come to believe about ourselves is superstition writ large. I trace what I consider to be difficulties with Bocheński’s account of wisdom — in relation to his take on morality, (meta-)ethics, and piety — to these idiosyncratic views. (shrink)