Limited distribution phenomena related to negation and negative polarity are usually thought of in terms of affectivity where affective is understood as negative or downward entailing. In this paper I propose an analysis of affective contexts as nonveridical and treat negative polarity as a manifestation of the more general phenomenon of sensitivity to (non)veridicality (which is, I argue, what affective dependencies boil down to). Empirical support for this analysis will be provided by a detailed examination of affective dependencies in Greek, (...) but the distribution of any will also be shown to follow from (non)veridicality. (shrink)

This unique volume explores what ethics has to offer the practicing physician, nurse, and allied health care worker. The authors introduce the basic vocabulary of ethics and present and discuss the most commonly used ethical theories, using case studies to illustrate how ethics work within the context of health care. Newcomers to the field will learn what ethics is all about and how it relates to the pragmatic concerns of the health care professional. Those who already have a working knowledge (...) of the field will find a new approach to ethical theory--personalism--which the authors believe can make the practical use of ethics more effective and reliable. (shrink)

Addiction is compulsive need for and use of a habit-forming substance. It is accepted as a mental illness in the diagnostic nomenclature and results in substantial health, social and economic problems. In the diagnostic nomenclature, addiction was originally included in the personality disorders along with other behaviours considered deviant. But it is now considered a clinical syndrome. Addiction is multifactorially determined, with substantial genetic influence. The development of addictions is also influenced by environmental factors, and an interplay between the two. (...) In the clinical context, addiction puts problem substance use on the agenda, and helps focus on the difficulties associated with drug use. But the concept of addiction is also used to distance the user from addicts, and in this way, may be counter-therapeutic. The addiction concept has also had a substantial influence on policy. The almost universal prohibition against drugs such as opiates, cocaine, cannabis and amphetamine has much support. But unfortunately, it has not been able to hinder the development of substance use problems. Optimism is fostered by the development of respectful ways of thinking about people with addictions, in particular, from advocates of motivational interviewing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Please Help Me”Rebecca L. VolpeTwo–year–old Jay was born prematurely at 26 weeks gestation, addicted to opiates. After several months in the Neonatal ICU, he was sent home, ventilator–dependent but with a high likelihood of survival and a low chance of severe, lasting disability. When Jay was 1½, he had a cardiopulmonary arrest at home. The parents of children who are on ventilators at home receive extensive education and training (...) about how to respond to something like an arrest. They are taught that a quick response is often critical to their child’s long–term prognosis. And yet, Jay’s parents took such a long time to respond to his code that Jay now has severe hypoxic ischemic encephalopathy: his brain was deprived of oxygen for so long that he has no higher cortical function, and will never think, speak, walk, or play.Currently, Jay is ventilator–dependent and has a very poor prognosis. Jay goes back and forth between a nursing home and the hospital. During one of his many hospitalizations, the ICU team decided to call an ethics consultation, because they felt that continued aggressive intervention was no longer in Jay’s best interests. I was the person on the other end of the line when the medical team called. After having a brief conversation with the attending physician, I left my office and walked to the Pediatric ICU to visit Jay. I arrived at the bedside—really just a large crib—and saw a baby with dark hair lying flat on his back. His tongue was swollen and protruding from his mouth, his eyes were puffy and closed, and his limbs were limp. On his belly was a piece of paper with the words, “BECKY PLEASE HELP ME” typed in huge, bold font. I looked up, into the eyes of the attending physician and said, “Did you type that?” The physician nodded yes. Much could be said about this physician’s behavior. But the bottom line—from a clinical perspective, at least—is that this ICU team was desperate, and that they had significant expectations that I would be able to help them.I began the work of the consultation. I reviewed the medical record, spoke with members of the treating team, and set up a time to talk to the family. During the family meeting, I learned that Jay’s parents wanted to continue to treat aggressively, and that they believed it was not their place to decide when it was their son’s time to die. That was [End Page 122] God’s decision. They could not fathom removing interventions that were maintaining their son’s life. They acknowledged that his quality of life was not high, but, still, it was life.The preferences of the treating team were in stark contrast to the parents’ preferences. The neurologists believed Jay did not have the capacity to experience physical pain, but the ICU team believed that continuing to treat Jay was cruel. Although the ICU team acknowledged that Jay was probably not suffering, they noted that we could not know for sure, and that sometimes Jay grimaced and withdrew—signs that are often interpreted as suffering. The ICU team also argued that given all the sick children in the world, and the scarcity of healthcare resources, it didn’t make sense to invest hundreds of thousands of dollars into prolonging Jay’s life. Additionally, they discovered that Jay had osteopenia (weak, brittle bones)—which was causing multiple bone fractures. The ICU team anguished over the thought of Jay’s small, soft bones continuing to break despite their best efforts.The bioethicist in me knows that, as long as the patient isn’t suffering and the parents aren’t demanding futile interventions (they weren’t), our role as providers was not to judge the parents’ value system. I told the ICU team over and over that different people place different value on Jay’s type of life, and that it wasn’t for us to tell them that their value structure was wrong. I talked with other members of the clinical ethics consultation service. Then I brought the case to the entire institutional... (shrink)

