Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception of (...) autonomy that is operative in the context of medicine. (shrink)

The relative neglect of Greek commentary by modern Aristotelian scholarship could be justified, if only the neglectors had sufficient knowledge of the material they disdain. The curt dismissal of ancient views on the active intellect by W. D. Ross is perhaps a paradigm case of misplaced condemnation, for he evidently failed to take account of what their authors were about. It would be open to those who wish to discount these commentators to argue that they were, to a greater or (...) lesser extent, influenced by their Neoplatonism, and that this impairs their judgment on Aristotelian problems. But that would not be sufficient ground for total neglect: it merely indicates the need for careful utilization. One might go so far as to ask whether it is not perfectly possible for a commentator who happened to be a Neoplatonist to offer straightforward and reasonably unbiased commentary on Aristotle. Even if the answer to that question were negative, is it not likely that such Neoplatonic views as he read into Aristotle would at least be slanted towards Aristotelianism? (shrink)

The phenomenon of ambivalence is an important one for any philosophy of action. Despite this importance, there is a lack of a fully satisfactory analysis of the phenomenon. Although many contemporary philosophers recognize the phenomenon, and address topics related to it, only Harry Frankfurt has given the phenomenon full treatment in the context of action theory - providing an analysis of how it relates to the structure and freedom of the will. In this paper, I develop objections to Frankfurt's account, (...) all revolving around the charge that his account contains a serious ambiguity between willing and identifying. With such objections in place, I then develop an analysis that avoids the difficulties and ambiguities that Frankfurt's analysis is prey to. I briefly distinguish ambivalence from other types of internal conflict. This paper aims to offer conceptual clarification on the phenomenon of ambivalence, which will then allow for discussions about the normative merits and demerits of ambivalence, the effects of ambivalence on autonomous action, and methods of resolution of ambivalence. (shrink)

An analysis of the identity issues involved in facial allograft transplantation is provided in this paper. The identity issues involved in organ transplantation in general, under both theoretical accounts of personal identity and subjective accounts provided by organ recipients, are examined. It is argued that the identity issues involved in facial allograft transplantation are similar to those involved in organ transplantation in general, but much stronger because the face is so closely linked with personal identity. Recipients of facial allograft transplantation (...) have the potential to feel that their identity is a mix between their own and the donor’s, and the donor’s family is potentially likely to feel that their loved one ‘‘lives on’’. It is also argued that facial allograft transplantation allows the recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent. Informing both recipients and donors about the role that identity plays in facial allograft transplantation could enhance the consent process for facial allograft transplantation and donation. (shrink)

This paper deals with the ethics of using knowledge about a person’s particular psychological make-up, or about the psychology of judgment and decision-making in general, to shape that person’s decisions and behaviors. Various moral concerns emerge about this practice, but one of the more elusive and underdeveloped concerns is the charge of manipulation. It is this concern that is the focus of this paper. I argue that it is not the case that any of the practices traditionally labeled as “manipulation” (...) are ipso facto morally wrong, nor is it even the case that any of these practices always has a single wrong making feature (e.g., infringement on autonomy) that is always present but may be outweighed by other morally relevant factors and be all things considered ethically permissible or morally right. I argue that the moral status depends on the extent to which the instance of influence (1) threatens or promotes autonomy, (2) has good aims and virtuous overtones or bad ones, and (3) fulfills or fails to fulfill duties, obligations, and expectations that arise out of the relationship between the influencer and influenced. I will explain in detail the moral relevance of these factors, showing why each is necessary, criteria for evaluation each, and demonstrating how they work in specific cases. (shrink)

Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with (...) refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand. (shrink)

Chapter 1 Welcome to A Kids Mensch Handbook What is a mensch, anyway? How can I be someone people respect? What's A Kid's Mensch Handbook all about? ...

An original examination of the relevance of behavioral economics for the practice of medical ethics.

This study investigated whether musical training and bilingualism are associated with enhancements in specific components of executive function, namely, task switching and dual-task performance. Participants belonging to one of four groups were matched on age and socioeconomic status and administered task switching and dual-task paradigms. Results demonstrated reduced global and local switch costs in musicians compared with non-musicians, suggesting that musical training can contribute to increased efficiency in the ability to shift flexibly between mental sets. On dual-task performance, musicians also (...) outperformed non-musicians. There was neither a cognitive advantage for bilinguals relative to monolinguals, nor an interaction between music and language to suggest additive effects of both types of experience. These findings demonstrate that long-term musical training is associated with improvements in task switching and dual-task performance. (shrink)

