Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence (...) between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM. (shrink)

As parents of a young woman who very much resembles Ashley, we recognize the way her parents speak of their daughter’s preciousness, and of the love and joy she brings into their life. We know too well the hardships associated with rearing a child with severe physical and intellectual disabilities, especially in our own society, unyielding as it is to the medical needs even “normals” have. We would not have our daughter Sesha undergo similar interventions. We do not believe (...) she is a perpetual child, even if her intellectual capacities do not exceed those of a child, for she has lived for thirty-seven years in this world and with that has acquired knowledge, sensitivities, and sensibilities that no child of “comparable” capacities could have. (shrink)

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved (...) in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT. (shrink)

According to the powerful qualities view, properties are both powerful and qualitative. Indeed, on this view the powerfulness of a property is identical to its qualitativity. Proponents claim that this view provides an attractive alternative to both the view that properties are pure powers and the view that they are pure qualities. It remains unclear, however, whether the claimed identity between powerfulness and qualitativity can be made coherent in a way that allows the powerful qualities view to constitute this sort (...) of alternative. I argue here that this can be done, given a particular conception of both the qualitativity and powerfulness of properties. On this conception, a property is qualitative just in the sense that its essence is fixed independently of any distinct properties, and it is powerful just if its essence grounds its dispositional role. (shrink)

Understanding everyday behavior relies heavily upon understanding our ability to improvise, how we are able to continuously anticipate and adapt in order to coordinate with our environment and others. Here we consider the ability of musicians to improvise, where they must spontaneously coordinate their actions with co-performers in order to produce novel musical expressions. Investigations of this behavior have traditionally focused on describing the organization of cognitive structures. The focus, here, however, is on the ability of the time-evolving patterns of (...) inter-musician movement coordination as revealed by the mathematical tools of complex dynamical systems to provide a new understanding of what potentiates the novelty of spontaneous musical action. We demonstrate this approach through the application of cross wavelet spectral analysis, which isolates the strength and patterning of the behavioral coordination that occurs between improvising musicians across a range of nested time-scales. Revealing the sophistication of the previously unexplored dynamics of movement coordination between improvising musicians is an important step towards understanding how creative musical expressions emerge from the spontaneous coordination of multiple musical bodies. (shrink)

Many philosophers have suggested that claims of need play a special normative role in ethical thought and talk. But what do such claims mean? What does this special role amount to? Progress on these questions can be made by attending to a puzzle concerning some linguistic differences between two types of 'need' sentence: one where 'need' occurs as a verb, and where it occurs as a noun. I argue that the resources developed to solve the puzzle advance our understanding of (...) the metaphysics of need, the meaning of 'need' sentences, and the function of claims of need in ethical discourse. (shrink)

Discussions about the nature of essence and about the inference problem for non-Humean theories of nomic modality have largely proceeded independently of each other. In this article I argue that the right conclusions to draw about the inference problem actually depend significantly on how best to understand the nature of essence. In particular, I argue that this conclusion holds for the version of the inference problem developed and defended by Alexander Bird. I argue that Bird’s own argument that this problem (...) is fatal for David Armstrong’s influential theory of the laws of nature but not for dispositional essentialism is seriously flawed. In place of this argument, I develop an argument that whether Bird’s inference problem raises serious difficulties for Armstrong’s theory depends on the answers to substantial questions about how best to understand essence. The key consequence is that considerations about the nature of essence have significant, underappreciated implications for Armstrong’s theory. (shrink)

It is often taken for granted that our desires can contribute to what it is rational for us to do. This paper examines an account of desire—the ‘guise of the good’— that promises an explanation of this datum. I argue that extant guise-of-the-good accounts fail to provide an adequate explanation of how a class of desires—basic desires—contributes to practical rationality. I develop an alternative guise-of-the-good account on which basic desires attune us to our reasons for action in virtue of their (...) biological function. This account emphasises the role of desire as part of our competence to recognise and respond to normative reasons. (shrink)

