This paper asks how we should conceptualize the relationship between responsibility and obligation. Its central concern is the relevance of considerations of obligation to the attribution of responsibility for what we do or bring about. The paper approaches this issue through an examination of Kant's complex, challenging and instructive theory of responsibility, in which strict obligation plays a pivotal role in attributions of responsibility for the outcomes of our actions. Even if we do not accept Kant's strongly juridical concept of (...) responsibility, his theory provides insight into the way in which we should see the connection between responsibility and obligation. (shrink)

Current efforts to think holistically about mental disorder may be assisted by considering the integrative strategies used by Hildegard of Bingen, a twelfth-century abbess and healer. We search for integrative strategies in the detailed records of Hilde-gard’s treatment of the noblewoman Sigewiza and in Hildegard’s more general writings. Three strategies support Hildegard’s holistic thinking: the use of narrative approaches to mental illness, acknowledging interdependence between perspectives, and applying principles of balance to the relationships between perspectives. Applying these three strategies to (...) the present-day conceptualization and treatment of mental disorder could move us toward a more thoroughly integrated understanding of the field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hildegard and HolismSuzanne M. Phillips (bio) and Monique D. Boivin (bio)Keywordsbiopsychosocial, integration, medieval, mental illnessWe appreciate the careful and enriching commentary offered by Kroll and by Radden on our paper about holistic views of mental illness in the writings of the twelfth-century abbess and healer Hildegard of Bingen. Both reviewers are well-established figures in the study of historical perspectives on mental illness, an area that we have just begun (...) to explore. We are glad for the opportunity to respond to their observations and thereby to continue the dialogue.First, we would like to clarify our purpose in preparing this paper. Nowhere do we claim that Hildegard used a biopsychosocial model of mental illness, either in addressing the needs of the particular case of Sigewiza, or more generally in her writings on illness and health. In fact, we agree with Kroll (2007, 370), when he states that Hildegard did not use a biopsychosocial model. We use the term “biopsychosocial” only three times in the paper, always by contrast with what we see in Hildegard’s writings. The present-day biopsychosocial model focuses on getting a range of perspectives on the table, encouraging the consideration of biological, psychological, and social issues when thinking about mental illness. This is a good thing, but we argue that it does not go far enough. Specifically, there has been insufficient attention to ways these perspectives might interact.How, then, might we describe Hildegard’s way of conceptualizing mental illness? In place of the label “biopsychosocial model,” Kroll suggests that Hildegard’s approach could be described as a “religious model” (p. 372). Here we disagree. By our reading, Hildegard’s description of mental illness involves religious components, certainly, but also humoral, astrological, interpersonal, community, and intrapsychic components. Radden correctly notes that we are not so much interested in the particular components as we are in their interactions. We are attracted to Hildegard’s writings because she attends to these interactions. Our students, like Kroll’s (p. 371), are curious about mind–body relationships, which represent one example of the interplay between components. Our concern is that the current biopsychosocial model often fails to satisfy our own, and our students’, interest in the nature of those interactions. Our hope is that Hildegard’s writings might help us to think more richly about the interactions.As Radden (2007, 373) points out, present-day psychiatrists and psychologists do in fact use mul-ticausal accounts of depression. And we agree that such accounts need not be reductionistic (Kroll, 371). But we also recognize that psychology and psychiatry have well-established reductionist (more specifically, materialist) habits. To borrow [End Page 377] Kroll’s phrase, the biological model threatens “to swallow all other models” (p. 371). We must guard against such reductionism, given the habits of our disciplines. As we noted, McHugh and Slavney (1998) respond to that threat by building walls between the perspectives, suggesting that we might use different perspectives when thinking about different sorts of problems. We think that there ought to be more synthetic, holistic ways of responding to that threat, and we are hopeful that Hildegard’s writings can help us to develop those.At a basic level, we see Hildegard asking different questions than people ask today. On the first page of his commentary, for example, Kroll poses the question of “which of these three modalities [bio-, psycho-, social] may be sufficient” (p. 369) in the particular medieval text. We found that the sufficiency of one modality or another does not concern Hildegard. We are not able to speak to the general point that Kroll raises, that one or another element is emphasized depending on the goal of the medieval text; we can report our experience in reading Hildegard, where we found no sense in which one or another component is privileged. Even though Hildegard operated within a thoroughly religious context, we did not find examples of her subsuming other factors under religion. Everything interacts with spiritual concerns, to be sure, but everything also interacts with the biological, and with the interpersonal, and with the astrological. Although it may seem odd to us post-Darwinian thinkers, Hildegard’s model is essentially... (shrink)

