El artículo tiene por objetivo analizar ciertos pasajes fundamentales de la Wissenschaftslehre y de las Paradoxien des Unendlichen de Bernard Bolzano en cuanto al análisis conjuntista se refiere. En dichos pasajes, Bolzano desarrolla conceptos fundamentales tales como multitud, colección e infinito que anticipan el carácter conjuntista y del análisis matemático moderno. Asimismo, se presentará un breve estudio de las Contribuciones a una más fundada exposición de la matemática y el apéndice, Sobre la teoría kantiana de la construcción de conceptos a (...) través de intuiciones, textos donde Bolzano muestra su rechazo por Kant.The article addresses the treatment of certain fundamental passages from Bolzano’s Wissenschaftslehre and Paradoxien des Unendlichen. In these passages, Bolzano describes some of his key concepts such “Multitude”, “Collections” and “Infinite” in the context of mathematical analysis and Set theory. Therefore, I discuss at length the unknown Contributions to a Better-Grounded Presentation of Mathematics and the appendix On the Kantian Theory of the Construction of Concepts through Intuitions, texts where Bolzano shows his rejection of Kant. (shrink)

RESUMEN La filosofía hegeliana en general, y en particular la “Ciencia de la lógica” y el tratamiento que en esta se hace sobre nociones como las de identidad y diferencia, generaron desde el momento mismo en que vio la luz, un sinnúmero de posiciones críticas tales como las de Schelling, los hegelianos de izquierda y, en general, de todos aquellos filósofos que, en virtud de las posibles implicaciones prácticas de una filosofía de la identidad buscaron “expurgar la semilla del dragón (...) del panteísmo hegeliano”, entre las cuales es necesario mencionar la legitimación de estados totalitarios y los genocidios asociados a ellos. Esta búsqueda, fue realizada sobre la afirmación de que el pensamiento hegeliano, al estar soportado sobre la identidad, implica una negación y, por tanto, aniquilación y reducción de la diferencia. En este sentido, el presente artículo busca examinar la noción hegeliana de la identidad, la correspondencia o no de las críticas que sobre el particular se han hecho sobre Hegel y, finalmente, analizar una de las salidas que, desde las interpretaciones hegelianas más recientes, se han hecho para responder a las críticas: la filosofía hegeliana in stricto sensu, una filosofía de la diferencia. ABSTRACT The Hegelian philosophy in general, and in particular the “Science of Logic” and the treatment that in this is made about notions as identity and difference, generated since its conception a countless critical positions such as those of Schelling, the left Hegelian and, in general, of all those philosophers who, accordingly with the posible practical implications of a philosophy of identity sought to “purge the dragon’s seed from Hegelian pantheism” among which it is worth to mention the legitimization of totalitarian states and genocide associated with them. This search was made on the assertion that Hegelian thought, being supported on the identity, implies a negation and, therefore, annihilation and reduction of the difference. In this sense, the present article seeks to examine the Hegelian notion of identity, the correspondence or not of the criticisms that have been made about Hegel and, finally, to analyze one of the outlets that, from the most recent Hegelian interpretations, have been made to respond to the criticisms: the Hegelian philosophy in stricto sensu, a philosophy of the difference. (shrink)

Background This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making.Methods A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and (...) qualitatively analyzed to identify actions associated with preference-concordant treatment.Results Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment.Conclusions Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care. (shrink)

The compulsive habit model proposed by Everitt and Robbins has accumulated important empirical evidence. One of their proposals is the existence of an axis, on which each a person with a particular addiction can be located depending on the evolutionary moment of his/her addictive process. The objective of the present study is to contribute in addressing the identification of such axis, as few studies related to it have been published to date. To do so, the use/abuse of Information and Communication (...) Technologies (ICT) was quantified on an initial sample of 807 subjects. Questionnaires were also delivered to measure impulsivity, compulsivity and symptoms of prefrontal dysfunction. Evidence of the existence of the proposed axis was obtained by means of Machine Learning techniques, thus allowing the classification of each subject along the continuum. The present study provides preliminary evidence of the existence of the Impulsivity-Compulsivity axis, as well as an IT tool so that each patient that starts getting treatment for an addiction can be statistically classified as “impulsive” or “compulsive.” This would allow the matching of each person with the most appropriate treatment depending on his/her moment in the addiction/abuse process, thus facilitating the individualized design of each therapeutic process and a possible improvement of the results of the treatment. (shrink)