Whether as New Year's resolutions, birthday wishes, or daily promises, most everyone vows at some point to make a major life change. But change is easier said than done, especially when it comes to better managing our wellness amidst the chaos of everyday living. Fortunately, wellness coach and award-winning writer Brett Blumenthal has devised a way to inspire and motivate her readers to live healthier and make positive changes in their lives. Although Blumenthal's method is not a quick (...) fix, it is a surprisingly simple one: make one small change per week, for fifty-two weeks, and at the end of a year, you'll be happier and healthier. After all, it is the small changes that are the most realistic, instead of trying to overhaul your lifestyle all at once. 52 Small Changes addresses all areas of wellbeing, including nutrition, exercise, stress management, mental wellness, and even the health of one's home environment. By guiding readers through these changes at an easy, manageable pace, Blumenthal provides an engaging roadmap to lasting results and "happier, healthier you."'. (shrink)

In ‘Reification and Assent in Research Involving Those Who Lack Capacity’, Smajdor argues that adults with impaired capacity to grant informed consent (AWIC) are often excluded from participating in biomedical research because they cannot provide informed consent, leading to decreased chances AWIC will benefit from such research. Smajdor uses Honneth’s concept of reification to propose that securing assent (rather than consent) in cases involving AWIC offers patients moral recognition that is not tied to their capacities. Assent provides this recognition by (...) including the patient in a shared moral sphere, highlighting her agency and worth without reducing her to her incapacity or a thing-to-be-managed. Assent also avoids grounding in, or a reliance on, the future development of autonomy (pp.5–6).1 Our recent research on patient and caregiver perspectives of potential paediatric deep brain stimulation (pDBS) for refractory obsessive–compulsive disorder (OCD) and dystonia demonstrates that paediatric neurosurgery patients desire the kind of recognition Smajdor associates with assent, and their caregivers largely agree.2 3 Since (generally) paediatric patients in the USA are unable to grant informed consent, their caregivers must provide it instead. This raises the question of how to properly integrate paediatric patients into the DBS decision-making process. One dimension along which this is evident is that …. (shrink)

Introduction: why the De anima commentaries? This book will concentrate on interpretations of the De anima in late antiquity, and what we can learn from ...

The editors of the _Journal of Medical Ethics_ support the call of the UK Health Alliance on Climate for urgent action to ensure that the current Conference of the Parties to the United Nations Framework Convention on Climate Change ‘finally delivers climate justice for Africa and vulnerable countries’. 1 As they note ‘Africa has suffered disproportionately although it has done little to cause the crisis’. The burden of climate change has thus far fallen disproportionately on Global South countries. The monsoon (...) in Pakistan this year killed over 1100 people and the public health implications of the flooding might affect the health of over 5 million people. 2 The South Asian monsoon impacts the lives of a billion people and the flooding associated with wet seasons is likely to occur eight times more frequently in future years than at present. 3 For many pacific islands such as Kiribati,... (shrink)

Comment les mots permettent-ils d’appréhender ces objets obscurs que sont nos emotions? Diverses langues européennes offrent-elles les mêmes perspectives sur cette réalité mouvante, explorée aussi par plusieurs disciplines appliquées (didactique, lexicographie, traitement automatique des langues)? Le volume tente de répondre à ces questions en mettant en relief certaines innovations théoriques et méthodologiques en sémantique lexicale et en analyse du discours. How do words allow us to understand these obscure objects that are our emotions? Do various European languages offer the same (...) perspective on this changing reality, when explored by several applied disciplines (language teaching, lexicography, natural language processing)? This volume offers answers by highlighting theoretical and methodological innovations in lexical semantics and discourse analysis. (shrink)

This volume contains papers by a group of leading experts on Aristotle and the later Aristotelian tradition of Neoplatonism. The discussion ranges from Aristotle's treatment of Parmenides, the most important pre-Socratic Greek philosopher, to Neoplatonic and medieval use of Aristotle, forwhich Aristotle himself set guidelines in his discussions of his predecessors. Traces of these guidelines can be seen in the work of Plotinus, and that of the later Greek commentators on Aristotle. The study of these commentators, and the recognition of (...) the philosophical interest and importance ofthe ideas which they expressed in their commentaries, is an exciting new development in ancient philosophy to which this book makes a unique and distinguished contribution. (shrink)

Little Vast Rooms of Undoing explores the relationship between identity and embodiment in public toilet spaces.

Die Buchreihe Konzepte der Sprach- und Literaturwissenschaft gibt Aufschluss über Prinzipien, Probleme und Verfahrensweisen philologischer Forschung im weitesten Sinne und dient einer Bestimmung des Standorts der Linguistik und Literaturwissenschaft. Die Reihe übergreift Einzelsprachen und Einzelliteraturen. Sie stellt sich in den Dienst der Reflexion und Grundlegung einer allgemeinen Sprach- und Literaturwissenschaft. Die Bände sind zum Teil informierende Einführungen, zum Teil wissenschaftliche Diskussionsbeiträge.

