BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

What are the types of action at issue in the free will and moral responsibility debate? Are the neuroscientists who make claims about free will and moral responsibility studying those types of action? If not, can the existing paradigm in the field be modified to study those types of action? This paper outlines some claims made by neuroscientists about the inefficacy of conscious intentions and the implications of this inefficacy for the existence of free will. It argues that, typically, the (...) types of actions at issue in the philosophical literature require proximal or distal conscious decisions and have the right kind of connection to reasons. It points out that neuroscientists are not studying this class of actions, as their studies focus on simple commanded actions (e.g., finger flex) and simple Buridan choices (e.g., push the left or right button). Finally, it argues that neuroscience already has the resources to study the types of action relevant for free will and moral responsibility and outlines two experiments which focus on skilled actions and moral choices that could be run using the available technology. (shrink)

In this paper I begin by arguing that there are significant intellectual and normative continuities between pre-Victorian hereditarianism and later Victorian eugenical ideologies. Notions of mental heredity and of the dangers of transmitting hereditary ‘taints’ were already serious concerns among medical practitioners and laymen in the early nineteenth century. I then show how the Victorian period witnessed an increasing tendency for these traditional concerns about hereditary transmission and the integrity of bloodlines to be projected onto the level of national health. (...) Tracing the gradual emergence of eugenical thought, I also highlight some of the more fundamental social, political and intellectual factors that promoted this predilection for extrapolating from the individual lineage to the nation and race. In doing so I argue that fully fledged eugenical thought was always unlikely to emerge prior to the early Victorian period. However, I am also able to show that Francis Galton's 1865 eugenical proposals were far from innovative and that identifying him as the ‘father’ of the eugenics movement is highly misleading. (shrink)

In Against Moral Responsibility, Bruce Waller launches a spirited attack on a system that is profoundly entrenched in our society and its institutions, deeply rooted in our emotions, and vigorously defended by philosophers from ancient times to the present. Waller argues that, despite the creative defenses of it by contemporary thinkers, moral responsibility cannot survive in our naturalistic-scientific system. The scientific understanding of human behavior and the causes that shape human character, he contends, leaves no room for moral (...) responsibility. Waller argues that moral responsibility in all its forms--including criminal justice, distributive justice, and all claims of just deserts--is fundamentally unfair and harmful and that its abolition will be liberating and beneficial. What we really want--natural human free will, moral judgments, meaningful human relationships, creative abilities--would survive and flourish without moral responsibility. In the course of his argument, Waller examines the origins of the basic belief in moral responsibility, proposes a naturalistic understanding of free will, offers a detailed argument against moral responsibility and critiques arguments in favor of it, gives a general account of what a world without moral responsibility would look like, and examines the social and psychological aspects of abolishing moral responsibility. Waller not only mounts a vigorous, and philosophically rigorous, attack on the moral responsibility system, but also celebrates the benefits that would result from its total abolition. (shrink)

In this article the author makes the case for a hybrid sourcehood–leeway compatibilist account of free will. To do so, she draws upon Lehrer’s writing on free will, including his preference-based compatibilist account and Frankfurt-style cases from the perspective of the cognizant agent. The author explores what distinguishes kinds of intentional influence in manipulation cases and applies this distinction to a new perspectival variant of Frankfurt cases, those from the perspective of the counterfactual intervenor. She argues that it matters what (...) kind of intentional influence is at issue in the counterfactual intervention and, further, that our judgments about desert of praise are affected by occupying the POV of the counterfactual intervenor. The author concludes that such attention to perspectival variants of Frankfurt cases supports the view that compatibilist sourcehood accounts of moral responsibility require an additional compatibilist could-have-done-otherwise condition to capture a more robust sense of moral responsibility. (shrink)

Autonomy is good for you. A strong sense of competent self-control and effective choice-making promotes both physical and psychological well-being. Loss of autonomous control—and a sense of helplessness—causes depression, increased sensitivity to pain, greater vulnerability to disease, and death. Well established by a wide range of psychological and physiological studies, the positive effects of patient autonomy are well known to competent physicians, nurses, and therapists. Conscientious caregivers are thus moving beyond grudging acceptance of informed consent toward clinical respect for patient (...) autonomy. (shrink)