Some of the most relevant problems today both in Science and practical problems involves Coupled Socio-ecological Systems, which are some of the best examples of Complex Systems. In this work we discuss groundwater-management as an example of these Coupled Socio-ecological System, also known as Coupled Human and Natural Systems. We argue that it is possible and even necessary to construct a contextual statistical theory of groundwater management. Contextuality implies some very different statistical features as entanglement and complementarity. We discuss some (...) interpretation about statistical entanglement and statistical complementarity in terms of groundwater flow theory and extraction equation. To this end, we propose a non-Kolmogorobian approach following the Växjö school of thought. One of the most straightforward conclusions is that in this way, a statistical-contextual treatment of groundwater management may not only give place to new flow equations, but it could have a profound impact in resource management. Then the new basic unity of analysis should be the indivisible pair. We should not talk any more about aquifer dynamics or resource management plans by themselves. Physical and social systems are coupled in a statistical-contextual fundamental way, and a socio-hydrogeological theory should be developed. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along (...) the way. The discussion closes with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along (...) the way. The discussion closes with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

Moral treatment refers to a psychological approach to treating mental disorder that arose across Europe and North America around the turn of the eighteenth century. It is mostly associated with the French physician Philippe Pinel (1745–1826) and the English Quaker philanthropist William Tuke (1732–1819). Pinel and Tuke each independently developed their own distinct models of the once popular therapy known as moral treatment. Although moral treatment is often considered to have been a successful therapy (...) in its early years, it was eventually replaced by custodial care on a mass scale and became a travesty of its earlier self. (shrink)

The York Retreat is famous in the histor y of nineteenth-centur y psychiatr y because of its association with moral treatment. Although there exists a substantial historical literature on the evolution of moral treatment at the Retreat, several interpretive problems continue to obscure its unique therapeutic legacy. The nature of moral treatment as practised at the Retreat will be clarified and discussed in a historical perspective. It will be argued that moral treatment (...) at the Retreat was pr imar ily a matter of affective conditioning guided by `benevolent theory'. (shrink)

Soldiers returning from war have always exhibited signs of psychological and emotional distress. In this book, Bernard J. Verkamp argues that the contemporary response to such symptoms—psychiatric treatment and therapy—is only a partial solution, and that when dealing with soldiers’ emotions of guilt and shame we would benefit greatly from a consideration of the religiously grounded practices of the Middle Ages. Drawing on a wide range of sources, including Reinhold Niebuhr, Michael Walzer, and the long tradition of just war (...) theory, Verkamp offers a stirring—and timely—call to reconsider our assumptions in light of historical understanding. “A wonderful book. The author’s erudition is staggering and the analysis is equally impressive.”—Stanley Hauerwas, Duke University. (shrink)

This work is the first book-length study devoted exclusively to a scholarly and systematic analysis of how soldiers returning from battle have been, or should be, treated morally. Long-scattered historical material is pulled together from a variety of sources to show why and how the early medieval custom of imposing penances on returning warriors first originated, and then, by the end of the Middle Ages, had lapsed into disuse.

This is a chapter on the history of ideas related to recovery. Moral treatment was a novel approach to caring for mentally ill patients that arose towards the end of the eighteenth century in Europe, and then spread to North America. It is most famously associated with the names of William Tuke in York, and Philippe Pinel in Paris. These two very different men—Tuke was a wealthy English Quaker businessman and philanthropist, and Pinel was a famous French medical (...) author and doctor—formulated two quite different approaches to the care of the mentally ill. Yet there are also important similarities in their approaches. The concept of “recovery” plays a fundamental role in both Tuke's and Pinel's conceptions of the care and treatment of mental illness. It is interesting, and important, to consider the underlying premises of their respective clinical approaches as we consider the nature and origins of the concept of “recovery” today. (shrink)