My discussion is concerned with how symbolic power constitutively structures our very identities in relation to one another and at the bodily level of lived experience. Although many accounts of the self and of subjectivity as socially situated have difficulties in their explanations of agency, Zaners work suggests a basis upon which the selfs independence from others can be understood. His phenomenology of embodied subjectivity explains how the emerging self presupposes presence with others. At the same time, however, co-presence also (...) reveals the selfs distinct perspective and capacity for circumstantial possibilizing, that is to say, actualizing another possible than the actual. My aim is to examine critically the intersections between Zaners phenomenology and other theoretical accounts of the socially situated self. I also show how Zaners work contributes to these discussions a way of understanding the possibility of agency that is rooted in embodied experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 227-231 [Access article in PDF] World Traveling as a Clinical Methodology for Psychiatric Care Suzanne M. Jaeger Keywords embodiment, dialogical consciousness, interpersonal communication, epistemic responsibility, self-knowledge, understanding IN HER ARTICLE "Moral Tourists and World Travelers," Nancy Potter suggests a way in which psychiatrists and psychologists could gain a better understanding of their mentally ill patients' experiences. Rather than assuming that hallucinations and (...) incoherent speech and behavior are merely senseless disconnections from reality, Potter argues that mental health care clinicians ought to spend time engaging patients on their own terms. Even when mental illness is a result of brain disease, much can be learned about the patient's experiences of their disease by temporarily setting aside the scientific frameworks of diagnosis and medical treatment. Potter uses Maria Lugones' concept of world traveling and recommends playfully accepting, and even entering into the patient's world (Lugones 1990). She calls world traveling a methodology and explains it in some detail. Moreover, at the close of her essay, Potter suggests that clinicians have a moral obligation to understand the mentally ill patient's world from the patient's perspective. This obligation is based on an appeal to our sense of what it is to be a responsible knower who attends to issues of trust and truth. Relying on arguments made by Lorraine Code (1987), Potter asserts that to try to understand the other's perspective is the responsible thing to do.My discussion focuses on the notion of play to which Potter appeals, as well as on what she sees as the moral obligation of clinicians to communicate with their mentally ill patients in extra-professional ways. This moral obligation arises because (a) the theoretical and professional frameworks of medical science are seen as inadequate, and (b) playfulness opens up mutually respectful, authentic interaction between persons. I generally agree with Potter's claims, and I want to situate them in the wider framework of an epistemological debate about the status of our knowledge of others. A broader context will help to elucidate the strengths of Potter's analysis as well as some points for critical discussion. I begin with the relationship of trust between clinicians and patients.Few people would disagree with the claim that patients need to be able to trust that their physicians are not harming them, but helping them to get better. If patients feel misunderstood, they will not trust their caretakers. This is probably even truer for psychiatric patients, whose conditions and loss of autonomy make establishing trust even more challenging. Psychiatric patients [End Page 227] often have their own ways of compensating for the symptoms of their mental illness. If either their will to survive or their compensatory strategies go unrecognized or misinterpreted, patients may respond by rejecting the well-intentioned efforts of caretakers to restore them to a degree of ease, measured as it must be by the standards of the professionals under whose care the patient remains. 1 Despite the fact that these standards are established through scientific testing procedures for the treatment of diseases, they may be experienced by patients as indifferent to the particular and unique features of their condition. Nestled within the issue of trust is thus a question of truth.Although current scientific knowledge of the human brain, and of human behavior, has made available a range of sophisticated therapies and psychotropic drugs, there are still many mental illnesses that leave families and clinicians wondering whether the treatment plans are providing any help. Alzheimer's disease and schizophrenia are two examples. There is a difference between, on the one hand, containing the patient's behavior by admitting the patient to a psychiatric ward and managing symptoms with psychotropic medications, and, on the other hand, understanding what is happening for the patient, from his or her perspective. Although psychiatric patients may not have a realistic sense of either their abilities or the extent and nature of their disease, there may be much about their experiences that ought to be known and understood by the professionals caring for them... (shrink)

