Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...) aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape thecontentof those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases. (shrink)

It may seem paradoxical to speak of the ‘goodlife’ for demented elderly. Many people consider dementia to be a life-wrecking disease and nursing homes to be terrible places. Still, it is relevant to ask how we can make life as good as possible for demented nursing home residents. This paper explores what three standard philosophical accounts of well-being — subjective preference theory, objectivist theories, and hedonism — have to say about the good life for demented people. It is concluded that (...) the relevant differences between the various philosophical theories manifest themselves not so much in their general account of the substantial content of ‘the good life’ but in a number of specific controversies. These concern the nature of well-being, the necessity of endorsement by the patient, the value of experience and the need for experiences to be rooted in reality. Moreover, it is argued that further research should pay detailed attention to the process of dementia and to the effects of this process on patients' identities, self-conceptions, capacities, preferences, values and the like, and that a narrative approach which incorporates the factor time may offer a more comprehensive account of the good life for demented elderly. (shrink)

This study investigates what professional caregivers working in nursing homes consider to be a good life for residents suffering from dementia. Ten caregivers were interviewed; special attention was paid to the way in which they deal with conflicting values. Transcripts of the interviews were analysed qualitatively according to the method of grounded theory. The results were compared with those from a similar, earlier study on ideals found in mission statements of nursing homes. The concepts that were mentioned by most interviewed (...) participants as important for a good life were ‘peace and quiet’, ‘going along with subjective experience’ and ‘no enforcement: the way the resident wants it’. A considerable overlap was found between the interviews and the mission statements; however, when compared with the mission statements, the interviews put less emphasis on individuality and on giving meaning, and more on offering residents pleasant activities. When faced with conflicting values, caregivers tend to make pragmatic and more or less intuitive decisions. Although this has its merits, it may be desirable to stimulate conscious reflection regarding conflict between different values. (shrink)

The purpose of this essay is to explore, and clarify, some key features in Aquinas’ account of the virtue of temperance, with an eye to answering some common objections raised against a positive evaluation of temperance. In particular, I consider three features of Aquinas’ understanding of temperance: First, the role of the rational mean in temperance; second, the role of rightly ordered passions in temperance; and third, the ‘despotic’ control of reason over the passions in temperance. Along the way I (...) consider three common objections to Aquinas’ account of temperance: the objection that temperance can be misused for evil, the objection that temperance devalues effort, and the objection that temperance devalues strong passions and thereby implicitly devalues the goodness of sexuality. In responding to these objections on behalf of Aquinas, I take the opportunity to clarify and slightly extend Aquinas’ account of temperance. (shrink)

The proponent of the epistemological gap maintains that value claims are justified in a different way than are nonvalue claims. I show that a neo-Aristotelian naturalized virtue ethics does not fall prey to this gap. There are ethical claims concerning human beings that are epistemically justified in a way logically identical to the way in which are justified certain nonethical claims about human and nonhuman organisms. This demonstration (1) lends credibility to naturalized virtue ethics, (2) calls into question the very (...) notion of an epistemological gap, and (3) confronts antinaturalists with a dilemma. (shrink)

In recent decades "virtue ethics" has become an accepted theoretical structure for thinking about normative ethical principles. However, few contemporary virtue ethicists endorse the commitments of the first virtue theorists---the ancient Greeks, who developed their virtue theories within a commitment to eudaimonism. Why? I believe the objections of modern theorists boil down to concerns that eudaimonist theories cannot properly account for two prominent moral requirements on our treatment of others. ;First, we think that the interests and welfare of at least (...) some others ought to give us non-instrumental reason for acting---that is, reason independent of consideration of our own welfare. Second, we think others are entitled to what we might call respect, just in virtue of their being persons. Eudaimonist accounts either cannot account for these intuitions at all, or they give the wrong sort of account. ;My dissertation assesses the resources of eudaimonism to meet these lines of criticism. Chapter 2, 3, and 4 survey the views of Plato, Aristotle, and the Stoics, to discover insights that are important for a successful response. In Chapters 5 and 6, I offer my own account, based on what I call empathic identification. This is the habit or disposition of seeing things, in effect, through the eyes of others. Empathic identification is a process through which the interpersonal transmission of reasons for actions between persons becomes possible. I argue first that our interest in our own eudaimonia justifies us in identifying empathically with others as a general habit or disposition. Second, I argue that empathic identification explains our intuitions about the respect others are due. So empathic identification generates the right sort of explanation of our intuitions about the constraints others and their interests impose upon us after all, and renders eudaimonist virtue ethics a viable form of ethical theory. (shrink)