THE TARGET OF ERICA LILLELEHT'S interesting comparison between 19th-century moral treatment and 20th-century psychiatric rehabilitation is contemporary psychiatric rehabilitation. Using Foucault's (1979) Discipline and Punish as her critical foil, she argues that psychiatric rehabilitation is "an approach to madness fraught with paradox." The paradox lies in the fact that the techniques of psychiatric rehabilitation can be practiced in a manner that contradicts its professed humanitarian intentions; notably, liberating the mad from "resource dependency and segregated living." The lesson to (...) be drawn from this paradox is that "our practices, may be shaped and reformulated to serve goals of which we are only dimly aware." The resulting "mindfulness" is supposed to make us more careful and critical of what to count as success and progress in psychiatric treatment... (shrink)

RESUMO O tema do artigo é a proliferação de más condutas na ciência que vem ocorrendo nas últimas décadas, designada ao longo do texto pelo termo "a epidemia". As más condutas são violações de normas éticas da ciência, sendo os tipos mais importantes as várias modalidades de fraude, e de falsidades autorais. O artigo divide-se em seis seções. Na primeira, apresenta-se o tema e alguns esclarecimentos terminológicos. Na segunda, são expostas as evidências que corroboram a existência da epidemia. A terceira (...) versa sobre a reação à epidemia, caracterizando sua dinâmica, marcada pelo conflito entre duas posições: a moralizadora, que aplica o tratamento moralizador no combate à epidemia; e a negacionista, que tende a negar a existência da epidemia e que resiste às medidas moralizadoras. A quarta seção versa sobre as causas da epidemia, introduz uma distinção entre produtivismo e producionismo e propõe uma análise das formas como o produtivismo fomenta as más condutas. A quinta consiste em uma crítica ao tratamento moralizador, fundamentada em suas inadequações, principalmente sua ineficácia. Na conclusão, procura-se dar uma ideia de qual seria uma alternativa satisfatória ao tratamento moralizador. ABSTRACT The article deals with the proliferation of violations of ethical norms of science, that started to develop a few decades ago. It will be referred to as "the epidemic". The most important types of these violations are varieties of fraud, and such forms of author misconduct as plagiarism, self-plagiarism, etc. The article is divided into six sections. In the first, the topic is introduced and some terminology clarified. In the second, evidence is presented which corroborates the existence of the epidemic. The third deals with the reaction to the epidemic, by characterizing its dynamics in terms of being dominated by conflict between two positions: the moralizing one - which promotes the application of the moralizing treatment to combat the epidemic; and the negationist one - which tends to deny the existence of the epidemic, and resists the moralizing measures. The fourth explores the causes of the epidemic. A distinction is introduced between productivism and productionism, and an analysis is proposed of the ways productivism fosters violations of ethical norms of science. The fifth consists of a critique of the moralizing treatment, based on its inadequacies, mainly its inefficacy. The conclusion points to an alternative to the moralizing treatment. (shrink)

For much of the 20th century, scholars of American and European applied psychology and psychiatry have concerned themselves with the concepts of progress and power. In an effort to revisit the character of 19th-century psychiatry and to use the results as a means of evaluating 21st-century practice, this paper explores the relationship between power and progress in two popular but chronologically distinct approaches to caring for the mad: 19th-century moral treatment and late 20th-century psychiatric rehabilitation. Using the theoretical (...) framework of Foucault (1979), moral treatment (as developed by Thomas Story Kirkbride, for example, [1854] 1973) and psychiatric rehabilitation (as developed by William A. Anthony and colleagues, for example, Anthony, Cohen, and Farkas 1990) are compared for the degree to which each is structured by disciplinary interests and technologies. Based on this textual analysis, important differences emerge. Not only do these differences cast moral treatment in a new, and perhaps more positive light, but they also shed light on how disciplinary structures might affect a psychiatric approach's ability to carry out expressly humanitarian goals. To the extent that both propositions are accurate, the traditional view equating psychology and psychiatry's progress with a diminished reliance on power is brought into question. (shrink)

