In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can (...) make more explicit what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

We argue that contemporary conceptualizations of “persons” have failed to achieve the moral goals of “person-centred care” (PCC, a model of dementia care developed by Tom Kitwood) and that they are detrimental to those receiving care, their families, and practitioners of care. We draw a distinction between personhood and selfhood, pointing out that continuity or maintenance of the latter is what is really at stake in dementia care. We then demonstrate how our conceptualization, which (...) is one that privileges the lived experiences of people with dementia, and understands selfhood as formed relationally in connection with carers and the care environment, best captures Kitwood’s original idea. This conceptualization is also flexible enough to be applicable to the practice of caring for people at different stages of their dementia. Application of this conceptualization into PCC will best promote the well-being of people with dementia, while also encouraging respect and dignity in the care environment. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use (...) of insights from the capabilities approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals (...) with insipient or immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed into (...) the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

In their strife for designing a moral system where everyone is given equal consideration, cosmopolitan theorists have merely tolerated partiality as a necessary evil (insofar it means that we give priority to our kin opposite the distant needy). As a result, the cosmopolitan ideal has long departed from our moral psychologies and our social realities. Here I put forward partial cosmopolitanism as an alternative to save that obstacle. Instead of demanding impartial universal action, it requires from us that we are (...) equally responsive in all the relationships we stand in. That goes from the local to the cosmopolitan sphere, since I defend that we are related with strangers as co-members of the global community. Thus, partiality not only is accommodated by cosmopolitanism, but actually supports it: only by having meaningful personal relationships we become able to care for distant strangers. (shrink)

Evidence based medicine (EBM) is under critical debate, and person centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include methods and medical model. I here argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two (...) seem committed to conflicting ontologies. This paper aims to make explicit some of the most fundamental assumptions that motivate EBM and PCH, respectively, in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order (...) to argue how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

The phrase ‘person‐centred care’ (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood (...) in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC. (shrink)

The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and (...) values like equality and liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme. (shrink)

Based on the Aristotelian dynamis-energeia-differentiation, a concept issuing dynamic coherence providers as the sub-level of individual realizations. This logical sub-level is given for any kind of realizations. Based on this two-level approach, to some degree similar to the two-level approach developed by Polanyi, model of biopsychosocial interaction is established. It is suggested as the theoretical basis for a person-centered approach in healthcare, integrating science and humanitites.

Nancy Jecker and Andrew Ko (2017) wish to present an account of personal identity which captures what matters to the patient and places the patient at the center of medical decisions. They focus particularly on medical interventions in the brain that can cause drastic changes in personality; under what circumstances should we say the patient has 'survived' these changes? More specifically, how can we best understand the notion of survival in a way that captures what is of concern to the (...) patient? This goal is laudable, however, their chosen account of narrative identity is ill-suited to this task for one reason in particular; it does not give sufficient guidance in predicting which medical decisions are likely to be experienced as disruptive to identity. (shrink)

Care ethicists have long insisted that Kantian moral theory fails to capture the partiality that ought to be present in our personal relationships. In her most recent book, Virginia Held claims that, unlike impartial moral theories, care ethics guides us in how we should act toward friends and family. Because these actions are performed out of care, they have moral value for a care ethicist. The same actions, Held claims, would not have moral worth for a (...) Kantian because of the requirement of impartiality. Although Kantian moral theory is an impartial theory, I argue that the categorical imperative in the Formulation of Humanity as an End and the duty of respect require that we give special treatment to friends and family because of their relationships with us. Therefore, this treatment does have moral value for a Kantian. (shrink)

As the world population is rapidly aging, stakeholders must address the care of the elderly with great concern. Also, loss of dignity is often associated with aging due to dementia, mobility problems and diminished functional autonomy. However, dignity is a polysemic term that is deemed useless by some ethicists. To counter this claim, we propose four concepts to define it better and make use accurately of this notion. These are human dignity, dignity of identity, dignities of excellence and attributed (...) dignities. Finally, we explain the importance of solicitude and human dignity in the care of the elderly. This will ensure the respect, friendship and dignity of the elderly in providing geriatric ethical care. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role and (...) integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to explore (...) the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinary approach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