Two days following her arrest, a forty-four-year-old woman died in jail from aspiration pneumonia secondary to Untreated opiate withdrawal. The New York State Commission of Corrections concluded in its final report that had adequate medical evaluation and treatment been afforded, her death would have been prevented. A forty-six-year-old male with a history of alcohol dependence was arrested for trespassing and held in the county jail. Three days later he became agitated and aggressive. Following physician orders, deputies placed him (...) in restraints. He subsequently vomited and seized. Fifteen minutes later, he experienced respiratory arrest and died.These cases highlight a serious, but neglected problem in jails across the country: inadequate assessment and treatment of drug and alcohol withdrawal among arrestees. In this article, we show that untreated drug or alcohol withdrawal is associated with adverse outcomes including needless pain and suffering, medical morbidity, and in some instances, death. (shrink)

Two days following her arrest, a forty-four-year-old woman died in jail from aspiration pneumonia secondary to Untreated opiate withdrawal. The New York State Commission of Corrections concluded in its final report that had adequate medical evaluation and treatment been afforded, her death would have been prevented. A forty-six-year-old male with a history of alcohol dependence was arrested for trespassing and held in the county jail. Three days later he became agitated and aggressive. Following physician orders, deputies placed him (...) in restraints. He subsequently vomited and seized. Fifteen minutes later, he experienced respiratory arrest and died.These cases highlight a serious, but neglected problem in jails across the country: inadequate assessment and treatment of drug and alcohol withdrawal among arrestees. In this article, we show that untreated drug or alcohol withdrawal is associated with adverse outcomes including needless pain and suffering, medical morbidity, and in some instances, death. (shrink)

Tieu, Matthew Review of: Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy, by Theodore Dalrymple, Encounter Books, 2006.

Medical and nursing personnel have an obligation to provide the medication necessary for every patient’s pain relief. This includes patients whose life-supporting mechanical ventilation is being removed, who may not exhibit traditional signs of pain or dyspnea. The purpose of this paper is not to argue a position on withdrawing life support. Rather, it argues that nurses and physicians have an obligation to provide pain-relieving medication, such as opiates, when life support is removed, to ensure that those entrusted to their (...) care do not experience pain or significant distress. This is based on the principle of double effect, by which two actions, one intended and one unintended, may be permissible if there is a proportionate reason. The goal in these situations is never to hasten death intentionally but to make patients’ pain and suffering tolerable as a matter of compassionate and loving care. (shrink)