In recent analytic metaphysics, the view that ‘ordinary inanimate objects such as sticks and stones, tables and chairs, simply do not exist’ has been defended by some noteworthy writers. Thomasson opposes such revisionary ontology in favour of an ontology that is conservative with respect to common sense. The book is written in a straightforward, methodical and down-to-earth style. It is also relatively non-specialized, enabling the author and her readers to approach problems that are often dealt with in isolation in a (...) more unified way.Thomasson's arguments are mainly counter-attacks on six ‘eliminativist’ arguments against ordinary objects. A causal redundancy argument espoused by Trenton Merricks holds that to suppose that there are ordinary objects is to suppose that these objects have distinctive causal powers. However, the casual efficacy of a baseball, for example, is exhausted by that of some suitably arranged …. (shrink)

Imagination is celebrated as our vehicle for escape from the mundane here and now. It transports us to distant lands of magic and make-believe, and provides us with diversions during boring meetings or long bus rides. Yet the focus on imagination as a means of escape from the real world minimizes the fact that imagination seems also to furnish us with knowledge about it. Imagination seems an essential component in our endeavor to learn about the world in which we live--whether (...) we're planning for the future, aiming to understand other people, or figuring out whether two puzzle pieces fit together. But how can the same mental power that allows us to escape the world as it currently is also inform us about the world as it currently is? Ten original essays grapple with this neglected question; in doing so, they present a diverse array of positions ranging from cautious optimism to deep-seated pessimism. Blending perspectives from philosophy of mind, cognitive science, epistemology, aesthetics, and ethics, Knowledge Through Imagination sheds new light on the epistemic role of imagination. (shrink)

Existence questions have been topics for heated debates in metaphysics, but this book argues that they can often be answered easily, by trivial inferences from uncontroversial premises. This 'easy' approach to ontology leads to realism about disputed entities, and to the view that metaphysical disputes about existence questions are misguided.

The most widely debated conception of democracy in recent years is deliberative democracy--the idea that citizens or their representatives owe each other mutually acceptable reasons for the laws they enact. Two prominent voices in the ongoing discussion are Amy Gutmann and Dennis Thompson. In Why Deliberative Democracy?, they move the debate forward beyond their influential book, Democracy and Disagreement.What exactly is deliberative democracy? Why is it more defensible than its rivals? By offering clear answers to these timely questions, Gutmann and (...) Thompson illuminate the theory and practice of justifying public policies in contemporary democracies. They not only develop their theory of deliberative democracy in new directions but also apply it to new practical problems. They discuss bioethics, health care, truth commissions, educational policy, and decisions to declare war. In "What Deliberative Democracy Means," which opens this collection of essays, they provide the most accessible exposition of deliberative democracy to date. They show how deliberative democracy should play an important role even in the debates about military intervention abroad.Why Deliberative Democracy? contributes to our understanding of how democratic citizens and their representatives can make justifiable decisions for their society in the face of the fundamental disagreements that are inevitable in diverse societies. Gutmann and Thompson provide a balanced and fair-minded approach that will benefit anyone intent on giving reason and reciprocity a more prominent place in politics than power and special interests. (shrink)

This is the first comprehensive exploration of ancient and modern tyranny in the history of political thought. Waller R. Newell argues that modern tyranny and statecraft differ fundamentally from the classical understanding. Newell demonstrates a historical shift in emphasis from the classical thinkers' stress on the virtuous character of rulers and the need for civic education to the modern emphasis on impersonal institutions and cold-blooded political method. By diagnosing the varieties of tyranny from erotic voluptuaries like Nero, the steely (...) determination of reforming conquerors like Alexander the Great and Julius Caesar and modernizing despots such as Napoleon and Ataturk to the collectivist revolutions of the Jacobins, Bolsheviks, Nazis and Khmer Rouge, Newell shows how tyranny is every bit as dangerous to free democratic societies today as it was in the past. (shrink)

