Context: In most jurisdictions where medical-aid-in-dying is available, this option is reserved for individuals suffering from incurable physical conditions. Currently, in Canada, people who have a mental illness are legally excluded from accessing MAiD. Methods: We developed a questionnaire for mental health care providers to better understand their perspectives related to ethical issues in relation to MAiD in the context of severe and persistent suffering caused by mental illness. We used a mixed-methods survey approach, using a concurrent embedded model with (...) both closed and open-ended questions. Findings: 477 healthcare providers from the province of Québec completed the questionnaire. One third of the sample were nurses, one quarter psychologists and one quarter psycho-educators. Nearly half of the respondents considered that people with a severe mental illness should be granted the right to opt for MAiD as a way to end their suffering. Respondents were more likely to feel comfortable listening to the person and participating in discussions related to MAiD for a mental illness than offering care or the means for the person to access MAiD. Most reported that they had not received adequate/sufficient training, education or preparation in order to address ethical questions surrounding MAiD. Conclusions: The findings highlight how extending MAiD to people with a mental illness would affect daily practices for mental healthcare providers who work directly with people who may request MAiD. The survey results also reinforce the need for adequate training and professional education in this complex area of care. (shrink)

Beyond Clinical Dehumanisation Toward the Other offers a rare and intimate portrayal of the moral process of a mental health clinician that interrogates the intractable problem of systemic dehumanization in community mental health care, and looks to the notion of 'wonder,' and the visionary relational ethics of Emmanuel Levinas, for a possible cure. This book is an ethical primer for mental health professionals, researchers, educators, advocates and service users working to re-imagine and heal a broken system by challenging the underpinnings (...) of entrenched dehumanization and standing with those they "serve". (shrink)

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...) acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Living labs are interdisciplinary and participatory initiatives aimed at bringing research closer to practice by involving stakeholders in all stages of research. Living labs align with the principles of participatory research methods as well as recent insights about how participatory ways of generating knowledge help to change practices in concrete settings with respect to specific problems. The participatory, open, and discussion‐oriented nature of living labs could be ideally suited to accompany ethical reflection and changes ensuing from reflection. To our knowledge, (...) living labs have not been explicitly trialed and reported in ethics literature. In this discussion paper, we report and discuss four initial issues that marked the process of setting up a living lab in ethics: (1) determining the goals and expected outcomes of an ethics living lab; (2) establishing operational procedures; (3) selecting communities and defining pilot projects; and (4) adopting a lens to tackle emerging questions and challenges. We explain these four issues and present the paths taken based on the novel and specific orientation, that is, living ethics, at the basis of this project. In alignment with living ethics and É‐LABO, we approach challenges as learning opportunities to ask not only “how” questions but also “why” questions. We hope that this discussion paper informed by our experience helps to clarify the theoretical, methodological, and practical approaches necessary to successfully adopt and employ living labs in ethics. (shrink)

Disorders of consciousness (DOC) are a family of related neurological syndromes characterized by deficits of varying degrees of wakefulness (e.g., sleep–wake cycles and arousal) or awareness (e.g., reacting to stimuli, interacting with the environment). Although coma rarely persists for more than a few weeks, some patients remain in a subsequent vegetative state or a minimally conscious state for months or years. Caring for patients with DOC raises ethical questions, but the perspectives of healthcare providers on these questions remain poorly documented. (...) We conducted a qualitative study involving healthcare providers with different backgrounds. Semistructured interviews were used to explore attitudes toward ethical issues. We found that contextual (e.g., time, resource allocation) and relational aspects (e.g., communication process, families) shaped how ethical challenges surfaced and were managed. We call for greater awareness of contextual, institutional and social aspects and focus on these issues in training programs. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