I defend a new account of constitutive essence on which an entity’s constitutively essential properties are its most fundamental, nontrivial necessary properties. I argue that this account accommodates the Finean counterexamples to classic modalism about essence, provides an independently plausible account of constitutive essence, and does not run into clear counterexamples. I conclude that this theory provides a promising way forward for attempts to produce an adequate nonprimitivist, modalist account of essence. As both triviality and fundamentality in the account are (...) understood in terms of grounding, the theory also potentially has important implications for the relation between essence and grounding. (shrink)

A recent, seemingly appealing version of the powerful qualities view defines properties’ qualitativity via an essentialist claim and their powerfulness via a grounding claim. Roughly, this approach holds that properties are qualities because they have qualitative essences, while they are powerful because their instances or essences ground causal-modal facts. I argue that this theory should be replaced with one that defines the powerfulness of qualities in terms of both a grounding claim and a ‘meta-grounding’ claim. Specifically, I formulate and defend (...) a view on which qualities are powerful just if instances of those qualitiesat least partiallyground dispositionsin virtue of the essences of those qualities. (shrink)

Experiences of urges, impulses, or inclinations are among the most basic elements in the practical life of conscious agents. This article develops a theory of urges and their epistemology. The article motivates a tripartite framework that distinguishes urges, conscious experiences of urges, and exercises of capacities that agents have to control their urges. The article elaborates the elements of the tripartite framework, in particular, the phenomenological contribution of motor imagery. It argues that experiences of urges and exercises of control over (...) urges play coordinate roles in enabling an agent’s awareness of their impulses. (shrink)

According to the governing conception of the laws of nature, laws, in some sense, determine concrete goings-on. Just how to understand the sort of determination at play in governance is, however, a substantial question. One potential answer to this question, which has recently received some attention, is that laws govern by grounding what happens in the concrete world. If this account succeeded, it would show that governance can be understood in terms of an independently motivated and widely accepted notion. Thus (...) far, though, the grounding conception of governance has not been developed or evaluated in detail. In this paper, I fill this gap by mapping out and evaluating various possible ways of developing this conception of governance. My main conclusion is that the grounding conception runs into serious difficulties in trying to capture the key idea that governing laws determine the distribution of fundamental property instances. (shrink)

According to a well-known argument against dispositional essentialism, the nature of unmanifested token powers leaves dispositional essentialists with an objectionable commitment to the reality of non-existent entities. The idea is that, because unmanifested token powers are directed at their non-existent token manifestations, they require the reality of those manifestations. Arguably the most promising response to this argument works by claiming that, if properties are universals, dispositional directedness need only entail the reality of actually existing manifestation types. I argue that this (...) response fails, because no version of the response can adequately accommodate dispositions of the sort that follow from Coulomb’s law. This result both defeats an important argument that dispositional essentialists ought to be realists about universals and appears to leave dispositional essentialists with a problematic commitment to either non-relational connections or a Meinongian ontology. (shrink)

Taylor has recently argued that adopting either the standard Kimian or Davidsonian approaches to the metaphysics of events quite directly solves the regress of pure powers. I argue, though, that on closer inspection Taylor’s proposal does not succeed, given either the Kimian or the Davidsonian account of events.

Thaddeus Metz has developed and defended a “modal-relational” account of moral status based on his interpretation of salient Sub-Saharan African values. Roughly, on this account, a being has moral status to the degree that it can enter into friendly or communal relationships with characteristic human beings. In this paper, it is argued that this theory’s true significance for environmental ethics has thus far not been recognized. Metz’s own view is that the theory entails that only sentient beings have moral status. (...) It is argued here that this is a mistake, and that, once this error is corrected, the view can be used to synthesize major, competing accounts of moral status into a novel, unified account of the moral status of human beings, sentient animals, non-sentient organisms, and inanimate members of the “web of life”. The result is a new framework for thinking about the moral status of various natural entities, which ought to be of great interest to environmental ethicists. (shrink)