This challenging study places fiction squarely at the centre of the discussion of metaphysics. Philosophers have traditionally treated fiction as involving a set of narrow problems in logic or the philosophy of language. By contrast Amie Thomasson argues that fiction has far-reaching implications for central problems of metaphysics. The book develops an 'artifactual' theory of fiction, whereby fictional characters are abstract artifacts as ordinary as laws or symphonies or works of literature. By understanding fictional characters we come to understand how (...) other cultural and social objects are established on the basis of the independent physical world and the mental states of human beings. (shrink)

Rebecca Lloyd Waller defends a temporal dualist interpretation of Descartes’ account of time to directly engage and address common interpretive puzzles. Descartes' Temporal Dualism offers a significant contribution to the understanding of an important, but frequently neglected component of Descartes’ ontology.

Arguments that ordinary inanimate objects such as tables and chairs, sticks and stones, simply do not exist have become increasingly common and increasingly prominent. Some are based on demands for parsimony or for a non-arbitrary answer to the special composition question; others arise from prohibitions against causal redundancy, ontological vagueness, or co-location; and others still come from worries that a common sense ontology would be a rival to a scientific one. Until now, little has been done to address these arguments (...) in a unified and systematic way. Ordinary Objects is designed to fill this gap, demonstrating that the mistakes behind all of these superficially diverse eliminativist arguments may be traced to a common source. It aims to develop an ontology of ordinary objects subject to no such problems, providing perhaps the first sustained defense of a common sense ontology in two generations. The work done along the way addresses a number of major issues in philosophy of language and metaphysics, contributing to debates about analyticity, identity conditions, co-location and the grounding problem, vagueness, overdetermination, parsimony, and ontological commitment. In the end, the most important result of addressing these eliminativist arguments is not merely avoiding their conclusions; examining their failings also gives us reason to suspect that many apparent disputes in ontology are pseudo-debates. For it brings into question widely-held assumptions about which uses of metaphysical principles are appropriate, which metaphysical demands are answerable, and how we should go about addressing such fundamental questions as "What exists?". As a result, the work of Ordinary Objects promises to provide not only the route to a reflective understanding of our unreflective common-sense view, but also a better understanding of the proper methods and limits of metaphysics. (shrink)

Philosophical theories often hinge on claims about what is necessary or possible. But what are possibilities and necessities, and how could we come to know about them? This book aims to help demystify the methodology of philosophy, by treating such claims not as attempted descriptions of strange facts or distant 'possible worlds', but rather as ways of expressing rules or norms.

The authors offer ways to encourage and educate Americans to participate in the public deliberations that make democracy work and lay out the principles of..