This paper uses chronic beryllium disease as a case study to explore some of the challenges for decision-making and some of the problems for obtaining meaningful informed consent when the interpretation of screening results is complicated by their probabilistic nature and is clouded by empirical uncertainty. Although avoidance of further beryllium exposure might seem prudent for any individual whose test results suggest heightened disease risk, we will argue that such a clinical precautionary approach is likely to be a mistake. Instead, (...) advice on the interpretation of screening results must focus not on risk per se, but on avoidable risk, and must be carefully tailored to the individual. These points are of importance for individual decision-making, for informed consent, and for occupational health. (shrink)

Some scholars have argued that CEOs may have excessive influence on their foundation's trustees to give away a portion of company profits to charitable causes in order to gain access to elite circles or support the CEO's personal causes. This may result in charitable contributions that ultimately serve the personal interests of the CEOs without regard to corporate interests or social needs. We examine the extent that CEOs appear to direct charitable giving to be compatible with their own personal interests, (...) and if CEO participation on the foundation board affects the relationship between CEO personal interests and charitable giving. Using a sample of 160 corporate foundations, our results showed that CEOs' interests, as measured by membership in different non-profit organizations, was associated with foundation charitable giving. This association decreased, but was not eliminated, when CEOs were absent from the foundation board. Implications of these findings for researchers and managers are discussed in regards to both agency theory and stewardship theory. (shrink)

In many facets of Western culture, including archaeology, there remains a legacy of perceiving gender divisions as natural, innate, and biological in origin. This belief follows that men are naturally pre-disposed to public, intellectual pursuits, while women are innately designed to care for the home and take care of children. In the interpretation of material culture, accepted notions of gender roles are often applied to new findings: the dichotomy between the domestic sphere of women and the public sphere of men (...) can color interpretations of new materials. In this innovative volume, the contributors focus explicitly on analyzing the materiality of historic changes in the domestic sphere around the world. Combining a global scope with great temporal depth, chapters in the volume explore how gender ideologies, identities, relationships, power dynamics, and practices were materially changed in the past, thus showing how they could be changed in the future. (shrink)

Scientific networks are often credited with bringing about institutional change and professional advancement, but less attention has been paid to their instability and occasional failures. In the 1970s optimism among academic women was high as changing US policies on sex discrimination in the workplace, including higher education, seemed to promise equity. Encouraged by colleagues, Shyamala Rajender charged the University of Minnesota with sex discrimination when it failed to consider her for a tenure-track position. The widely cited case of this chemist (...) was not, however, settled easily and involved nearly a decade of university grievance procedures and litigation that grew to a class action lawsuit. As the case gained national attention and internal resistance stiffened, the clusters of women who had been encouraging flickered, faded and sometimes regrouped. A negotiated settlement (consent decree) ended Rajender’s case, and it opened the door for hundreds of others to present their grievances regarding gender discrimination. Networks and support groups proved important but also unstable for individuals who sought equity before and during the implementation of the decree. The Rajender case thus exposes the painful, balky and inevitably contentious process of fighting discrimination. It also demonstrates the power and limits of institutions and litigation, as well as the possibilities and disappointments of informal and formal women’s networks. (shrink)

Previous research on counterfactual thoughts about prevention suggests that people tend to focus on enabling rather than causing events and controllable rather than uncontrollable events. Two experiments explore whether counterfactual thinking about enablers is distinct from counterfactual thinking about controllable events. We presented participants with scenarios in which a cause and an enabler contributed to a negative outcome. We systematically manipulated the controllability of the cause and the enabler and asked participants to generate counterfactuals. The results indicate that when only (...) the cause or the enabler is controllable participants undid the controllable event more often. However, when the cause and enabler are matched in controllability participants undid the enabler slightly more often. The findings are discussed in the context of the mental model, functional and judgement dissociation theories as well as previous research on counterfactual thinking. The importance of controllability and.. (shrink)

Do individuals have a positive right of self-defence? And if so, what are the limits of this right? Under what conditions does this use of force extend to the defence of others? These are some of the issues explored by Dr Uniacke in this comprehensive 1994 philosophical discussion of the principles relevant to self-defence as a moral and legal justification of homicide. She establishes a unitary right of self-defence and the defence of others, one which grounds the permissibility of (...) the use of necessary and proportionate defensive force against culpable and non-culpable, active and passive, unjust threats. Particular topics discussed include: the nature of moral and legal justification and excuse; natural law justifications of homicide in self-defence; the Principle of Double Effect and the claim that homicide in self-defence is justified as unintended killing; and the question of self-preferential killing. This is a lucid and sophisticated account of the complex notion of justification, revolving around a critical discussion of trends in the law of self-defence. (shrink)