While the inference problem is widely thought to be one of the most serious problems facing non-Humean accounts of laws, Jonathan Schaffer has argued that a primitivist response straightforwardly dissolves the problem. On this basis, he claims that the inference problem is really a pseudo-problem. Here I clarify the prospects of a primitivist response to the inference problem and their implications for the philosophical significance of the problem. I argue both that it is a substantial question whether this sort of (...) response ought to be accepted and that the inference problem, contra Schaffer, remains a significant problem with important implications for the non-Humean position. I also argue that this discussion indicates grounds to be wary about applying the Schaffer-style strategy of straightforwardly dissolving problems by stipulation to other philosophical problems. (shrink)

Desire satisfaction has not received detailed philosophical examination. Yet intuitive judgments about the satisfaction of desires have been used as data points guiding theories of desire, desire content, and the semantics of ‘desire’. This paper examines desire satisfaction and the standard propositional view of desire. Firstly, I argue that there are several distinct concepts of satisfaction. Secondly, I argue that separating them defuses a difficulty for the standard view in accommodating desires that Derek Parfit described as ‘implicitly conditional on their (...) own persistence’, a problem posed by Shieva Kleinschmidt, Kris McDaniel, and Ben Bradley. The solution undercuts a key motivation for rejecting the standard view in favour of more radical accounts proposed in the literature. (shrink)

“Strong AI” is the view that it is possible for an artificial agent to be mentally indistinguishable from human agents. Because the behavioral dispositions of artificial agents are determined by underlying dispositional systems, Strong AI seems to entail human behavioral dispositions are also determined by dispositional systems. It is, however, highly intuitive that non-dispositional, phenomenal properties, such as being in pain, at least partially determine certain human behavioral dispositions, like the disposition to take a pain killer. Consequently, Strong AI seems (...) to conflict with an intuitive view of phenomenal properties’ role in determining human behavioral dispositions. My goal here is not directly to evaluate this tension, but rather to clarify how dispositionalism in the metaphysics of properties bears on it. While a tempting thought is that dispositionalism fits well with Strong AI’s thoroughly dispositional account of human behavior, I argue that this thought does not hold for dispositionalism in general. In particular, I argue that combining a version of the “powerful qualities view” with certain dispositionalist conceptions of the will leads to a version of the intuitive view of phenomenal properties that is radically incompatible with Strong AI. I argue further that this view also raises a challenge for the weaker claim that an artificial agent could be behaviorally indistinguishable from a human agent. (shrink)

This paper develops an understanding of climate denial as an expression of alienation in the sense described by Marx. We first argue for an expanded and differentiated conception of climate denial, theorizing four distinct types that go beyond the simple rejection of an anthropogenic warming trend: naturalist denialism, technological denialism, gradualist denialism, and politicized denialism. We then claim that these forms of climate denial illustrate and are illustrative of Marx’s concept of alienation from species-being (Gattungswesen). The article is intended as (...) a contribution to the growing literature on climate denial as a social and ideological problem rather than as an individual epistemic or moral issue. (shrink)

This paper evaluates the claim that some desires provide reasons in virtue of their connection with conscious affective experiences like feelings of attraction or aversion. I clarify the nature of affective desires and several distinct ways in which affective desires might provide reasons. Against accounts proposed by Ruth Chang, Declan Smithies and Jeremy Weiss, I motivate doubts that it is the phenomenology of affective experiences that explains their normative or rational significance. I outline an alternative approach that centralises the function (...) of such experiences. (shrink)

This introduction provides brief outlines of the articles collected in this special issue of the International Journal of Philosophical Studies on the topic of Ethics and Emotions. It also announces the winners of the 2021 Robert Papazian and PERITIA prizes.