It is often noted that institutional objects and artifacts depend on human beliefs and intentions and so fail to meet the realist paradigm of mind‐independent objects. In this paper I draw out exactly in what ways the thesis of mind‐independence fails, and show that it has some surprising consequences. For the specific forms of mind‐dependence involved entail that we have certain forms of epistemic privilege with regard to our own institutional and artifactual kinds, protecting us from certain possibilities of ignorance (...) and error; they also demonstrate that not all cases of reference to these kinds can proceed along a purely causal model. As a result, realist views in ontology, epistemology, and semantics that were developed with natural scientific kinds in mind cannot fully apply to the kinds of the social and human sciences. In closing I consider some wider consequences of these results for social science and philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.2 (2004) 125-128 [Access article in PDF] Comparing Psychoanalytic and Cognitive-Behavioral Perspectives on Control Bruce N. Waller Keywords freedom, locus of control, psychoanalysis, self-efficacy, volition Cognitive behavioral research on locus of control and self-efficacy has produced an extensive body of empirical results that might prove useful to psychoanalytic researchers endeavoring to strengthen the empirical foundation of psychoanalytic therapy. Cognitive-behaviorists and psychoanalysts share a common (...) interest in the importance of perspectives and belief systems and their impact on individual freedom, and comparative research on therapeutic effectiveness could yield benefits for both therapeutic approaches.Locus of control and self-efficacy are central elements in cognitive-behavioral psychology, and they play an important role in cognitive-behavioral therapy. Although the psychoanalytic approach does not explicitly employ those concepts, psychoanalytic therapists are obviously concerned with problems of effective action and internal obstacles to action. Attention to these two perspectives and their overlapping interests offers potential benefits for both the cognitive-behavioral and the psychodynamic approaches to psychological research and therapy.One potential benefit is the development of useful tools for advancing empirically based research on psychoanalysis. As Lehrer (1999) states, it is advantageous to ground psychoanalysis in "firm empirical evidence whenever possible." Although there have obviously been significant positive steps in that direction (Singer 2003; Weiss 1995, 1988; Weiss and Sampson 1986), psychoanalytic researchers have recognized that one source of difficulty is in finding clearly measurable research objectives and hypotheses (Burgin 2002). Cognitive-behavioral research on locus of control and self-efficacy has produced an extensive body of research using clear measurement standards that could prove useful in the empiricist approach to psychodynamic theories. In particular, those cognitive-behavioral research findings might offer a means of extending empirical investigation of psychodynamic theory in a direction usually regarded as difficult to test empirically: the study of psychoanalytic effectiveness to "change your way of seeing" (Lieberman 1999). Shifting locus of control or efficacy expectations in specific domains (Bandura 1997) [End Page 125] would empirically confirm the effectiveness of psychoanalytic techniques. It might well be that some efficacy expectations are enhanced more effectively by psychodynamic processes than by cognitive-behavioral therapy, or that psychoanalysis is effective in enhancing some specific efficacy expectations but not others. This could potentially extend the empirical examination of psychoanalytic theory as well as provide a base of comparison with cognitive-behavioral therapy techniques.Although self-efficacy enhancement might be a fruitful empirical test for psychodynamic therapy, therapeutic intervention to modify locus of control potentially could be even more productive. Current research indicates that one's orientation toward locus of control is a relatively stable characteristic, although it can be modified (Holyrod et al. 1984; Rotter 1979; Sadow and Hopkins 1993). One reason for locus of control stability may be that the locus of control imposes a perspective on the conceptualization of all one's experiences: from a strong internal locus of control perspective I view failures and successes as largely my own doing, whereas from an external locus perspective even my most effective efforts are seen as events that were outside my control: "I guess it was just my time to do well on a math exam," rather than "My hard work for that exam really paid off." (Lieberman makes this phenomenon quite clear in his excellent discussion of transparency.) Although locus of control is not easily modified, it is important to find effective means of helping subjects to achieve such changes, because research shows that a strong internal locus of control is positively correlated with success in work, sports, studies, marriage, and psychological adjustment (Lefcourt 1981, 1992), as well as with better health care behavior and better health (Bandura 1977; Schorr and Rodin 1982; Schulz 1976; Schulz and Hanusa 1978; Wallston 1993). Those deeply enmeshed in an external locus of control enjoy less real freedom and suffer severe disadvantages.How does one effect a shift in such a basic orientation? Not easily. From a psychoanalytic approach, the key will lie in recognizing and reconceptualizing the beliefs that impede effective action. Cognitive-behaviorists are more likely to... (shrink)

Ruling Passion is the only book-length study of tyranny, statesmanship, and civic virtue in three major Platonic dialogues, the Georgias, the Symposium, and the Republic. It is also the first extended interpretation of eros as the key to Plato's understanding of both the depths of human vice and the heights of human aspirations for virtue and happiness. Through his detailed commentary and eloquent insights on the three dialogues, Waller Newell demonstrates how, for Plato, tyranny is a misguided longing for (...) erotic satisfaction that can be corrected by the education of eros toward the proper objects of its pleasure: civic virtue and philosophy. (shrink)

Pragmatists (such as William James) recommend optimism as a successful strategy, and recent psychological research has confirmed its value. But optimism comes at a price: optimists are less accurate in their assessments and expectations than are pessimists. Thus optimism ‘proves itself to be good in the way of belief’, and by pragmatic standards should count as true; but that makes the accuracy costs of optimism invisible (the problem is only exacerbated by Rorty's recommendation that pragmatists stop speaking of truth altogether). (...) The problem prevents pragmatists from offering a Darwinian explanation of why pessimism survives, and also blocks any pragmatist account of the well‐documented and highly successful exploratory behavior of many animal species. (shrink)

The patient's right to informed consent is grudgingly acknowledged by medical professionals, firmly established in law, and brandished as a shibboleth by most bioethicists. But questions remain concerning genuine patient autonomy, and the doctrine of informed consent offers inadequate answers. In addition to the continuing controversy over what counts as “informed,” the passive acquiescence implied by “consent” seems a pale shadow of genuine autonomy.

