Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician''s responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient''s decisions and a surrogate''s and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional (...) capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate''s decision. They have to assess the surrogate''s decisional capacity and attitude toward the patient as well as the reasons that support the surrogate''s decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment. (shrink)

There is nothing more humbling to one’s inner moral compass than to realize that you do not initially know what is right or wrong! I found myself in just such a situation after reading the above case. Much has been written, both in the professional literature and the popular media, about the “Ashley Treatment” since Gunther and Diekema published their article in 2006. It is unclear if others in the United States or around the world have, to any significant degree, (...) adopted growth attenuation therapy and/or surgical intervention for children with severe neurological compromise, but the case quoted above suggests that hospital ethics committees may also be struggling with these decisions. An informal survey of pediatric endocrinologists, mentioned in a recent article on the topic, claims that many physicians are facing this dilemma as well. (shrink)

I would like to present the details of an actual case from my own experience over which I, along with the family, have agonized. I think this case brings into focus some of the unique issues in perinatal medicine where multiple patients, some real and some potential, can enter into a single decision. I hope that through this presentation others may gain insight into the complexities of applied ethics in perinatal medicine.

Classical logic has been attacked by adherents of rival, anti-realist logical systems: Ian Rumfitt comes to its defence. He considers the nature of logic, and how to arbitrate between different logics. He argues that classical logic may dispense with the principle of bivalence, and may thus be liberated from the dead hand of classical semantics.

Plato of Athens, who laid the foundations of the Western philosophical tradition and in range and depth ranks among its greatest practitioners, was born to a prosperous and politically active family circa 427 BC. In early life an admirer of Socrates, Plato later founded the first institution of higher learning in the West, the Academy, among whose many notable alumni was Aristotle. Traditionally ascribed to Plato are thirty-five dialogues developing Socrates' dialectic method and composed with great stylistic virtuosity, together with (...) the Apology and thirteen letters. The four works in this volume recount the circumstances of Socrates' trial and execution in 399 BC. In Euthyphro, set in the weeks before the trial, Socrates and Euthyphro attempt to define holiness. In Apology, Socrates answers his accusers at trial and unapologetically defends his philosophical career. In Crito, a discussion of justice and injustice explains Socrates' refusal of Crito's offer to finance his escape from prison. And in Phaedo, Socrates discusses the concept of an afterlife and offers arguments for the immortality of the soul. This edition, which replaces the original Loeb edition by Harold North Fowler, offers text, translation, and annotation that are fully current with modern scholarship." -- Publisher's description. (shrink)

In this paper, I address the question of whether it is ever permissible to grant a request for physician-aid-in-dying (PAD) from an individual suffering from treatment-resistant depression. I assume for the sake of argument that PAD is sometimes permissible. There are three requirements for PAD: suffering, prognosis, and competence. First, an individual must be suffering from an illness or injury which is sufficient to cause serious, ongoing hardship. Second, one must have exhausted effective treatment options, and one’s prospects for recovery (...) must be poor. Third, the individual must be judged competent to request PAD. I argue that many cases of treatment-resistant depression meet the first two requirements. Thus, the key question concerns the third. I consider four features of depression that might compromise a person’s decision-making capacity. Ultimately, I conclude that PAD requests from depressed patients can be permissibly granted in some circumstances. (shrink)

This discussion paper continues the debate over risk‐related standards of mental competence which appears in Bioethics 5. Dan Brock there defends an approach to mental competence in patients which defines it as being relative to differing standards, more or less rigorous depending on the degree of risk involved in proposed treatments. But Mark Wicclair raises a problem for this approach: if significantly different levels of risk attach, respectively, to accepting and refusing the same treatment, then it is possible, on this (...) account, for a patient to be considered competent to accept, but not refuse, the treatment, or vice versa. I argue that this puzzle does not constitute a genuine problem for a risk‐related standard. To this end I focus on the situation where, of two mutually exclusive options, one is riskier, but offering more pronounced benefit, while the other is safer, but offering less benefit. I argue for this proposition: it can take far less insight to know that the safe option is good than to know that the risky option is better. Now say one is actually informed enough to know that the safe option is good, but not enough to know whether the risky option is better; in such a case one is competent to say yes to that first option (the safe one), but not to say yes to the other. (I argue in passing that Pascal's Wager can be interpreted as having precisely this deliberative structure.) I thus conclude that cases do indeed exist where one can be competent to say yes but not no, or vice versa; and that it is thus not an anomaly in the risk‐related standard that it entails the existence of such cases. (shrink)

Arguments strong enough to justify skeptical theism will be strong enough to justify the position that every claim about God is empirically unfalsifiable. This fact is problematic because that position licenses further arguments which are clearly unreasonable, but which the skeptical theist cannot consistently accept as such. Avoiding this result while still achieving the theoretical objectives looked for in skeptical theism appears to demand an impossibly nuanced position.