Slurring expressions display puzzling behaviour when embedded, such as under negation and in attitude and speech reports. They frequently appear to retain their characteristic qualities, like offensiveness and propensity to derogate. Yet it is sometimes possible to understand them as lacking these qualities. A theory of slurring expressions should explain this variability. We develop an explanation that deploys the linguistic notion of focus. Our proposal is that a speaker can conversationally implicate metalinguistic claims about the aptness of a focused slurring (...) expression. This explanation of variability relies on independently motivated mechanisms and is compatible with any theory of slurring expressions. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

Argument mapping is a way of diagramming the logical structure of an argument to explicitly and concisely represent reasoning. The use of argument mapping in critical thinking instruction has increased dramatically in recent decades. This paper overviews the innovation and provides a procedural approach for new teaches wanting to use argument mapping in the classroom. A brief history of argument mapping is provided at the end of this paper.

Emotional Intelligence (EI) has been conceptualized in the literature either as a dispositional tendency, in line with a personality trait (trait EI; Petrides and Furnham, 2001), or as an ability, moderately correlated with general intelligence (ability EI; Mayer and Salovey, 1997). Surprisingly, there have been few empirical attempts conceptualizing how the different EI approaches should be related to each other. However, understanding how the different approaches of EI may be interwoven and/or complementary is of primary importance for clarifying the conceptualization (...) of EI and organizing the literature around it. We introduce a theoretical framework explaining how trait EI, ability EI, and emotion information processing – a novel component related to EI recently introduced in the literature (e.g., Fiori and Vesely Maillefer, 2018) – may contribute to effective emotion-related performance and provide initial evidence supporting its usefulness in predicting EI-related outcomes. More specifically, we show that performance in a task in which participants had to infer the mental and emotional states of others, namely a Theory of Mind task, was predicted jointly (e.g., interaction effects) by trait EI, ability EI, and emotion information processing, after controlling for personality and IQ (N = 323). Our results argue for the importance of investigating the joint contribution of different aspects of EI in explaining variability in emotionally laden outcomes. (shrink)

We examined change over time in the relationship between moral identity and presence of meaning during early adulthood. Moral identity refers to a sense of morality and moral values that are central to one’s identity. Presence of meaning refers to the belief that one’s existence has meaning, purpose, and value. Participants responded to questions on moral identity and presence of meaning in their senior year of high school and two years after. Mixed effects model analyses were used to examine how (...) moral identity and presence of meaning interacted during this two-year period. The findings demonstrated that moral identity positively predicted presence of meaning over time. (shrink)

Five experiments demonstrate the central role of knowledge attributions in social evaluations. In Experiments 1–3, we manipulated whether an agent believes, is certain of, or knows a true proposition and asked people to rate whether the agent should perform a variety of actions. We found that knowledge, more so than belief or certainty, leads people to judge that the agent should act. In Experiments 4–5, we investigated whether attributions of knowledge or certainty can explain an important finding on how people (...) act based on statistical evidence, known as “the Wells effect”. We found that knowledge attributions, but not certainty attributions, mediate this effect on decision making. 2018 APA, all rights reserved). (shrink)

This research investigates 3- and 5-year-olds' relative fairness in distributing small collections of even or odd numbers of more or less desirable candies, either with an adult experimenter or between two dolls. The authors compare more than 200 children from around the world, growing up in seven highly contrasted cultural and economic contexts, from rich and poor urban areas, to small-scale traditional and rural communities. Across cultures, young children tend to optimize their own gain, not showing many signs of self-sacrifice (...) or generosity. Already by 3 years of age, self-optimizing in distributive justice is based on perspective taking and rudiments of mind reading. By 5 years, overall, children tend to show more fairness in sharing. What varies across cultures is the magnitude of young children's self-interest. More fairness (less self-interest) in distributive justice is evident by children growing up in small-scale urban and traditional societies thought to promote more collective values. (shrink)