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

Irrelevant emotional stimuli often capture attention, disrupting ongoing cognitive processes. In two experiments, we examined whether availability of rewards can prevent...

Empathy has for a long time, at least since the eighteenth century, been seen as centrally important in relation to our capacity to gain a grasp of the content of other people's minds, and predict and explain what they will think, feel, and do; and in relation to our capacity to respond to others ethically. In addition, empathy is seen as having a central role in aesthetics, in the understanding of our engagement with works of art and with fictional characters. (...) A fuller understanding of empathy is now offered by the interaction of research in science and the humanities. This volume draws together nineteen original chapters by leading researchers across several disciplines, together with an extensive Introduction by the editors. The individual chapters reveal how important it is, in a wide range of fields of enquiry, to bring to bear an understanding of the role of empathy in its various guises. It offers the ideal starting-point for the exploration of this intriguing aspect of human life. (shrink)

The effective altruism movement (EA) is one of the most influential philosophically savvy movements to emerge in recent years. Effective Altruism has historically been dedicated to finding out what charitable giving is the most overall-effective, that is, the most effective at promoting or maximizing the impartial good. But some members of EA want the movement to be more inclusive, allowing its members to give in the way that most effectively promotes their values, even when doing so isn’t overall-effective. When we (...) examine what it means to give according to one’s values, I argue, we will see that this is both inconsistent with what EA is like now and inconsistent with its central philosophical commitment to an objective standard that can be used to critically analyze one’s giving. While EA is not merely synonymous with act utilitarianism, it cannot be much more inclusive than it is right now. (shrink)

This book is a philosophical exploration of disorientation and its significance for action. Disorientations are human experiences of losing one's bearings, such that life is disrupted and it is not clear how to go on. In the face of life experiences like trauma, grief, illness, migration, education, queer identification, and consciousness raising, individuals can be deeply disoriented. These and other disorientations are not rare. Although disorientations can be common and powerful parts of individuals' lives, they remain uncharacterized by Western philosophers, (...) and overlooked by ethicists.Disorientations can paralyze, overwhelm, embitter, and misdirect moral agents, and moral philosophy and motivational psychology have important insights to offer into why this is. More perplexing are the ways disorientations may prompt improved moral action.Ami Harbin draws on first person accounts, philosophical texts, and qualitative and quantitative research to show that in some cases of disorientation, individuals gain new forms of awareness of political complexity and social norms, and new habits of relating to others and an unpredictable moral landscape. She then argues for the moral and political promise of these gains. A major contention of the book is that disorientations have 'non-resolutionary effects': they can help us act without first helping us resolve what to do. In exploring these possibilities, Disorientation and Moral Life contributes to philosophy of emotions, moral philosophy, and political thought from a distinctly feminist perspective. It makes the case for seeing disorientations as having the power to motivate profound and long-term shifts in moral and political action. A feminist re-envisioning of moral psychology provides the framework for understanding how they do so. (shrink)

Quietist Moral Realists accept that there are moral facts and properties, while aiming to avoid many of the explanatory burdens thought to fall on traditional moral realists. This chapter examines the forms that Quietist Moral Realism has taken and the challenges it has faced, in order to better assess its prospects. The best hope, this chapter argues, lies in a pragmatist approach that distinguishes the different functions of diverse areas of discourse. This paves the way for a form of Quietism (...) that does not simply remain quiet about the explanatory demands of metaethics, but rather is able to diagnose where they go wrong. By combining a neopragmatic analysis of the discourse with an easy approach to ontology, , we can develop a form of Quietist Moral Realism that is far stronger than critics of quietism have appreciated. (shrink)