The problem of divine hiddenness has become one of the most prominent arguments for atheism in the current philosophy of religion literature. Schellenberg (Divine hiddenness and human reason 1993), one of the problem’s prominent advocates, holds that the only way to prevent completely the occurrence of nonresistant nonbelief would be for God to have granted all of us a constant awareness of Him (or at least a constant availability of such awareness) from the moment we achieved the age of reason. (...) Now, if that were the case, we might be faced with a difficult obstacle to the development of a proper, meaningful relationship with God: namely, since the experience of God would be so unutterably wonderful (at least for some), we could be at risk of coming to commune with God not from love of Him but for the amazing experience that that communion involves. In other words, given that mystical union with infinite perfection is, qua experience, inconceivably better than that of any drug, we might come to treat God as something analogous to a powerful narcotic, seeking the experience for the pleasure of the experience more than from any devotion. Since God wants to foster genuinely meaningful relationship with Him, He rightly delays granting us such awareness of Himself, even though that leaves open the risk that nonresistant nonbelief could arise. (shrink)

Metaphysical orthodoxy maintains that the relation of ontological dependence is irreflexive, asymmetric, and transitive. The goal of this paper is to challenge that orthodoxy by arguing that ontological dependence should be understood as non- symmetric, rather than asymmetric. If we give up the asymmetry of dependence, interesting things follow for what we can say about metaphysical explanation— particularly for the prospects of explanatory holism.

In addition to endogenously produced opiates, which are part of normal affiliative neurocircuitry and attachment formation, exogenous opiates – such as drugs of addiction and abuse – may affect affiliation. We consider possible modulatory effects of such exogenous opiates on the development of early parent–infant attachment from both parents' and infants' perspectives.

In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the easy availability of prescription opioids. More recently, this problem has been seen outside of North America affecting individuals at similar rates in Australia and Europe. We argue that (...) physicians are also confronted with an ethical crisis where a capitalist-consumerist society is contributing to this opioid crisis in which societal, legal and business interests push physicians to overprescribe opioids. Individual physicians often find themselves unequipped and unsupported in attempts to curb the prescribing of opioid medications and balance competing goals of alleviating pain against the judicious use of pain medications. Physicians, individually and as a community, must reclaim the ethical mantle of our profession, through a more nuanced understanding of autonomy and beneficence. Furthermore, physicians and the medical community at large have a fiduciary duty to patients and society to play a more active role in curbing the widespread distribution of opioids in our communities. (shrink)

The purpose of the book is to clarify the notion of existential dependence and cognate notions, such as supervenience and the notion of an internal relation. I defend the view that such notions are best understood in terms of the concept of metaphysical grounding, i.e. the concept of one fact obtaining in virtue of other facts, where ‘in virtue of’ has a distinctively metaphysical meaning.

“Stem Cells Dependently Arising and Empty” May 2021, Buddhism and Culture (a Korean-language Buddhist magazine sponsored by the Foundation for the Promotion of Korean Buddhism), Korea.

Ontological dependence is a relation—or, more accurately, a family of relations—between entities or beings. For there are various ways in which one being may be said to depend upon one or more other beings, in a sense of “depend” that is distinctly metaphysical in character and that may be contrasted, thus, with various causal senses of this word. More specifically, a being may be said to depend, in such a sense, upon one or more other beings for its existence (...) or for its identity. Some varieties of ontological dependence may be analyzed in modal terms—that is, in terms of distinctly metaphysical notions of possibility and necessity—while others seem to demand an analysis in terms of the notion of essence. The latter varieties of ontological dependence may accordingly be called species of essential dependence. Notions of ontological dependence are frequently called upon by metaphysicians in their proposed analyses of other metaphysically important notions, such as the notion of substance. (shrink)

According to the response-dependence view of moral responsibility, a person is morally responsible just in case, and in virtue of the fact that, she is an appropriate target for reactive attitudes. This paper raises a new puzzle regarding response-dependence: there is a mismatch between the granularity of the reactive attitudes and of responsibility facts. Whereas the reactive attitudes are comparatively coarse-grained, responsibility facts can be quite fine-grained. This poses a challenge for response-dependence, which seeks to ground facts (...) about responsibility in facts about the reactive attitudes. Specifically, reactive attitudes are not enough for grounding facts about degrees of moral responsibility. The responsedependence view thus requires significant revisions or supplementations. (shrink)