Job burnout, organizational commitment, and work environment continue to be important areas of research to be studied in the realm of company employment and employee retention. Job burnout is the state of physical and emotional exhaustion and perceiving one’s profession as dull or overwhelming. Meanwhile, organizational commitment refers to the company’s attitude towards the organization and their employees, encompassing loyalty, moral responsibility, and their willingness to work. And lastly, work environment provides opportunities for employees to establish connections, develop skills, and (...) maximize their full potential in performing tasks. For the current study, researchers utilized descriptive-correlational research design to investigate the influence of Work Environment towards the job burnout and organizational commitment of BPO agents in selected companies in Bulacan, Philippines. Hence, Danish Psychosocial Work Environment Questionnaire (DPQ), Maslach Burnout Inventory - General Survey (MBI-GS), and the Three-Dimensional Model of Organizational Commitment Scale (ACS, NCS, CCS) were employed to properly assess the study's objectives. Multiple Linear Regression Analysis was performed to analyze the collected data. Based on the analysis, findings show that work environment has no significant influence on the job burnout and organizational commitment of BPO Agents. Furthermore, the results of this study were thoroughly evaluated, leading to an in-depth discussion. Based on the findings, recommendations were made to benefit the stakeholders of the study and contributeto the existing body of knowledge. (shrink)

Wayne Martin and colleagues argue that decisions about patients’ best interests must sometimes take into account the interests of others Doctors often find themselves in circumstances where they must make decisions on behalf of an incapacitated patient. As a matter of both ethics and law, such decisions must be taken in the best interests of the patient, but uncertainty remains about what is meant by best interests, especially in relation to the interests of others. Should the interests of others enter (...) into a determination of the patient’s best interests? We believe that they should and argue against a recent trend to focus solely on the patient. It only takes a moment’s reflection to appreciate that the interests of one person are often wrapped up with the interests of others. A patient has an interest in recovering from her illness, but so do her family, employer, care providers, etc. Sometimes these various interests can be independently specified, but in other cases they are inextricably intertwined. Suppose that I am a single parent whose overriding interest is to ensure the wellbeing of my children. In that case the proper specification of my best interest is a function of theirs; I simply cannot determine the one without considering the other. This can create an ethical problem in medical decision making. In circumstances where medical staff must make a decision in the best interests of an incapacitated patient, to what extent can or should they take account of the interests of other people whose lives are affected by the outcome? These ethical issues have taken on a concrete legal shape in the UK with the implementation of the Mental Capacity Act 2005, which specifies that, “An act done, or decision made, under this Act for or on behalf of a person who lacks capacity …. (shrink)

Scientific information plays an important role in shaping policies and recommendations for behaviors that are meant to improve the overall health and well-being of the public. However, a subset of the population does not trust information from scientific authorities, and even for those that do trust it, information alone is often not enough to motivate action. Feelings of shame can be motivational, and thus some recent public policies have attempted to leverage shame to motivate the public to act in accordance (...) with science-based recommendations. We argue that because these shame policies are employed in non-communal contexts, they are both practically ineffective and morally problematic: shame is unlikely to be effective at motivating the public to behave in accordance with science-based policy, and shaming citizens is an unethical way to get them to comply. We argue that shame-based policies are likely to contribute to further distrust in scientific authority. (shrink)

The pandemic of COVID-19 prompted several paradigm shifts throughout society, including in education. This study aimed to examine the relationships of students' engagement in online synchronous collaborative learning activities (OSCLA) with their self-efficacy (LSE), peer social support (LPSS), state of well-being (SWB), and level of academic performance (LAP). A total of 176 Filipino Grade 12 SHS students, 18 years old and older, from a private educational institution were purposively selected for this study. Data were generated using an online survey. Results (...) show that collaborative learning activities are frequently conducted (median = 4) in their synchronous online classes. It also revealed that their LSE is high (median = 4), their LPSS is high (median = 4), their LE is moderate (median = 3), their SWB is high (median = 4), and their LAP is high (median = 94.85). The results showed a statistically significant correlation of their LSE (r = 0.69, p 0.001) and LPSS with their OSCLA LE (r = 0.438, p 0.001). A statistically significant positive moderate correlation between LE and SWB (r = 0.536, p 0.001) was also found, however, no correlation was found between their OSCLA LE and LAP (r = 0.065, p = 0.393). Thus, the use of a well-designed OSCLA is strongly recommended as it positively impacts students' SWB but should be regularly reviewed for its effectiveness in sustaining improvement in the LAP of the students. (shrink)