This Open Access book provides both a broad perspective and a focused examination of cow care as a subject of widespread ethical concern in India, and increasingly in other parts of the world. In the face of what has persisted as a highly charged political issue over cow protection in India, intellectual space must be made to bring the wealth of Indian traditional ethical discourse to bear on the realities of current human-animal relationships, particularly those of humans with cows. (...) Dharma, yoga, and bhakti paradigms serve as starting points for bringing Hindu--particularly Vaishnava Hindu--animal ethics into conversation with contemporary Western animal ethics. The author argues that a culture of bhakti--the inclusive, empathetic practice of spirituality centered in Krishna as the beloved cowherd of Vraja--can complement recently developed ethics-of-care thinking to create a solid basis for sustaining all kinds of cow care communities. (shrink)

The accelerated development of science and technology, along with the economical growth of countries and the rise of the phenomenon of globalization have had consequences in different aspects of human life. Social injustice, inequality, violence, fighting within and between countries, along with ecological misfortunes calls out for an ethical system that regulates and brings new light to human behaviour in this globalized world. The globalization dynamic of the techno-scientific, world market economic culture suggests the need of an urgent formation of (...) conscience of a global ethics. Having in mind this world panorama, in this process of ethical development we must analyze how bioethics can respond to the great challenge that this globalization plants. We propose that the key to the answer lies within the proposal developed by the personalistic current, which looks to solve real moral problems of concrete human persons, without leaving out anyone and looking to respond to all the dimentions of the human person. -/- El acelerado desarrollo de la ciencia y la tecnología, junto con el crecimiento económico de los países y la consolidación del fenómeno de la globalización ha tenido consecuencias en los diferentes ámbitos de la vida del ser humano. La injusticia social, la desigualdad, la violencia, las luchas dentro de los países y entre los países, así como el descalabro ecológico reclaman un sistema ético que regule y dé nuevas luces al comportamiento humano en este mundo globalizado. La dinámica de globalización de la cultura tecnocientífica y económica de mercado mundial, sugiere la necesidad de una urgente toma de conciencia de una ética global. Teniendo en cuenta este panorama mundial, en este trabajo analizamos cómo la bioética puede responder a este gran desafío que plantea la globalización. Proponemos que la clave fundamental de la respuesta está en la propuesta que ha sido desarrollada por la corriente personalista, la cual plantea y da solución a los problemas morales reales de rostros humanos concretos, sin dejar fuera a nadie y sin dejar fuera ninguna de las dimensiones del hombre. (shrink)

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to explore (...) the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinaryapproach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

The personal identity relation is of great interest to philosophers, who often consider fictional scenarios to test what features seem to make persons persist through time. But often real examples of neuroscientific interest also provide important tests of personal identity. One such example is the case of Phineas Gage – or at least the story often told about Phineas Gage. Many cite Gage’s story as example of severed personal identity; Phineas underwent such a tremendous change that Gage “survived as a (...) different man.” I discuss a recent empirical finding about judgments about this hypothetical. It is not just the magnitude of the change that affects identity judgment; it is also the negative direction of the change. I present an experiment suggesting that direction of change also affects neuroethical judgments. I conclude we should consider carefully the way in which improvements and deteriorations affect attributions of personal identity. This is particularly important since a number of the most crucial neuroethical decisions involve varieties of cognitive enhancements or deteriorations. (shrink)