This essay provides an opinionated survey of some recent developments in the literature on ontological dependence. Some of the most popular definitions of ontological dependence are formulated in modal terms; others in non-modal terms (e.g., in terms of the explanatory connective, ‘because’, or in terms of a non-modal conception of essence); some (viz., the existential construals of ontological dependence) emphasise requirements that must be met in order for an entity to exist; others (viz., the essentialist construals) focus (...) on conditions that must be satisfied in order for an entity to be the very entity it is at each time at which it exists; some are rigid, in the sense that they concern a relation between particular entities; others are generic, in the sense that they involve only a relation between an entity and some entities or other, which bear certain characteristics. I identify three potential measures of success with respect to which these different definitions of ontological dependence can be evaluated and consider the question of how well they in fact meet these desiderata. I end by noting that certain challenges face even the most promising essentialist construals of ontological dependence. (shrink)

Are grounding claims fully general in character? If an object a is F in virtue of being G, does it follow that anything that’s G is F for that reason? According to the thesis of Weak Formality, the answer here is ‘yes’. In this paper, however, I argue that there is philosophical utility in rejecting this thesis. More exactly, I argue that two currently unresolved problems in contemporary metaphysics can be dealt with if we hold that there can be cases (...) of ‘kind-dependent grounding’, the key thought being that once we allow for such cases, we must also accept that Weak Formality is false. (shrink)

ABSTRACT People who are paid to provide basic care for others are frequently undervalued, exploited and expected to reach often unrealistic standards of care. I argue that appropriate social recognition, support and fair pay for people who provide care for those who are disabled, frail and aged, or suffering ill health that impedes their capacity to negotiate daily activities without support, depends on a reconsideration of the paradigm of the citizen or and moral agent. I argue that by drawing on (...) the ideas of human vulnerability and dependency as central to our personhood, a more realistic conception of selves, citizens and persons can be developed that better recognises the inevitability of human dependency and the social value of care work. I also indicate the significance of this vulnerability‐focussed view for ethical evaluation of the emotional aspects of care relationships. (shrink)

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop an ethic (...) of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (shrink)

The dominant view about the nature of aesthetic value holds it to be response-dependent. We believe that the dominance of this view owes largely to some combination of the following prevalent beliefs: 1 The belief that challenges brought against response-dependent accounts in other areas of philosophy are less challenging when applied to response-dependent accounts of aesthetic value. 2 The belief that aesthetic value is instrumental and that response-dependence about aesthetic value alone accommodates this purported fact. 3 The belief that (...) response-dependence about aesthetic value alone accommodates the widely acknowledged anthropocentricity of aesthetic value. 4 The belief that response-dependence about aesthetic value alone accommodates aesthetic normativity. We argue that each of these beliefs is false, and that the dominance of response-dependent accounts of aesthetic value is therefore largely without foundation. (shrink)

Kantian moral concepts concerning respect for human dignity have played a central role in articulating ethical guidelines for medical practice and research, and for articulating some central positions within bioethical debates more generally. The most common of these Kantian moral concepts is the obligation to respect the dignity of patients and of human research subjects as autonomous, self-determining individuals. This article describes Kant’s conceptual distinction between dignity and autonomy as values, and draws on the work of several contemporary Kantian philosophers (...) who employ the distinction to make sense of some common moral intuitions, feelings, and norms. Drawing on this work, the article argues that the conceptual distinction between dignity and autonomy as values is indispensable in the context of considering our obligations to those who are dependent and vulnerable. (shrink)

In this paper, I defend two claims about domination. The first is that dispositional theories, which hold that domination obtains just in case one has the ability to interfere with another, are not compelling in accounting for the domination of persons with severe cognitive disabilities. This is because these accounts fall victim to, what I call, the dependency challenge. The second claim is that exercise theories of domination, which hold that domination obtains only when one has actually interfered with another, (...) more plausibly account for the domination of persons with severe cognitive disabilities. (shrink)

“Non-Self from the perspective of the Gene” November 2021, Buddhism and Culture (a Korean-language Buddhist magazine sponsored by the Foundation for the Promotion of Korean Buddhism), Korea.