The paper starts with reflections on Plato’s critique of the poets and the preference many express for Aristotle’s view of poetry. The second part of the paper takes a case study of analytic treatments of ancient philosophy, including the ancient philosopher poets, to examine the poetics of analytic philosophy, diagnosing a preference in Analytic philosophy for a clean non-poetic style of presentation, and then develops this in considering how well historians of philosophy in the Analytic tradition can accommodate the contributions (...) of philosophers who wrote in verse. The final part of the paper reviews the current enthusiasm for decoding Empedocles’ vague and poetic descriptions of the cosmic cycle into a precise scientific periodicity on the basis of the recently discovered Byzantine scholia on Aristotle. I argue that this enthusiasm speaks to a desire for definite and clear numerical values in place of poetic motifs of give and take, and that this mathematical and scientific poetic is comparable to the preferred poetic of analytic philosophy. (shrink)

Comment concilier le relatif et l’universel? C’est à cette délicate tâche que s’était attelée il y a déjà quelques années Madame Delmas-Marty, spécialement dans le domaine des droits de l’homme. Le présent ouvrage envisage une difficulté supplémentaire en croisant les interrogations sur le pluralisme juridique avec la question de l’effectivité du droit économique. La prise en compte des pluralismes, notamment du pluralisme juridique, contribue-t-elle à une meilleure effectivité du droit économique? Ou bien, au contraire, le pluralisme juridique est-il un facteur (...) d’ineffectivité du droit économique? Dans cette recherche, les auteurs se sont attachés au pluralisme aussi bien dans la production du droit économique que dans le règlement des différends. C’est ainsi que le lecteur est appelé à cheminer dans la diversité des formes nouvelles qu’empruntent les régulations juridiques pour partir à la recherche des multiples intérêts que peut prendre en charge le droit économique, qu’ils soient individuels, collectifs ou même futurs. Le voyage se poursuit, là encore dans les mondes aussi bien des formes que de la substance. L'ouvrage, après avoir cherché à cerner la notion d’effectivité au regard de notions voisines comme l’efficacité ou l’efficience, s’interroge in fine sur l’éventualité des voies d’un dépassement de la notion de pluralisme juridique. (shrink)

There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.