Since Henry Shue’s classic 1978 paper on torture, the “ticking-bomb case” has seemed to demonstrate that torture is morally justified in some moral emergencies (even if not as an institution). After presenting an analysis of torture as such and an explanation of why it, and anything much like it, is morally wrong, I argue that the ticking-bomb case demonstrates nothing at all—for at least three reasons. First, it is an appeal to intuition. The intuition is not as widely shared (...) as necessary to constitute the required demonstration. Second, the intuition is not as reliable as necessary for such a demonstration. We lack the experience that would vouch for it. And, third, Shue’s own discussion suggests that what we are intuiting (if we share Shue’s intuition) is an excuse rather than a justification. (shrink)

Philosophical Perspectives, Volume 35, Issue 1, Page 23-49, December 2021.

Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this thepsychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the (...) psychological approach claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive. (shrink)

Mandatory vaccination against COVID-19 is a highly controversial issue, and many members of the public oppose it on the grounds that they should be free to determine what happens to their own body. Opinion has generally favored parental authority with respect to vaccination of children, but less attention has been paid to the ethical complexities of how to respond when mature minors refuse vaccination that is requested by their parents. We present a case in which a mature minor, who was (...) psychiatrically hospitalized, refused vaccination that had been requested by her parents, which led to significant moral distress for her caregivers. (shrink)

This essay is written in the belief that questions relating to the treatment of impaired and imperiled newborns cannot be adequately resolved in the absence of a general moral theory of parent-child relations. The rationale for treatment decisions in these cases should be consistent with principles that ought to govern the normal work of parenting. The first section of this paper briefly examines the social contract theory elaborated by John Rawls in his renowned book A Theory of (...) Justice and extracts from it normative principles that can guide us in our attempt to lay a rational foundation for parenthood. The second section clarifies the implications of a Rawlsian theory for the problem at hand by examining several standards that have been proposed for the treatment of impaired newborns: the strict right-to-life standard, the medical decision standard, and the quality-of-life standard. A Rawlsian standard, by contrast, is autonomy-based. That is, it would have us base our treatment decisions on consideration of the child's capacity for developing critical rationality in making decisions on his or her own. This standard, it is suggested, avoids morally objectionable features of the others. (shrink)

In the heat of the Civil War, Abraham Lincoln made a speech in which he referred sympathetically to the Southern rebels. A member of the audience lambasted him for wanting to treat his enemies kindly when he ought to be thinking of destroying them. Lincoln's answer: "Why, madam, do I not destroy my enemies when I make them my friends?" Harshness and cruelty were to be banished from the moral imagination of the nation he was trying to save. The (...) late Jack Maple, a famously flamboyant but phenomenally effective former deputy commissioner of the NYPD, wrote that "the more information a detective has, the more creative, authoritative and effective he or she can be." Under attack in 2001, and then at war in Iraq in 2003, American law enforcement, intelligence and military really didn't have much information at first. They rounded up the usual suspects, but didn't know what usual meant. So they smacked people around, and that was always a bad idea, as Maple said: "Forget that smacking somebody around is illegal and just plain wrong, it's also the quickest way to ruin the chances of getting a statement of any kind." Professional interrogators talk about building empathy and dependence. Maple would get down on his knees and pray with a suspect if he thought that would work. But the best technique? "If you can get them to laugh, you'll get a statement. That's always true." Internal CIA documents reveal that empathy is also likely what got Abu Zubaydah to reveal how Al Qaeda planned 9/11 and its other operations. His torture brought nothing of real value, only the moral demeaning of his tormentors.... (shrink)

Substance use and misuse occurs at a very high rate among people with mental health problems and the relationship between the two conditions is complex. In this paper we argue that treatment of substance use in dual diagnosis clients must begin from an understanding of the losses suffered by those with mental illness. We outline the fundamental condition of effective agency, unified agency, which is disrupted in mental illness and show how this is needed to secure access to central (...) social and moral goods such as continuing employment and satisfying relationships. We argue that drug use will be disvaluable primarily in so far as it too prevents access to this set of agential goods and focuses the agent on synchronic well-being to the exclusion of diachronic well-being. The goals and methods of treatment for dual diagnosis patients should thus reflect the primary impairment to unified agency. (shrink)