The main theory at the core of this monograph is that the person is an entity ontologically new, since she is able to perform an act of self-transcendence, which is meant as her critical distancing from her own “self”, understood as subject of social recognition (Anerkennung), in order to open to the encounter with the world (Weltoffenheit). This allows us to consider a person in a new way, different both from confessional interpretations that see her only as a (...) center of the spirit and from reductivistic views. Schelling examines the act of self-transcendence through the concept of ecstasy, whereas Scheler associates it with the phenomenological reduction. The act of self-transcendence, that Schelling sees as originated by the “hunger of being”, is at the roots of the formation process of a person (Bildung): the person takes her shape by exiting from her own self-referential dimension and encountering otherness. If considered from this viewpoint, Plato’s “epimeleia heautou” exceeds an intimistic perspective: the “care” is no more a solipsistic self-care, but rather becomes the care through which the person transcends her own self to open to the relationships with otherness. It turns, therefore, into a care for world-openness (care for Weltoffenheit). The transformation of the individual and of society so becomes the double-faced aspect of the same process. The development of this set of problems occurs through a dialogue with Schelling’s and Scheler’s positions, but it is also supported by a historical-philosophical investigation, that for instance provides evidence of the influences of Schelling’s Berlin period on Scheler’s last theories and on the philosophical anthropology of the 20th century. Schelling was the first to conceive the concept of “eccentricity” in an anthropological sense, since until then the term had been confined to Kepler’s astronomy. Consequently, the planets’ elliptic (eccentric) movement heightens to an emblematic metaphor of human nature and freedom. The monograph also examines a possible convergence between Plato’s epimeleia heautou and Scheler’s phenomenological reduction. The book ends with a chapter on the topic of Vorbild. The exemplary testimony, that is Vorbild, becomes witnessing evidence immune from any pedagogical-moralistic intent: in fact, if it should relapse into the rhetoric of the “wish to give a good example”, it would immediately conform to the opposite logic of the model. A model is universal in so far as it makes everyone more like the others, nullifying the diversity, whereas exemplariness is universal in so far as it makes everyone more unique and motivates each one to follow her own characteristic path of existential trans-formation. Exemplarity doesn’t convey any contents, but rather encourages a kind of solidaristic involvement. Yet there are also negative exemplarities (Gegenbild) that place obstacles in the formation and block the existence of the personal center. (shrink)

The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and (...) that triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

Phineas Gage’s story is typically offered as a paradigm example supporting the view that part of what matters for personal identity is a certain magnitude of similarity between earlier and later individuals. Yet, reconsidering a slight variant of Phineas Gage’s story indicates that it is not just magnitude of similarity, but also the direction of change that affects personal identity judgments; in some cases, changes for the worse are more seen as identity-severing than changes for the better of comparable magnitude. (...) Ironically, thinking carefully about Phineas Gage’s story tells against the thesis it is typically taken to support. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet (...) medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

The purpose of this study is to find out that whether the jobs of nurses in Pakistan are fulfilling their necessary requirements or not. This issue is being analyzed by the relation of Person-Job (P-J) Fit with three different JobBehaviors and the whole relation is being tested under the moderation of Agreeableness, which is a personality trait of the Big5 Model. A survey method is deployed, questionnaires are used to obtain data. 120 Nurses were accessed from different hospitals of (...) Islamabad/Rawalpindi. Data were analyzed through statistical tests and regression analysis. Findings of the study highlight that P-J fit is related positively to job satisfaction of nurses and negatively to their Turnover Intentions.Where no significant impact of agreeableness as a moderator is found for this study. The Sample size was too small (120participants). This may restrict the generalizability of the studies. In the Pakistani context, only a limited study has been conducted on nurses. Thus, this piece of research will play a significant role in enhancing and boosting the confidence of deprived nurses of Pakistan by identifying the causes of negative job outcomes and help in mitigating those triggers. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows from (...) certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due (...) to the greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