In this paper I explore a famous part of Plato’s Theaetetus where Socrates develops various models of the mind (picturing it first as a wax tablet and then as an aviary full of specimen birds). These are to solve some puzzles about how it is possible to make a mistake. On my interpretation, defended here, the discussion of mistakes is no digression, but is part of the refutation of Theaetetus’s thesis that knowledge is “true doxa”. It reveals that false doxa (...) is possible only if there is a certain stock of abstract knowledge, conceptual knowledge, that is not awareness of the particular individual that is being described. The individual must be identified under some description, or seen as something of a certain kind. Error can only occur if the description applied misdescribes the situation, but then if it is to be applied falsely it must first have been known from somewhere else. So knowledge cannot be reduced to the application of descriptions to particulars, but is to be found in the prior possession of abstract descriptions that can be deployed in identifying particular individuals on the ground. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:370 HISTORY OF PHILOSOPHY Leibniz. By Edmondo Clone. (Napoli : Libreria scientifica editrice. Pp. 540. L.4.000.) L'ouvrage d'E. Cione est une presentation d'ensemble de l'oeuvre de Leibniz. L'auteur situe d'abord Leibniz dans son milieu culturel et dans son ambiance historique. Puis il aborde les probl~mes relatifs ~ la monade et ~ l'univers. Une troisi~me partie traite du choix divin, du real et des possibles. La quatri~me s'attache au difficile (...) probl~me de la liberte~ en Dieu et dans l'homme. Enfin, Clone precise queles sont et doivent ~tre les activite~s de l'homme dans los domaines de la logique, de la morale, de l'esth~tique, de la religion. Par consequent, ne serait-que par l'ampleur des mati~res ~tudi~es, on dispose ici d'une vaste fresque qui met en place l'ensemble des preoccupations philosophiques de Leibniz, et qui d~ploie son ~ventail en un certain sens, disons celui de la Monadologie, toute entree dans la philosophie de Leibniz ~tant bonne, pourvu, si j'ose dire, qu'on en sorte. Or, on en sort, car l'au~eur appuie ses connaissanc~s sur une pratique quotidienne des ~extes de Leibniz, sur une documentation de premiere main qui lui fair honneur, sur une somme de lectures [eibniziennes qui l'aident s orienter son dessein. Cet ouvrage repose sur l'humus fertile d'un vaste savoir technique et livresque concernant la philosophic de Leibniz. I1 est donc, de ce point de vue, document~ avec pr4cision, et il atteint le fond des probl~mes abord4s. Enfin, rauteur ne perd pas ses propres droits dans cette ~tude, et pr4cise d'un oeil vigilant quelles sont es d4fectuositds de cette pens4e, qui n'a sa pleine signification que si on ne la coupe pas de sos racines th4ologiques. I1 semble que lh, le destin de Leibniz diff~re de celui de Clone, puisque, pour ce dernier, le philosophe d'Hanovre ne parvient pas ~ p4n~trer le sens profond de la r~alit(~ spirituelle, c'est-h-dire de la libert4 de l'homme. ANDRE ROBINET Orldans, France David Hume: Prophet o] the Counter-Revolution. By Laurence L. Bongie. (Oxford University Press, 1965. Pp. xvii + 182.35s.) This excellent work uncovers and analyzes the amazing influence of Hume's historical and political views on the world of late 18th-century France. First Professor Bongie admirably recounts the immense impact of Hume's History o] England in France when it originally appeared. The work was wildly praised by French royalty, by the philosophes, by Catholic intellectuals, by almost everyone except the Huguenot exiles. Hume's alleged impartiality and philosophical approach made him for France of the time, the finest historian of the age, the new Tacitus. Everyone found great profundity in the History, and each group managed to overlook those aspects of Hume's views that conflicted with their own outlook, and stressed those aspects that fitted in with their own predilections. it was Turgot who apparently first realized that Hume was not the zeal hero of those who were to transform France, and that Hume's political philosophy and his picture of human nature "glean'd" through the study of history were hardly in accord with the theories of the reformers and the future revolutionists. In their correspondence, Hume and Turgot revealed the enormous gulf that separated them, the latter believing in the endless perfectibility of mankind, the former, much more sceptical and much readier to accept man in his historical condition. For Hume, there was always a struggle between order and liberty, and dangers on both sides with no ideal solution in sight, while for the optimistic Turgot a new and better world was just around the corner. What Turgot saw as their differences became clearer a few years later to moderates like Mirabeau, Mably and Brissot. Hume, for them, did not really see the importance of liberty, the fundamental rights of man, the real lessons of History. The moderates began boosting, translating and commenting on an antidote to Hume's History, the liberal Whig version of English history by Catherine Macaulay-Graham, a work finally published in French under Mirabeau... (shrink)

Professor Christopher Stead was Ely Professor of Divinity from 1971 until his retirement in 1980 and one of the great contributors to the Oxford Patristic Conferences for many years. In this paper I reflect on his work in Patristics, and I attempt to understand how his interests diverged from the other major contributors in the same period, and how they were formed by his philosophical milieu and the spirit of the age. As a case study to illustrate and diagnose his (...) approach, I shall focus on a debate between Stead and Rowan Williams about the significance of the word idios in Arius's theology (in the course of which I also make some suggestions of my own about the issue). (shrink)

In the article “Nudging and Informed Consent”, Cohen argues that the use of “nudging” by physicians in the clinical encounter may be ethically warranted because it results in an informed consent where obligations for beneficence and respect for autonomy are both met. However, the author's overenthusiastic support for nudging and his quick dismissal of shared decision-making leads him to assume that “soft” manipulation is un-problematic and that “wisdom” on the side of medical professionals will suffice to guard against abuse. Opposing (...) this view, we propose that: 1) patient preferences and values should not be boiled down to rational or irrational decisions based on cognitive reasoning alone, 2) potential threats to the physician-patient must be mitigated and could be minimized by employing alternative strategies that acknowledge the impact of cognitive heuristics in shaping decision-making but maintain transparency and trust, and 3) patient preferences and values can be legitimately influenced only under specific circumstances. The latter include: (1) exhaustion of other means; (2) evidence that nudging is effective in a specific context; (3) evidence of clear and active public misinformation (e.g., industry promoting smoking); (4) explicit pubic dialogue between various stakeholders including medical professional societies about nudging; (5) upholding shared decision-making as a preferred approach; and (6) a rich understanding of clinical reality beyond the simple dichotomy of beneficence-autonomy. (shrink)