Scientific revolution is a widely known concept. But does revolution really occur in science? Change through revolution means that present thinking does not retain anything from the past, because everything is thrown away due to the revolution. Does this pattern of change really correspond to the history of science? There is another pattern which is called evolution. This writing will show that process of evolution rather than revolution presents the real situation of scientific change. According to this concept, science grows (...) as an organic species grows in certain environment. An organism is different from its every former stage, yet it remains the same organism throughout its life. In the same way, we will find both change and continuity in scientific growth. (shrink)

How to draw the line between depression-as-disorder and non-pathological depressive symptoms continues to be a contested issue in psychiatry. Relatively few philosophers have waded into this debate, but the tools of philosophical analysis are quite relevant to it. In this paper, I defend a particular answer to this question, the Contextual approach.On this view, depression is a disorder if and only if it is a disproportionate response to a justifying cause or else is unconnected to any justifying cause. I present (...) four objections to this approach and then defend it from them. Along the way, I explain why it matters whether we get this question right. (shrink)

The local food movement has been touted by some as a profoundly effective way to make our food system become more healthy, just, and sustainable. Others have criticized the movement as being less a challenge to the status quo and more an easily co-opted support offering just another set of choices for affluent consumers. In this paper, we analyze three distinct sub-movements within the local food movement, the individual-focused sub-movement, the systems-focused sub-movement, and the community-focused sub-movement. These movements can be (...) combined within any particular campaign or within the goals of any particular organization or individual activist, but they are nevertheless quite different from each other, and come out of different conceptualizations of what food, people, and locality are. We argue that most of the critiques leveled against local food are actually directed against the individual-focused sub-movement, which is most compatible with the current industrial food system, and perhaps not surprisingly receives the most mainstream attention. Further, we argue that while each movement has its own strengths and weaknesses, it is the community-focused sub-movement that has the most potential to radically transform the global food system. (shrink)

Food Sovereignty is a vibrant discourse in academic and activist circles, yet despite the many shared characteristics between issues surrounding food and public health, the two are often analysed in separate frameworks and the insights from Food Sovereignty are not sufficiently brought to bear on the problems in the public health discourse. In this paper, I will introduce the concept of 'self-organised community viability' as a way to link food and health, and to argue that what I call the 'Health (...) Security' paradigm requires a 'Health Sovereignty' response modelled on Food Sovereignty. (shrink)

One serious harm facing communities in the Anthropocene is epistemic loss. This is increasingly recognized as a harm in international policy discourses around adaptation to climate change. Epistemic loss is typically conceived of as the loss of a corpus of knowledge, or less commonly, as the further loss of epistemic methodologies. In what follows, I argue that epistemic loss also can involve the loss of epistemic self-determination, and that this framework can help to usefully examine adaptation policies.

This paper concerns the attempt to formulate an empirical version of the problem of evil, and the attempt to counter this version by what is known as ‘sceptical theism’. My concern is to assess what is actually achieved in these attempts. To this end I consider the debate between them against the backdrop of William Rowe's distinction between expanded standard theism and restricted standard theism (which I label E and R respectively). My claim is that the empirical version significantly fails (...) to challenge E in the way that a workable logical version would; and that sceptical theism significantly fails to defend R in the way that a workable theodicy would. My conclusion is that sceptical theism and the empirical argument play a significantly more limited role in the debate over evil than the arguments they are supposed to replace. (Published Online August 11 2004). (shrink)

Despite US policy documents which recommend that in areas of environmental risk, interaction between scientific experts and the public move beyond the so-called “Decide, Announce, and Defend model,” many current public involvement policies still do not guarantee meaningful public participation. In response to this problem, various attempts have been made to define what counts as sufficient or meaningful participation and free informed consent from those affected. Though defining “meaningfulness” is a complex task, this paper explores one under-examined dimension that concerns (...) the relationship between consent and the idea that citizens should be sufficiently informed: epistemic capacity. This paper will look at some of the work on meaningful participation and consent, give a definition of epistemic capacity, and argue that only a community with sufficient epistemic capacity can have the understanding and competence to give informed enough consent and thus participate meaningfully. (shrink)

Drawing out the 'unwritten' book on music from which Deleuze left many clues, but no manuscript, the essays in this volume explore what he said and thought about music and how music informed his thinking.