S. Matthew Liao and Christian Barry argue that the patient-centered approach to deontology that I have developed—the restricting claims principle —‘is beset with problems.’ They think that it cannot correctly handle cases in which a potential victim sits in the path of an agent doing what she needs to do for some greater good, or in which a person’s property is used to benefit others and harm her. They argue that cases in which an agent does what would (...) be permissible but acts on a malicious reason show that agent intentions, rather than patientclaims, are fundamental to deontology. And they claim that the RCP presupposes the means principle in a way that shows that it is not really offering anything new. I argue here that all of these charges are mistaken. Doing so allows me to offer important refinements to the RCP, to highlight two common mistakes in reasoning about cases, and to set challenges for agentcentered approaches to deontology. (shrink)

Spirituality connotes praxis informed by religious or faith convictions. This can transform the individual and society at large. Christian spirituality is centered on how a person’s relationship with the God of Jesus Christ informs and directs one’s approach to existence and engagement with the world. The ecosystem concerns humanity and relationship with it is invariably influenced by faith or religious informed praxis. The reality of climate change is convincing many people that humankind’s common homeland needs to be treated (...) with care and respect if created beings are to have a congenial habitat now and in the future. This article avers that Christian spirituality can contribute to eco-friendly behavior through re-formation of the behavior of people and emboldening their goodwill as regards the responsibility of all towards the care of the earth. Finally, this research proffers a three-fold model of eco-spirituality - scriptural, selfcontrol, and sacramental approaches to the earth – as a contribution towards stemming the tide of ecological assaults on creation. Textual analysis is the method used in this research. (shrink)

What is the place of coherence, or structural rationality, in good first-personal deliberation? According to Kolodny (2005), considerations of coherence are irrelevant to good first-personal deliberation. When we deliberate, we should merely care about the reasons or evidence we have for our attitudes. So, considerations of coherence should not show up in deliberation. In response to this argument, Worsnip (2021) argues that considerations of coherence matter for how we structure deliberation. For him, we should treat incoherent combinations of attitudes (...) as off-limits in deliberation. Some important questions are left unanswered by both camps. What do we mean by considerations of coherence “showing up” in first-personal deliberation? How do we interpret the divide between reasons-responsiveness and coherence? How should we interpret cases in which considerations of coherence interact with other norms or requirements? In this paper, I show how Haack’s (1993) crossword puzzle analogy sheds light on these questions. Also, the crossword puzzle analogy allows us to evaluate Kolodny’s objection and identify promising avenues for future research. (shrink)

Both Martin Heidegger and Harry Frankfurt have argued that the fundamental feature of human identity is care. Both contend that caring is bound up with the fact that we are finite beings related to our own impending death, and both argue that caring has a distinctive, circular and non-instantaneous, temporal structure. In this paper, I explore the way Heidegger and Frankfurt each understand the relations among care, death, and time, and I argue for the superiority of Heideggerian version (...) of this nest of claims. Frankfurt claims that we should conceive of the most basic commitments which practically orient a person in the world and define his identity (“volitional necessities”) as naturalistic facts, foundational for and located completely without the normative space of reasons. In support of this he appeals to the supposedly foundational role played in human life by the instinct for self-preservation, what Frankfurt calls the “love of living.” The claim is that in questions of practical identity there is a definite priority of the factual over the normative. Frankfurt’s naturalistic model of volitional necessity is motivated by a misunderstanding of the temporal structure of care, a misunderstanding that helps lead him to an implausible conception of the basic structures of human identity. Heidegger advances an anti-naturalistic conception of caring, one bound up with his way of understanding how human beings relate to their own future. I argue that the existential, temporal, and normative significance that Frankfurt attributes to the naturalized “love of living” is better captured by the Heideggerian claim that human identity is defined by being “for-the-sake-of” certain projects and commitments, a way of being lived out in the way Heidegger calls “being-towards-death.”. (shrink)