Proportionality is widely accepted as a necessary condition of justified self-defense. What gives rise to this particular condition and what role it plays in the justification of self-defense seldom receive focused critical attention. In this paper I address the standard of proportionality applicable to personal self-defense and the role that proportionality plays in justifying the use of harmful force in self-defense. I argue against an equivalent harm view of proportionality in self-defense, and in favor of a standard of proportionality in (...) self-defense that requires comparable seriousness and takes into account the wrong, as opposed simply to the harm that the victim is fending off. I distinguish the standard of proportionality in self-defense from proportionality in circumstances of necessity, and I discuss whether proportionality is an internal or an external constraint on the right of self-defense. (shrink)

What is family-centred care of a hospitalized child? A critical understanding of the concept of family-centred care is necessary if this widely preferred model is to be differentiated from other health care ideals and properly evaluated as appropriate to the care of hospitalized children. The article identifies distinguishable interpretations of family-centred care that can pull health professionals in different, sometimes conflicting directions. Some of these interpretations are not qualitatively different from robust interpretations of the ideals of parental participation, care-by-parent and (...) partnership in care that are said to be the precursors of family-centred care. A prominent interpretation that regards the child and his or her family collectively as the ‘unit of care’ arguably arises from ambiguity and is significantly problematic as a model for the care of hospitalized children. Clinical practice driven by this interpretation can include courses of action that do not aim to do what will best promote a hospitalized child’s welfare, and such cases will not be unusual. More broadly, this interpretation raises challenging questions about the responsibilities and authority of health professionals in relation to the interests of hospitalized children and their families. (shrink)

This article explores the connection between terrorism and the ethics of war, specifically the relevance of the moral wrongfulness of terrorism in elucidating one important aspect of the ethics of war. It begins with an overview of terrorism’s central features and the ethical issues associated with terrorism. It then discusses two considerations. First, terrorism can occur within civil society as well as in contexts of armed combat or war. Second, terrorist tactics are answerable to principles that govern ethically acceptable conduct (...) of war, not the other way around. The chapter also tackles the question of whether the jus in bello principle of discrimination that prohibits targeting innocent people ought to represent an absolute prohibition, as opposed to a very stringent constraint. It argues that an analysis of the structure of terrorism and its distinctive wrongfulness can be helpful in morally interpreting the jus in bello principle of discrimination. (shrink)

This article discusses the nature of euthanasia, and the way in which redevelopment of the concept of euthanasia in some influential recent philosophical writing has led to morally less discriminating killing/letting die/not saving being misdescribed as euthanasia. Peter Singer's defence of non-voluntary ‘euthanasia’of defective infants in his influential book Practical Ethics is critically evaluated. We argue that Singer's pseudo-euthanasia arguments in Practical Ethics are unsatisfactory as approaches to determining the legitimacy of killing, and that these arguments present a total utilitarian (...) improvement policy—not a case for non-voluntary euthanasia. (shrink)

The paper’s central focus is the ‘duty’ theory of punishment developed by Victor Tadros in The Ends of Harm. In evaluating the ‘duty’ theory we might ask two broad closely related questions: whether in its own terms the ‘duty’ theory provides a justification of the imposition of hard treatment or suffering on an offender; and whether the ‘duty’ theory can provide a justification of punishment. This paper is principally concerned with the second question, which stems from a significant difference between (...) Tadros’s ‘duty view’ of punishment, as opposed to more familiar theories that seek to justify punishment as essentially the imposition of a penalty for wrongdoing. In addressing this question I highlight this particular difference as problematic for Tadros’s ‘duty’ theory. The issues concern Tadros’s conception of punishment and the central features of his ‘duty view’: the claim that punishment of some offenders can be justified as the fulfilment of a duty of protection that they owe principally to those whom they have wrongfully harmed. (shrink)

This paper disputes Uwe Steinhoff’s view that a _jus ad bellum_ requirement of necessity can be merged with a condition of proportionality. It argues that the proposed merger detracts from a conceptual and moral understanding of the structure and rationale of both the necessity and the proportionality considerations applicable in a range of moral contexts, including those of war and so-called lesser evils cases, where these conditions are intended as action-guiding.

As sharing and secondary research use of biospecimens increases, IRBs and researchers face the challenge of protecting and respecting donors without comprehensive regulations addressing the human subject protection issues posed by biobanking. Variation in IRB biobanking policies about these issues has not been well documented.