As a result of the stress of responding to the COVID-19 pandemic, nurses, doctors, and other healthcare workers have been expressing a great deal of frustration and anger, sometimes directed at patients who have chosen not to get vaccinated. This paper examines the moral status of such anger in light of philosophical treatments of anger's purpose, benefits, and drawbacks. A theory of appropriate anger is sketched, after which healthcare workers’ anger toward perceived patient wrongdoing is assessed in light of philosophical (...) considerations for and against anger. Ultimately, it is argued that it would be better for nurses and doctors not to experience this kind of anger, and this conclusion is used to motivate a moral case for additional support for overtaxed healthcare workers. (shrink)

This paper argues that it is problematic for the future of Deleuze studies that it is difficult if not impossible to answer the question ‘what is the right thing to do?’ from a Deleuzian perspective. It then argues that one of the key reasons Deleuze studies has made limited progress in this area is its over-emphasis on desire and the corresponding tendency to extrapolate ‘ought’ from ‘is’, which as Hume showed is a category mistake. It proposes that to develop a (...) workable ethical discourse from Deleuze's work we need to rethink how we read his work and approach it afresh. (shrink)

Sustainability is commonly recognized as an important goal, but there is little agreement on what sustainability is, or what it requires. This paper looks at some common approaches to sustainability, and while acknowledging the ways in which they are useful, points out an important lacuna: that for something to be sustainable, people must be willing to work to sustain it. The paper presents a framework for thinking about and assessing sustainability which highlights people working to sustain. It also briefly discusses (...) Integrated Water Resource Management and the example of the California Water Plan to explore what such a perspective brings that is overlooked in other approaches, and how this approach might be pursued. Ultimately, this framework argues that a system can only be described as sustainable if people’s work to sustain the system is biophysically possible, socially possible, and if people would freely choose to do the sustaining work. -/- Read More: http://ascelibrary.org.proxy1.cl.msu.edu/doi/abs/10.1061/%28ASCE%29WR.1943-5452.0000526. (shrink)