The purpose of this paper is to provide a justification of punishment which can be endorsed by free will skeptics, and which can also be defended against the "using persons as mere means" objection. Free will skeptics must reject retributivism, that is, the view that punishment is just because criminals deserve to suffer based on their actions. Retributivists often claim that theirs is the only justification on which punishment is constrained by desert, and suppose that non-retributive justifications must therefore endorse (...) treating the people punished as mere means to social ends. Retributivists typically presuppose a monolithic conception of desert: they assume that action-based desert is the only kind of desert. But there are also personhood-based desert claims, that is, desert claims which depend not on facts about our actions, but instead on the more abstract fact that we are persons. Since personhood-based desert claims do not depend on facts about our actions, they do not depend on moral responsibility, so free will skeptics can appeal to them just as well as retributivists. What people deserve based on the mere fact of their personhood is to be treated as they would rationally consent to be treated if all they had in view was the mere fact of their personhood. We can work out the implications of this view for punishment by developing a hypothetical consent justification in which we select principles of punishment in the Rawlsian original position, so long as we are careful not to smuggle in the retributivist assumption that it is under our control whether we end up as criminals or as law-abiding citizens once we raise the veil of ignorance. (shrink)

Thomistic Hylomorphists claim that we human persons have rational or intellective souls which can continue to exist separately from our bodies after we die. Much of the recent scholarly discussion of Thomistic Hylomorphism has centered on this thesis and the question of whether human persons can survive death along with their souls or whether only their souls can survive in this separated, disembodied, post-mortem state. As a result, two rival versions of Thomistic Hyomorphism have been formulated: Survivalism and Corruptionism. (...) This chapter makes a new contribution to the debate between Survivalists and Corruptionists by identifying a heretofore undiscussed problem for Corruptionist Thomistic Hylomorphism. In particular, it is argued that if Corruptionists were right that human persons cannot survive their deaths along with their souls, this would undermine the grounds on which all Thomistic Hylomorphists, including Corruptionists, rely to justify their belief that our souls can continue to exist after our deaths. Given this, it is argued that Thomistic Hylomorphists have grounds for thinking that our souls can continue to exist after our deaths only if they allow, as Survivalists do and Corruptionists do not, that we human persons can continue to exist after our deaths, with souls but no bodies. (shrink)

Dilip Ninan has raised a puzzle for centered world accounts of de re attitude reports extended to accommodate what he calls “counterfactual attitudes.” As a solution, Ninan introduces multiple centers to the standard centered world framework, resulting in a more robust semantics for de re attitude reports. However, while the so-called multi-centered world proposal solves Ninan’s counterfactual puzzle, this additional machinery is not without problems. In Section 1, I present the centered world account of attitude reports, (...) followed by the extension to counterfactual attitudes which Ninan targets with his puzzle. In Section 2, I pose the counterfactual puzzle and present Ninan’s multi-centered world solution, emphasizing similarities and differences between multi-centered and centered world accounts of attitude reports. In Section 3, I argue the counterfactual attitude wishing falls under the purview of the multi-centered proposal, but that the proposal generates false predictions for wish reports concerning unsatisfiable content. I canvass responses, ultimately concluding Ninan’s proposal requires substantial revisions. (shrink)

Book review : The philosophy of person‐centred healthcareBy Derek Mitchell, Michael Loughlin, Cambridge: Cambridge Scholars Publishing. 2023.201 pp. £64.99. ISBN (10): 1‐5275‐9058‐5, ISBN (13): 978‐1‐5275‐9058‐8.

Agent-centered morality has been a serious challenge to ethical theories based on agent-neutral morality in defining what is the moral point of view. In this paper, my concern is to examine whether arguments for agent-centered morality, in particular, arguments for agent-centered option, can be justified. -/- After critically examining three main arguments for agent-centered morality, I will contend that although there is a ring of truth in the demands of agent-centered morality, agent-centered morality is (...) more problematic than agent-neutral morality. Nevertheless, we need to take seriously the challenges to agent-neutral morality by finding a way to reflect the insight of agent-centered morality within the framework of agent-neutral morality without collapsing it into agent-centered morality. As a way of doing so, I suggest that we need to integrate the situated, rather than transcendental, nonideal, rather than idealized, and dialogical, rather than monological, perspectives developed in feminist ethics, into agent-neutral morality. (shrink)