Is it morally acceptable to instigate criminal offenders to participate in rehabilitative treatment by offering treatment in return for early release from prison? Some theorists have supported such treatment schemes by pointing to the beneficial consequences that follow from the treatment. Others have suggested that the schemes are unacceptably coercive, which implies that consent becomes an illusion. This paper argues that the discussion—with clear parallels to debates of other healthcare treatment offers in medical ethics—has adopted (...) a too narrow focus. By failing to consider the question as a penal theoretical problem, the arguments—both by proponents and critics of coercive treatment—become premature. (shrink)

ABSTRACT In this article, the author offers a reconstruction and criticism of Brian Leiter's interpretation of Nietzsche's criticism of conventional morality in Nietzsche on Morality. Leiter's interpretation is said to falter because it attributes to Nietzsche an implausible combination of positions. First, Nietzsche is said to be a value antirealist. But he is also said to defer to the value of the flourishing of his audience, who are limited to a certain subset of “higher” humans. The author argues that, in (...) spite of Leiter's attempt to defend this view, he ultimately fails to explain how Nietzsche can be confident in the normative force of the higher humans' flourishing and, so, his criticism of morality. Since the author takes the problems of Leiter's reading to bear on a prevalent general reading of Nietzsche, the author concludes with a brief sketch of a plausible alternative. (shrink)

The goal of my comments regarding the case study of Eve Hyde — presented in the introduction of this symposium — is not first and foremost to resolve the conflict between individual autonomy and medical paternalism regarding non-consensual psychiatric treatment. Instead, the goal is to step back far enough from what is generally accepted as the morally appropriate basis for non-consensual psychiatric treatment, including involuntary hospitalization and medication, and to ask very basic questions about when patients may permissibly (...) be treated without their consent. My goal, in short, is Socratic — to explore aspects of what we take for granted in order better to determine whether we ought to take them for granted. Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients, such as Eve Hyde, in order to preserve the patient’s best interests and restore the patient’s autonomy. Such arguments typically specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighed against other factors. (shrink)

In this paper I will argue for a plausible account for moral luck in the Ruist tradition. In part one I will offer a preliminary framework for moral luck to establish an intersection between Ruist virtue ethics and its counterparts outside of Ruism. I will situate the term moral luck in a Ruist context. Although the term moral luck does not appear in The Mengzi the concept was known to Master Meng and is useful for comparison (...) with its foreign counterparts. In part two, guided by Thomas Nagle’s four categories for moral luck, I show where Ruist moral luck can be found in The Mengzi. I conclude by highlighting the contributions that Ruism offers to the broader moral luck discussion. (shrink)

The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the (...) commitment to toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

A series of cases have crystallized disputes about when medical treatments are useful or futile, and consequently about the doctor-patient relationship, resource allocation, communication, empathy, relief of suffering, autonomy, undertreatment, overtreatment, paternalism and palliative care. It is helpful to understand that utility and futility are complimentary concepts and that judgments about whether treatments are useful or futile in the contested cases have common features. They are: (1) grounded in medical science, (2) value laden, (3) at or near the threshold of (...) utility, and (4) burdensome. No schema for linedrawing escapes borderline cases and we should focus upon justification of the empirical, ethical and evaluative components underlying these judgments, rather than make an arbitrary decision about whether doctors, patients or societal consensus should be the final arbiter. Keywords: futility, ethics, physician authority, consent CiteULike Connotea Del.icio.us What's this? (shrink)

Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients (1) to preserve the patient's best interests and (2) to restore the patient's autonomy. Such arguments specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighted against other factors. Varying by jurisdiction, legal statutes usually require, in addition, at least (3) that there exists the threat of harm to self or others. In this paper, I argue against embracing the first (...) two elements of this prevailing view. I also argue for a very restricted reading of the third element, based on the moral limits of permissible state action. (shrink)