In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) there is a lack of (...) a theoretical limit on higher-order risk attitudes (eg, second, third, fourth order), and (3) the consideration of higher-order risk attitudes is actually more paternalistic than Makins suggests because it narrows what counts as an autonomous preference to the limited occasions in which an individual actually reflects on his or her own risk attitude. On the issue of practicality, we can reasonably expect that healthcare professionals would find difficulty eliciting the higher-order risk attitudes of their patients. Take for example the patient who has never expressed his higher-order desire to be more risk adverse and who is not willing nor comfortable expressing this desire. What is the healthcare professional expected to do in this situation? This is even more of a concern for the incapacitated patient, to which Makins seems to imply that …. (shrink)

"The studies collected in this book are all concerned with aspects of the Platonic tradition, either in its own internal development in the Hellenistic age and the period of the Roman Empire, or with the influence of Platonism, in one or other of its forms, on other spiritual traditions, especially that of Christianity." [Book jacket].

The graph edit distance (GED) measures the dissimilarity between two graphs as the minimal cost of a sequence of elementary operations transforming one graph into another. This measure is fundamental in many areas such as structural pattern recognition or classification. However, exactly computing GED is NP-hard. Among different classes of heuristic algorithms that were proposed to compute approximate solutions, local search based algorithms provide the tightest upper bounds for GED. In this paper, we present K-REFINE and RANDPOST. K-REFINE generalizes and (...) improves an existing local search algorithm and performs particularly well on small graphs. RANDPOST is a general warm start framework that stochastically generates promising initial solutions to be used by any local search based GED algorithm. It is particularly efficient on large graphs. An extensive empirical evaluation demonstrates that both K-REFINE and RANDPOST perform excellently in practice. (shrink)

This volume contains papers by a group of leading experts on Aristotle and the later Aristotelian tradition of Neoplatonism. The discussion ranges from Aristotle's treatment of Parmenides, the most important pre-Socratic Greek philosopher, to Neoplatonic and medieval use of Aristotle, for which Aristotle himself set guidelines in his discussions of his predecessors. Traces of these guidelines can be seen in the work of Plotinus, and that of the later Greek commentators on Aristotle. The study of these commentators, and the recognition (...) of the philosophical interest and importance of the ideas which they expressed in their commentaries, is an exciting new development in ancient philosophy to which this book makes a unique and distinguished contribution. (shrink)

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

Epicurus on Freedom has considerable merit, but there are some elements of O
Keefe
s argument that are worthy of a second thought. Two of O
Keefe
s major claims are that Epicurus
s proposal of swerves as an answer to the problem of whether we have the ability to do otherwise would be an inadequate answer, and that Epicurus should be concerned with the problem of openness and contingency of the future, not the problem of our ability to do otherwise. I address each of (...) these claims. (shrink)

Taking Ourselves Seriously and Getting It Right is written in a manner that is accessible to all. Frankfurt’s arguments are, as usual, clear and persuasive. Korsgaard’s, Bratman’s, and Dan-Cohen’s comments are thought provoking. There are, however, two main areas in which Frankfurt’s arguments need clarification (the notion of wholehearted identification, and the concept of ambivalence), and there are misunderstandings of Frankfurt at work in Korsgaard’s (relationship between the self and the will, and concept of the will for Frankfurt) and Bratman’s (...) (meaning of "necessity" for Frankfurt) comments. (shrink)

What’s wrong with the contemporary American medical system? What does it mean when a state’s democratic presidential primary casts 40% of its votes for a felon incarcerated in another state? What’s so bad about teaching by PowerPoint? What is _truly_ the dirtiest word in America? These are just a few of the engaging and controversial issues that Michael Blumenthal, poet, novelist, essayist, and law professor, tackles in this collection of poignant essays commissioned by West Virginia Public Radio. In these (...) brief essays, Blumenthal provides unconventional insights into our contemporary political, educational, and social systems, challenging us to look beyond the headlines to the psychological and sociological realities that underlie our conventional thinking. As a widely published poet and novelist, Blumenthal brings along a lawyer’s analytical ability with his literary sensibility, effortlessly facilitating a distinction between the clichés of today’s pallid political discourse and the deeper realities that lie beneath. This collection will captivate and provoke those with an interest in literature, politics, law, and the unwritten rules of our social and political engagements. (shrink)

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw (...) conclusions about what we do (or do not) owe them. This paper argues that at best the concept of “personhood” is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. (shrink)

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw (...) conclusions about what we do (or do not) owe them. This paper argues that at best the concept of “personhood” is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. (shrink)

In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

Health care reform sits, once again, in the eye of the political storm. This article, based on an analysis of past health care debates, offers nine historical lessons for contemporary reformers. We describe the most important political do's and don'ts.