When one considers one's own persistence over time from the first-person perspective, it seems as if facts about one's persistence are "further facts," over and above facts about physical and psychological continuity. But the idea that facts about one's persistence are further facts is objectionable on independent theoretical grounds: it conflicts with physicalism and requires us to posit hidden facts about our persistence. This essay shows how to resolve this conflict using the idea that imagining from the first-person (...) point of view is a guide to centered possibility, a type of possibility analyzed in terms of centered worlds. (shrink)

If one can get the targets of one's current wants only by acquiring new wants (as in the Prisoner's Dilemma), is it rational to do so? Arguably not. For this could justify adopting unsatisfiable wants, violating the rational duty to maximize one's utility. Further, why cause a want's target if one will not then want it? And people "are" their wants. So if these change, people will not survive to enjoy their wants' targets. I reply that one rationally need not (...) advance one's future wants, only current ones. Furthermore, rational choice seeks not utility (the co-obtaining of a want and its target), but satisfaction (the eventual obtaining of what is now wanted) -- otherwise, it would be irrational to care now about what happens after one dies. Finally, persons survive "rational" changes of values. Thus reflection on the rational revision of values illuminates the conditions on personal identity and the bases and aims of rational choice. (shrink)

In his paper, ‘What moral work can Nussbaum’s account of human dignity do in the context of dementia care?’, Soofi seeks to modify Nussbaum’s conception of dignity to deal with four key objections that arise when appeals to dignity are made in the context of dementia care. We will not discuss the first of these, the redundancy of dignity talk, since this issue has already been much discussed in the literature. Instead, we will focus on the remaining three (...) issues raised, that of the exclusion of persons with advanced dementia from having dignity, unjustified speciesism as a ground of human dignity, and the unclear practical implications that follow from having dignity. (shrink)

Narrated in the first person, Peter Carey’s novel about the life of Australian bushranger Ned Kelly incorporates other aspects of speech derived both from Carey’s personal experience and from the editorial process. Kelly's voice is toned down to some extent by virtue of the latter, introducing expressions Kelly himself would not have used. Identifying these elements, along with the specific attributes of Kelly’s own speech, enjoins a diversity of cultural and social groupings that intersect and, in some instances, compete (...) with or contradict one another. Shifts in speakers might be signalled by textual markers or by adopting different expressive qualities and speech patterns, which may or may not include a change in grammatical person. In this novel, at one instance, a shift in person is apparent, but I want to argue, not necessarily a shift in the identity of the speaker because, although the grammatical voice shifts, its qualitative features are largely unaltered. The shift nonetheless introduces a significant change. Paradoxically, as far as literary theory is concerned, the subjective qualities produced through voice mean that stylisations of speech may be indicative of character point of view, rather than what is understood to be narrative voice, because they might function in narrative as inflections of speech that do not correspond to the established voice of the grammatically instanced speaker—offering a focalised perspective instead. The shift in True History presents problems in these terms, however: the point of view instanced here is clearly that belonging to the speaker, though the voice is Kelly’s, for the narrator’s point of view determines the generality of the descriptive terms where once these were specific and personal. Had the novel been narrated wholly in third person, an unproblematic reading of Kelly’s point of view, suggested by the use of his voice, would be possible. But the shift undermines this—Kelly’s point of view gives way to another, instanced in the shift that takes place in narrative voice. Carey, in other words, inverts the convention. This is not an instance of free indirect style or discourse, where grammatical mood is at odds with the speaker’s position and tenses align with the implicated subject position of another. The same features of voice that might identify character point of view must, in absence of any disparity of mood or tone, function in respect to narrative voice to convey something of its speaker’s subjectivity, and this seems apparent here: the speaker shares Kelly’s subjective emotional and intellectual perspective, but no longer occupies the subject position. Carey’s voicing of the bushranger therefore complicates distinctions between voice and point of view by revealing qualitative features of voice to be important to the question of who is speaking the narrative. (shrink)