Do you need to know the name of the god you're praying to? If you get the name wrong what happens to the prayer? What if the god has more than one name? Who gets to decide whether the name works (you or the god or neither)? What are names anyway? Are the names of the gods any different in how they work from any other names? Is there a way of fixing the reference without using the name so as (...) to avoid the problems of optional names? There is a type of formula used in prayer in ancient Greece which I call (in this paper) a "precautionary formula". The person praying uses expressions like "whether you want to be called [x] or [y]", and "if this is the name by which you would like to be called". I also include here the practice of adding definite descriptions that identify the god by means other than the name (e.g. their place of birth or residence, their deeds etc). In this paper I ask what these formulae were for, why so many occur in philosophical work, particularly Plato, and whether the puzzles about the names of the gods go back to the Presocratics. (shrink)

In this paper I argue that we can better understand Plato’s Phaedo, if we don’t concentrate solely on the hints of Pythagoreanism among the characters and their doctrines, as though that were the principal key to the dialogue’s dialec- tical targets. I suggest that the dialogue is intended to make us think of the meta-physics of at least one other Presocratic predecessor, besides any Pythagorean influence (which may be much less than has been thought). Not least among the thinkers of (...) whom we are reminded is Heraclitus. In the Phaedo, Plato invites us to explore the limitations of these earlier metaphysical views, and to consider how far they can or cannot make space for the capacity of the soul to direct the body, to make decisions, to grasp eternal truths and potentially to survive in perpetuity beyond the decay of the body. (shrink)

I explore some enlightening alternative economic theories in Plato’s Republic which help to cast doubt on standard models of rationality in economics. Starting from Socrates’ suggestion that things work best if everyone says ‘mine’ about the same things, I discuss a kind of ‘belonging’ which merits more attention in political and economic theory. This kind of belonging is not about owning property, but it can (better) explain the desire to do things for others and for the collective good. But did (...) Socrates forget to invoke it when addressing the puzzle about why the philosopher would willingly return to the cave? (shrink)

Philosophers are generally somewhat wary of the hints of number mysticism in the reports about the beliefs and doctrines of the so-called Pythagoreans. It's not clear how much Pythagoras himself (as opposed to his later followers) indulged in speculation about numbers, or in more serious mathematics. But the Pythagoreans whom Aristotle discusses in the Metaphysics had some elaborate stories to tell about how the universe could be explained in terms of numbers—not just its physics but perhaps morality too. Was this (...) just fanciful speculation? Is it muddled as a theory of causality, as Aristotle suggests? I shall try to rehabilitate the passion for numbers by linking it with the notions of harmony and proportion in other thinkers who have a higher credibility factor in the philosophical stakes, and by showing that the desire to reduce quality to quantity, and to discover an exact science that can explain human life and meaning, is a serious philosophical passion that doesn't easily go away. And, after all, why should it? (shrink)

A universal basic income is an unconditional allowance, sufficient to live on, paid in cash to every citizen regardless of income. It has been a Green Party policy for years. But the idea raises many interesting philosophical questions, about fairness, entitlement, desert, stigma and sanctions, the value of unpaid work, the proper ambitions of a good society, and our preconceptions about whether leisure or jobs are the thing we should prize above all for free citizens. Coming from the perspective of (...) ancient philosophy, I consider the answers offered in the ancient world to some of these questions, and how we might learn from rethinking our notions of how to create a good society in which people can be free and realise their creative and intellectual potential. (shrink)

This book is an amazing treasure trove of riches, and my response, done properly, would probably occupy three monographs. Naturally, Rashed is addressing quite a few controversial issues concerning the interpretation of Empedocles, and on some of these I would heartily disagree with his conclusions, or have minor quibbles; but all his contributions are welcome and reflect a most impressive breadth of learning and scholarship. Where I disagree, it is mostly not that Rashed’s reports of the tex...