Research on mental health and illness presents a variety of unique ethical challenges. This article argues that institutional review boards (IRBs) can improve their reviews of such research by including the perspectives of individuals with the condition under study either as members of the IRB or as consultants thereto. Several reasons for including the perspectives of these individuals are advanced, with the discussion organized around a hypothetical case study involving the assessment of a novel talk-therapy modality. Having made this case, (...) the article goes on to explain how to implement the idea by building on a recent proposal by Rebecca Dresser, who argues in a number of publications for the inclusion of former research participants in the IRB review process. Finally, concerns about protecting reviewer and consultant confidentiality are addressed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Buddhisms and DeconstructionsFrancis X. Clooney, SJBuddhisms and Deconstructions. Edited by Jin Y. Park, with an afterword by Robert Magliola. Lanham, MD: Rowman & Littlefield Publishers, Inc., 2006. Pp. xxii + 290.Buddhisms and Deconstructions originated in a panel on "Buddhism, Deconstruction, and the Works of Robert Magliola" at the twenty-second annual convention [End Page 182] of the International Association for Philosophy and Literature. Half its essays began as conference (...) papers, while the rest (including several published elsewhere) were solicited for the volume. Implicit too are an awareness of other volumes—for example, Harold Coward's Derrida and Indian Philosophy (1990) and (with Toby Foshay) Derrida and Negative Theology (1992)—and the conviction that such volumes, although making a contribution, have not adequately sorted out what can usefully be said with respect to that tantalizingly elusive couple, deconstruction and Buddhism.The volume exemplifies many starting points and avenues for testing the Buddhism-deconstruction relationship, but all of it is clearly mapped. "Buddhism and Deconstruction" (section 1) illumines some basic issues underlying Buddhist-deconstructionist comparisons: "Naming the Unnameable: Dependent Co-arising and Différence" (Jin Y. Park) and "Nagarjuna and Deconstruction" (Ian Mabbett). "Buddhism Deconstructs" (section 2) explores how deconstruction can be analyzed from a Buddhist perspective, and includes "Derridean and Madhyamika Buddhist Theories of Deconstruction" (Zong-qi Cai) and "Indra's Postmodern Net" (David R. Loy). "Deconstructing Buddhism" (section 3), with essays on "Deconstructive and Foundationalist Tendencies in Indian and Tibetan Buddhism" (Roger R. Jackson) and "Ji Zang's Sunyata-Speech: Derridean Denegation with Buddhist Negations" (Ellen Y. Zhang), looks in the other direction, still further deconstructing Buddhism. "Chan/Zen Buddhist Deconstruction" (section 4) furthers the critique with another pair of detailed analyses, "The Chan Deconstruction of Buddha Nature" (Youru Wang) and "Sudao: Repeating the Question in Chan Discourse" (Frank W. Stevenson). All these authors stick with cases in order to test the larger Buddhism and deconstruction hypothesis, showing, unsurprisingly, that similarities and differences make comparisons work out in different ways and for different conclusions. It matters which Buddhist tradition is brought into play, how one interprets some particular Buddhist thinker, and (because almost everyone here is thinking of "Derrida" and "deconstruction" at the same time) how someone with Buddhist learning ought to read which early or late essay by Derrida. Altogether, these eight essays illumine specific examples and contribute to the volume's larger topic, as we narrow down and define the Budhism-Deconstructionism conversation. Loy perhaps speaks for many of the authors here:From a Buddhist perspective, the post-structural realization that the meaning of a text cannot be totalized—that language/thought never attains a self-presence which escapes differences—is an important step towards the realization that there is no abiding-place for the mind anywhere within Indra's net. But the textual dissemination liberated by Derrida's deconstruction will not be satisfactory unless the dualist sense-of-self—not just its discourse—has been deconstructed.(p. 80)Or, as Ellen Zhang soberly puts it, [End Page 183]The play of sunyata/denegation implies a movement of thought that sees the surplus of thought, and understanding this surplus sometimes requires the un-thought. The moment of negativity is, therefore, also the moment of construction and creativity. Sunyata/denegation is not simply a nihilistic place of reducing meaning to non-meaning, reality to non-reality. On the contrary, it is the moment of emancipation of meanings, we find in the Chinese traditions from Zhuangzi to Buddhist philosophers and Chan masters. Meanwhile, the experiential dimensions in the process of transforming our thought and consciousness explored by Daoism and Buddhism also offer a possible critique of postmodern discourse.(p. 121)One could well imagine an entire volume made of just these essays with just such insights.But there is more. In "Deconstructing Life-Worlds" (section 5), two essays—"The Veil Rent in Twain: A Buddhist Reading of Robert Magliola's Deconstructive Chiasm" (Jane Augustine) and "Emmanuel, Robert" (Gad Horowitz)—remind us that the volume is indeed a still more complex three-way conversation, including also the writings and personality (evident by the vehicle of an Afterword) of Robert Magliola, a scholar of both Buddhism (which he teaches... (shrink)

Anthropology at the Edge: Essays on Culture, Symbol, and Consciousness. J. Ian Prattis. Lanham, MD: University Press of America, 1996. $27.50 (paper), xviii. 311 pp.

Biopower is a prominent force in mental health, with psychiatry having a strong influential grasp across the areas of definition of mental disorders, diagnosis, care, treatment, and legislation. One area that impacts upon the everyday lives of community mental health service users is treatment, largely dominated by medication. This paper will explore biopower in relation to the practices and management of mental health service users’ medication regimens. Michel Foucault’s insistence in his later work that power is the product of bodily (...) forces will be drawn upon in highlighting the importance of undertaking analysis of medication regimens. Taking examples from a project focused on service user experience, the concept of ‘somatic enactment’ is suggested as a means through which to open up biopower to the localised concerns of service users with regard to the issue of managing one’s body on a day to day basis, as affected by medication. In doing so, the author seeks to move towards a notion of biopower that does not only work on a ‘top down’ manner, and in which processes of embodied subjectification can be illuminated, without recourse to a straightforward power-resistance framework. (shrink)

This paper develops an approach to analysing the importance of anticipations of the future on present actions in the lives of mental health service users, for whom sensing stability in the future is important as part of the recovery process. The work of Henri Bergson and Alfred North Whitehead is drawn upon to argue that temporality is understood spatially, and that past and future experience only exist in relation to their shaping of present activity. This process is produced spatially rather (...) than chronologically. Drawing on empirical work with community mental health service users the paper focuses on the home space as a key site for organising space in anticipation of future life. This involves analysing accounts of home making in which we see the role of anticipatory futures in the ordering of domestic space. The paper concludes by arguing that home spaces are a key site related to ongoing psychological well being, and that analysis of such spaces is important in terms of highlighting practices through which service users attempt to ‘make the future’. . (shrink)

