The present paper constitutes a development of the position that illness, whether bodily or mental, should be analyzed as an incapacitating failure of bodily or mental capacities, respectively, to realize their functions. The paper undertakes this development by responding to two critics. It addresses first Szasz’s continued claims that (1) physical illness is the paradigm concept of illness and (2) a philosophical analysis of mental illness does not shed any light on the social and legal role of the idea. Then, (...) in reply to Wakefield, the aim is to defend the account as an interpretation of Aristotle and to argue that this Aristotelian view of mental illness is preferable to one that rests on a supposed value free account of human function. More generally the discussion points to the fact that both Wakefield and Szasz rely on a number of metaphysical assumptions about the supposedly empirical nature of medical diagnosis, about the relation between facts and values, and about mind and body (among others), which are open to challenge. In particular the paper indicates an aristotelian approach to the fusion, in the natural world, of so-called facts and values, and the relevance of this fusion to the analysis of the concept of illness. This suggests the debate over distinct conceptions of that concept must both illumine and be illuminated by these deeper metaphysical questions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Thomas Aquinas and Cognitive TherapyChristopher Megone (bio)Keywordsemotions, rationality, cognitivism, Aristotelian psychology, powersGiuseppe butera has written a stimulating and persuasive defence of the view that Aquinas’s philosophical psychology (APP) can provide “a profound and cogent philosophical framework for cognitive therapy (CT).” In this short commentary, I respond to Butera’s claims from the perspective of one possible reading of the moral psychology of Aristotle, one of Aquinas’s major philosophical influences. Given (...) the general debt that Aquinas owes to Aristotle, as noted by Butera, this may provide a helpful slant on Butera’s interpretation of Aquinas.Indeed although Butera offers Aquinas as an alternative source for a philosophical underpinning of CT, rather than the Stoics cited by Beck, one might think that Socrates, Plato, and Aristotle could in any case be put forward as equally fruitful areas for inquiry in this context. Thus, one might think that Socrates’ moral psychology, which led him to the cognitivist claim that virtue is knowledge, provides a commitment to a CT-related perspective that both predated and itself influenced the Stoics. And one might then expect to learn things of relevance to CT from the ways in which Plato and Aristotle responded to that Socratic cognitivist outlook.From such an Aristotelian perspective, then, Butera’s approach is very welcome. He makes a strong case for considering Aquinas’s broadly Aristotelian conception of the human person as a desirable alternative to any account that depends on Cartesian substance dualism (of mind and body). On the Aristotelian account, by contrast, the human person is itself a single substance comprised of form (the soul) and matter (the body), the ensouled body constituting a substantial unity. The soul is a set of essential powers, the powers each human has which makes him/her a human being. These powers are necessarily linked in such a way as to comprise that unity and enmattered in a body, each enmattered set of powers constituting an individual member of the species.As Butera also notes, Aquinas follows Aristotle in supposing there to be five basic kinds of human essential powers—vegetative or nutritive, locomotive, sensitive or perceptual, appetitive or desiderative, and rational. Taken together, these distinguish humans from other species. And broadly speaking Aquinas thinks of the distinctively human motivational features as having three parts, non-rational appetites or desires, appetites or desires open to reason, and the purely rational intellect.Within this broad framework, Butera offers an account of APP and in particular of the emotions whose treatment is so important with CT. Given that this account is broadly congenial from an Aristotelian perspective, I offer three main comments. First, Butera makes interesting methodological claims, which I briefly explore. Second, and most [End Page 373] substantially, I examine Butera’s claims about emotions in APP in terms of some Aristotelian points about the acquisition of emotions. Third, I suggest that these latter points bring out a slight tension between the way in which Butera endorses CT at the outset of his paper and his slightly more qualified remarks at the end of it.MethodIn footnote 1, Butera talks of “the differences and complementarity of the methods employed by philosophers and scientists.” However, although he fairly notes that the ambitions of his paper far exceed its scope, so he cannot be expected to have elaborated this theme, his methodological comments do raise some questions as to how exactly we might understand the relation between the two modes of inquiry. He suggests, as noted, that APP can provide the philosophical underpinnings for CT. He goes on to indicate that APP can provide a deeply rooted and highly articulated philosophical explanation for the effectiveness of CT (347). This consists in showing that the principles and methods of CT can be philosophically grounded by APP (348), which he exemplifies by identifying seven points of contact between CT and APP.Butera contrasts this approach with that of Beck, who is content for CT to be “an empirically grounded system of psychological principles and therapeutic methods” (347). So what does the philosophical material add? According to Butera, “employing the rational, dialectical method of the philosophers, [Aquinas] is able to sound depths inaccessible... (shrink)

Background Conducting clinical trials with pre-term or sick infants is important if care for this population is to be underpinned by sound evidence. Yet, approaching the parents of these infants at such a difficult time raises challenges to obtaining valid informed consent for such research. In this study, we asked, What light does the analytical literature cast on an ethically defensible approach to obtaining informed consent in perinatal clinical trials? -/- Methods In a systematic search, we identified 30 studies. We (...) began our analysis by applying philosophical frameworks, which were then refined as concepts emerged from the analytical studies, to present a coherent picture of a broad literature. -/- Results Between them, the studies addressed four themes. The first three were the ethical basis for parental informed consent for neonatal and/or perinatal research, the validity of parental consent in this context, and the range of possible options in methods for gaining consent. The last was the issue of risk and the possibility of a double-standard or asymmetry in the current approaches to the requirement for consent for research and consent for clinical treatment. -/- Conclusions In addressing these issues, the analysed studies showed that, whilst there are a variety of possible defences for seeking parental ‘consent’ to neonatal and/or perinatal clinical trials, these are all consistent with the strongly and widely held view that it is important that parents do give (or decline) consent for such research. So far as the method of obtaining consent is concerned, none of the existing consent processes reviewed by the research is satisfactory, and there are philosophical reasons for supposing that at least some parents will fail to give valid consent in a neonatal context. Furthermore, in giving parental ‘consent’ in a perinatal context, parents are authorising infant participation, not giving ‘proxy consent’. Finally, there are reasons for giving weight to both parental ‘consent’ and the infant’s best interests in both research and clinical treatment. However, there are also reasons to treat these factors differently in the two contexts, and this may be partly due to the differing relevance of risk in each case. A significant gap is the lack of any detailed discussion of a process of emergency and/or urgent ‘assent’, in which parents assent or refuse their baby’s participation as best they can during the emergency and later give full consent to continuing participation and follow-up. (shrink)