There is mounting evidence that methylphenidate (MPH; Ritalin) is being used by healthy college students to improve concentration, alertness, and academic performance. One of the key concerns associated with such use of pharmaceuticals is the degree of freedom individuals have to engage in or abstain from cognitive enhancement (CE). From a pragmatic perspective, careful examination of the ethics of acts and contexts in which they arise includes considering coercion and social pressures to enhance cognition. We were interested in understanding how (...) university students, parents of university students, and healthcare providers viewed autonomy and coercion in CE using MPH. We found that perspectives converged on the belief that CE is a matter of personal and individual choice. Perspectives also converged on the existence of tremendous social pressures to perform and succeed. Parents emphasized personal responsibility and accountability for CE choices, and expressed feelings of worry, sadness and fear about CE. Students emphasized the importance of personal integrity in CE, expressed tolerance for personal choices of others, and highlighted the challenge that CE poses to maintaining one’s personal integrity. Healthcare providers emphasized the health consequences of CE. These results illustrate: (1) the importance of understanding how context is viewed in relation to perspectives on autonomous choice; (2) the limitations of individualistic libertarian approaches that do not consider social context; and (3) the ethical implications of public health interventions in a value-laden debate where perspectives diverge. (shrink)

Discussion surrounding ethical and social issues in deep brain stimulation (DBS) has increased. This article introduces a special section on the ethics of DBS in The Journal of Clinical Ethics.

Catherine Bachelard-Jobard a choisi une approche pluridisciplinaire afin de comprendre, sans aucun manichéisme, si notre société est réellement en marche vers l'eugénisme. En d'autres termes, sommes-nous en train de nous diriger vers un monde d'enfants parfaits procédant de la sélection pré-natale, décidée par les parents et autorisée par la loi? Les parents peuvent-ils encore choisir de mettre au monde un enfant différent? Enfin, les barrières posées par le législateur aux désirs individuels sont-elles suffisantes? C'est ce débat passionnant que l'auteur (...) se propose d'éclairer, à la lumière des origines historiques de ce problème, dans un ouvrage de référence. (shrink)

The spillovers in knowledge among largely college-educated workers were among the key reasons for the impressive degree of economic growth and spread of entrepreneurship in the United States during the 1990s. Prior 'industrial policies' in the 1970s and 1980s did not advance growth because these were based on outmoded large manufacturing models. Zoltan Acs and Catherine Armington use a knowledge spillover theory of entrepreneurship to explain new firm formation rates in regional economies during the 1990s period and beyond. The (...) fastest-growing regions are those that have the highest rates of new firm formation, and which are not dominated by large businesses. The authors of this text also find support for the thesis that knowledge spillovers move across industries and are not confined within a single industry. As a result, they suggest, regional policies to encourage and sustain growth should focus on entrepreneurship among other factors. (shrink)

Interroger le concept d'identité en le mettant en rapport avec l'altérité renvoie à la célèbre formule de Rimbaud : "Je est un autre" qui, à la charnière des XXe et XXIe siècles, suscite toujours de nombreuses interrogations dans un monde où le moi est de plus en plus instable et en quête de repères, où l'identité se revendique le plus souvent au nom de la différence, que ce soit au niveau individuel ou communautaire. La culture hispanique de part et d'autre (...) de l'Atlantique est particulièrement sensible à ces phénomènes et à l'évolution du rapport à l'autre qui peut créer des métissages culturels inédits. Ainsi, les nombreuses contributions du volume rendent-elles compte de la complexité et de l'intérêt d'un tel questionnement à travers une réflexion sur la langue, la littérature et les arts visuels sans oublier les bouleversements inter-relationnels générés par l'apparition d'Internet. (shrink)