The shift from conventional, face-to-face classroom teaching to distance education is a complex process that brings various challenges. To better understand the impact of this transition, the researchers examined the perceptions of secondary science teachers (n = 42) and students (n = 137). Specifically, the study focused on evaluating learner-centered, action-oriented, and transformative learning – referred to as LCAOT learning – in science distance education. The researchers developed a 26-item, 4-point Likert scale questionnaire that was distributed online to the (...) target respondents. Additionally, the researchers interviewed teachers and students and analyzed various documents, such as self-learning modules and learners’ activity sheets, to triangulate the survey data. The findings revealed that the principles of LCAOT learning were apparent in science distance education and exemplified through tools such as the Know, Want to Know, and Learned charts and personal journals. The study also revealed that teachers and students faced challenges during the transition to distance education, including inadequate equipment and poor internet connectivity. However, they responded to these challenges by using various means of communication, collaborating with peers, and exploring new roles and identities. The researchers recommend using the developed instrument and continuing to evaluate the effectiveness of teaching strategies employed in distance education in science, as well as further studies on the impact of LCAOT learning on students’ academic achievement. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional (...) role. I examine two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

Persons care about their future selves. They reason about their future selves’ interests; they plan for their future selves’ happiness and they worry about their future selves’ suffering. This paper is interested in the interplay between diachronic prudential reason and certain accounts of the metaphysics of personal identity that fall under the broad umbrella ‘conventionalist’. Some conventionalists conclude that under certain conditions there are intractable decisions for there is no fact of the matter regarding whether a person-stage ought (...) (prudentially) to ϕ. This paper will suggest otherwise. These decisions are not intractable if we allow that it is sometimes rational for a person-stage to discount the utility of certain future person-stages. The paper then goes on to explore an alternative position that conventionalists might occupy which does not involve any such discounting: prudential relativism. According to prudential relativism it is impossible to offer a single, correct, answer to the question: should person-stage, P, ϕ at t? For according to prudential relativism there is no stage-independent stance from which to evaluate whether a person-stage ought to ϕ. Yet it is not, for all that, intractable, from P’s perspective, whether or not to ϕ. (shrink)

This article analyzes emerging artificial intelligence (AI)-enhanced lie detection systems from ethical and human resource (HR) management perspectives. I show how these AI enhancements transform lie detection, followed with analyses as to how the changes can lead to moral problems. Specifically, I examine how these applications of AI introduce human rights issues of fairness, mental privacy, and bias and outline the implications of these changes for HR management. The changes that AI is making to lie detection are altering the roles (...) of human test administrators and human subjects, adding machine learning-based AI agents to the situation and establishing invasive data collection processes as well as introducing certain biases in results. I project that the potentials for pervasive and continuous lie detection initiatives (“truth machines”) are substantial, displacing human-centered efforts to establish trust and foster integrity in organizations. I argue that if it is possible for HR managers to do so, they should cease using technologically-based lie detection systems entirely and work to foster trust and accountability on a human scale. However, if these AI-enhanced technologies are put into place by organizations by law, agency mandate, or other compulsory measures, care should be taken that the impacts of the technologies on human rights and wellbeing are considered. The article explores how AI can displace the human agent in some aspects of lie detection and credibility assessment scenarios, expanding the prospects for inscrutable, “black box” processes and novel physiological constructs (such as “biomarkers of deceit”) that may increase the potential for such human rights concerns as fairness, mental privacy, and bias. Employee interactions with autonomous lie detection systems rather with than human beings who administer specific tests can reframe organizational processes and rules concerning the assessment of personal honesty and integrity. The dystopian projection of organizational life in which analyses and judgments of the honesty of one’s utterances are made automatically and in conjunction with one’s personal profile provides unsettling prospects for the autonomy of self-representation. (shrink)