Recent changes to the Common Rule have helped reduce regulatory burden on researchers conducting minimal risk research. However, in this paper, I propose a way of minimizing burden further within the existing confines of the current regulations. I focus my discussion on the newly created “benign behavioral interventions” category of exempt research, arguing that this exemption from the federal regulations governing research with human subjects should be more expansively interpreted by the Secretary's Advisory Committee on Human Research Protections (SACHRP) than (...) is currently the case. Specifically, I argue against the restriction, advocated by SACHRP, that the exemption exclude “physical (bodily) tasks” unless they are “incidental to the behavioral intervention.” This restriction, I argue, is problematically vague and does no significant moral work. Acceptance of my proposed reinterpretation of “benign behavioral interventions” would, I hope, result in a significant reduction in regulatory burden for minimal risk research. (shrink)

The view that pleasure's value might be merely instrumental has not received much support from philosophers. Indeed, few things seem more clearly to be of intrinsic value than pleasure. However, Matthew Pianalto has provided a sophisticated defense of the purely instrumental view. In this paper I respond to Pianalto's argument. I defend it from some recent criticism, while nevertheless ultimately concluding that it fails.

Though the Earth, and all inferior Creatures be common to all Men, yet every Man has a Property in his own Person. This no Body has any Right to but himself. The Labour of his Body, and the Work of his hands, we may say, are properly his. Whatsoever then he removes out of the State that Nature hath provided, and left it in, he hath mixed his Labour with, and joyned it to something that is his own, and thereby (...) makes it his Property. It being by him removed from the common state Nature placed it in, hath by his labour something annexed to it, that excludes the common right of other Men. For this Labour being the unquestionable Property of the Labourer, no Man but he can have a right to what that is once joyned to, at least where there is enough, and as good left in common for others. John Locke, Second Treatise of Government, section 27. (shrink)

In this paper, I will look at what role being able to provide justification plays in several prominent conceptions of epistemology, and argue that taking the ability to provide reasons as necessary for knowledge leads to a biasing toward false negatives. However, I will also argue that asking for reasons is a common practice among the general public, and one that is endorsed by “folk epistemology.” I will then discuss the fact that this asking for reasons is done neither constantly (...) nor arbitrarily, but rather in a systematic way that produces ignorance by oppressing some knowledge and some knowers, in particular those from already marginalized groups. After looking at the implications of all this, I will ultimately argue that we must be very careful when we ask for reasons, and acknowledge it as the powerful weapon it is. (shrink)

Containing over 750 in-depth entries, this is the most wide-ranging and up-to-date dictionary of critical theory available. It covers the whole range of critical theory, including the Frankfurt school, cultural materialism, cultural studies, gender studies, film studies, literary theory, hermeneutics, historical materialism, internet studies, and sociopolitical critical theory. Entries clearly explain even the most complex of theoretical discourses, such as Marxism, psychoanalysis, structuralism, deconstruction, and postmodernism. There are biographies of important figures in the field, with feature entries for those who (...) have heavily influenced areas of the discipline, e.g. Deleuze. -/- Entries are fully cross-referenced and contain further reading where appropriate. To provide extra information this edition features an appendix of recommended web links, which are accessible via the Dictionary of Critical Theory companion website, where they are also checked regularly and kept up to date. -/- Covering all aspects of the subject from globalization and race studies, to queer theory and feminism, this multidisciplinary A-Z is essential for students of literary and cultural studies and is useful for anyone studying a humanity subject requiring a knowledge of theory. (shrink)

Rather than follow along the lines of many scholarly interpretations of Patañjali's "Yoga-Sūtra," which views Yoga as a radical separation or isolation of "spirit" or pure consciousness (puruṣa) from "matter" (prakṛti), this essay suggests that the "Yoga-Sūtra" seeks to "unite" or integrate these two principles by correcting a basic misalignment between them. Yoga thus does not advocate the abandonment or condemnation of the world, but supports a stance that enables one to live more fully in the world without being enslaved (...) by worldly identification. (shrink)

This volume in the Deleuze Connections series debates and extends Deleuze's political thought through engagement with contemporary political events and concepts. Against recent critique of Deleuze as a non-political thinker, this book explores the specific innovations and interventions that Deleuze's profoundly political concepts bring to political thought and practice. The contributors use Deleuze's dynamic theoretical apparatus to engage with contemporary political problems, themes and possibilities, including micropolitics, cynicism, war, democracy, ethnicity, friendship, revolution, power, fascism, militancy, and fabulation.