This paper defends Flatland—the view that there exist neither determination nor dependence relations, and that everything is therefore fundamental—from the objection from explanatory inefficacy. According to that objection, Flatland is unattractive because it is unable to explain either the appearance as of there being determination relations, or the appearance as of there being dependence relations. We show how the Flatlander can meet the first challenge by offering four strategies—reducing, eliminating, untangling and omnizing—which, jointly, explain the appearance as of (...) there being determination relations where no such relations obtain. Since, plausibly, dependence relations just are asymmetric determination relations, we argue that once we come mistakenly to believe that there exist determination relations, the existence of other asymmetries (conceptual and temporal) explains why it appears that there are dependence relations. (shrink)

This essay attempts to provide and defend what may be the first actual argument in support of P. F. Strawson's merely stated vision of a response-dependent theory of moral responsibility. It does so by way of an extended analogy with the funny. In part 1, it makes the easier and less controversial case for response-dependence about the funny. In part 2, it shows the tight analogy between anger and amusement in developing the harder and more controversial case for response- (...) class='Hi'>dependence about a kind of blameworthiness. It then defends the view from three serious skeptical challenges. (shrink)

Quasi-realists aim to account for many of the trappings of metanormative realism within an expressivist framework. Chief among these is the realist way of responding to the Euthyphro dilemma: quasi-realists want to join realists in being able to say, "It’s not the case that kicking dogs is wrong because we disapprove of it. Rather, we disapprove of kicking dogs because it’s wrong." However, the standard quasi-realist way of explaining what we are up to when we assert the first of these (...) two sentences rests on a mistaken identification of metaphysical dependence (or grounding) with counterfactual covariation. This chapter proposes a better way for expressivists to understand such sentences, on which they serve to express complex states of mind in which an attitude bears a relation of psychological dependence (or basing) to another state of mind. It is argued that this proposal is a natural, versatile, and fruitful approach for expressivists to take that helps them secure the first half of the Euthyphro contrast—but at the cost of making it difficult to see how expressivists can make sense of that contrast’s second half. (shrink)

When unknowingly experiencing a perceptual hallucination, a subject can attempt to think specifically about what is, as far as he or she can tell, the perceived object. Is the subject then deceived about his or her cognitive situation? I answer negatively. Moreover, I argue that this answer is compatible with holding that thought specifically about a certain object – singular thought – is object-dependent. By contrast, both critics and advocates of the view that singular thought is object-dependent have assumed this (...) view to be committed to postulation of illusions of object-dependent thought in cases like that mentioned. The core ingredient in my illusion-free version of the view is a special form of disjunctivism. Alleged cases of illusion are not considered parasitic on ‘the good case’ where the object thought about is perceived. (shrink)

Response-dependence theories have historically been very popular in aesthetics, and aesthetic response-dependence has motivated response-dependence in ethics. This chapter closely examines the prospects for such theories. It breaks this category down into dispositional and fittingness strands of response-dependence, corresponding to descriptive and normative ideal observer theories. It argues that the latter have advantages over the former but are not themselves without issue. Special attention is paid to the relationship between hedonism and response-dependence. The chapter also (...) introduces two aesthetic properties that lead to wrong kinds of reasons problems for aesthetic response-dependence: insightfulness and the capacity to change one’s perspective. These properties do not have obvious parallels in the ethical domain, and so present an obstacle for response-dependence even in aesthetics. The chapter ends by examining replies on behalf of the response-dependence theorist, ultimately suggesting that a restricted form of response-dependence is the most promising way forward for fans of such theories. (shrink)