In the film classic Blade Runner, the story explores the notion of personal identity through that of carefully crafted androids. Can an android have a personality; can androids be persons? The title of the original story by Philip K. Dick is Do Androids Dream of Electric Sheep? The story suggests that our sense of being a person depends on our having memories that connect us with our childhood. In the movie, the androids are only a couple of years old, (...) but have adult bodies. To complete them as persons they are given simulated memories of childhood. Some psychiatrists have decided that even humans dream only of electric sheep. I explore how Popper’s world 3 can help to defend a notion of personhood that can be used to criticize the thesis that persons are simply complex physical processes and that all their serious life-problems can be conceptualised as a form of physical illness. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

Since Chenyang Li’s (1994) groundbreaking article there has been interest in reading early Confucian ethics through the lens of care ethics. In this paper, I examine the prospects for dialogue between the two in light of recent work in both fields. I argue that, despite some similarities, early Confucian ethics is not best understood as a form of care ethics, of the kind articulated by Nel Noddings (1984, 2002) and others. Reasons include incongruence deriving from the absence in (...) the Chinese texts of a developed account of need, and doubts about whether the parent-child relationship in Confucian thought is best characterized by ‘care’. More importantly, care is merely one value directing the Confucian commitment to family and personal bonds, with different kinds of relationship, including the five relationships presented in the Mencius, entailing different idealized modes of relating to others. (shrink)

Two lines of investigation into the nature of mental content have proceeded in parallel until now. The first looks at thoughts that are attributable to collectives, such as bands' beliefs and teams' desires. So far, philosophers who have written on collective belief, collective intentionality, etc. have primarily focused on third-personal attributions of thoughts to collectives. The second looks at de se, or self-locating, thoughts, such as beliefs and desires that are essentially about oneself. So far, philosophers who have written on (...) the de se have primarily focused on de se thoughts of individuals. This paper looks at where these two lines of investigations intersect: collective de se thoughts, such as bands' and teams' beliefs and desires that are essentially about themselves. There is a surprising problem at this intersection: the most prominent framework for modeling de se thoughts, the framework of centered worlds, cannot model a special class of collective de se thoughts. A brief survey of this problem's solution space shows that collective de se thoughts pose a new challenge for modeling mental content. (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare (...) matters, and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)

The philosophy of science of Patrick Suppes is centered on two important notions that are part of the title of his recent book (Suppes 2002): Representation and Invariance. Representation is important because when we embrace a theory we implicitly choose a way to represent the phenomenon we are studying. Invariance is important because, since invariants are the only things that are constant in a theory, in a way they give the “objective” meaning of that theory. Every scientific theory gives (...) a representation of a class of structures and studies the invariant properties holding in that class of structures. In Suppes’ view, the best way to define this class of structures is via axiomatization. This is because a class of structures is given by a definition, and this same definition establishes which are the properties that a single structure must possess in order to belong to the class. These properties correspond to the axioms of a logical theory. In Suppes’ view, the best way to characterize a scientific structure is by giving a representation theorem for its models and singling out the invariants in the structure. Thus, we can say that the philosophy of science of Patrick Suppes consists in the application of the axiomatic method to scientific disciplines. What I want to argue in this paper is that this application of the axiomatic method is also at the basis of a new approach that is being increasingly applied to the study of computer science and information systems, namely the approach of formal ontologies. The main task of an ontology is that of making explicit the conceptual structure underlying a certain domain. By “making explicit the conceptual structure” we mean singling out the most basic entities populating the domain and writing axioms expressing the main properties of these primitives and the relations holding among them. So, in both cases, the axiomatization is the main tool used to characterize the object of inquiry, being this object scientific theories (in Suppes’ approach), or information systems (for formal ontologies). In the following section I will present the view of Patrick Suppes on the philosophy of science and the axiomatic method, in section 3 I will survey the theoretical issues underlying the work that is being done in formal ontologies and in section 4 I will draw a comparison of these two approaches and explore similarities and differences between them. (shrink)