According to what McMahan and Savulescu (2024) call the “popular position”, embryo selection is less ethically problematic than gene editing (other things being equal). The Two-Tier View, defended by McMahan and Savulescu, implies that the popular position is mistaken. The authors treat gene editing of embryos similarly to standard cases of medical treatments that promise expected benefits for the (subsequent) person even though gene editing also may create risks of harmful side effects for her. McMahan and Savulescu assume that if (...) gene editing is (successfully) done, it is better for the person who developed from the beneficently edited embryo. And, if the editing had not been done, although it was possible, that would have been worse for the same person in question. Thus, the comparator must always be a possible, even if unlikely, world in which she would have existed. That is why gene editing, in their view, resembles medical treatments. Therefore, assuming that standard medical treatments are not more ethically problematic than embryo selection, they conclude that (in general) gene editing should also be treated as not more problematic than embryo selection. In this paper, I am taking one step further than McMahan and Savulescu in questioning the central assumptions in the bioethical debates about new reproductive technologies. In the previous work, we argued that the very distinction between person-affecting and identity-affecting interventions is based on a questionable form of material-origin essentialism (Żuradzki and Dranseika 2022). Here, I argue that the bipartite distinction between person-affecting and impersonal reasons, as used by McMahan and Savulescu, insufficiently represents different possible counterfactual comparisons between real and merely possible outcomes. In particular, I argue that the evaluation of gene editing requires counterfactual comparisons to situations in which the benefited person might or might not exist. Such evaluation requires an additional class of reasons, let me call them “semi-person-affecting,” that cannot be reduced to either person-affecting or impersonal ones. This aspect of gene editing makes it dissimilar to standard cases of medical treatments. (shrink)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is (...) in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

This paper proposes that the question “What should I believe?” is to be answered in the same way as the question “What should I do?,” a view I call Equal Treatment. After clarifying the relevant sense of “should,” I point out advantages that Equal Treatment has over both simple and subtle evidentialist alternatives, including versions that distinguish what one should believe from what one should get oneself to believe. I then discuss views on which there is a distinctively (...) epistemic sense of should. Next I reply to an objection which alleges that non-evidential considerations cannot serve as reasons for which one believes. I then situate Equal Treatment in a broader theoretical framework, discussing connections to rationality, justification, knowledge, and theoretical vs. practical reasoning. Finally, I show how Equal Treatment has important implications for a wide variety of issues, including the status of religious belief, philosophical skepticism, racial profiling and gender stereotyping, and certain issues in psychology, such as depressive realism and positive illusions. (shrink)

Ketamine is a well-known and widely available general anesthetic from the 1960s that, in sub-anesthetic doses, has been adopted in a limited manner for the treatment of acute suicidality and treatment-resistant depression. Its short onset time and short duration of action make it feasible for use at outpatient clinics. In the US, it has a long history of off-label use and was officially approved for depression treatment in 2019. In Finland, it has been administered to selected hospitalized (...) patients in the public healthcare system since 2010 and became available at a private outpatient clinic very recently. In Norway, it has been administered off-label at a private clinic for approximately 500 patients since mid-2010s and at a public clinic for approximately 300 patients since 2020, with plans on opening more clinics in 2024. In the US, the treatment has been administered to hundreds of thousands of patients. -/- The retrospective ethnographic inquiry part of this study features a Finnish woman in her twenties who suffered from treatment-resistant depression, rooted in her insecure childhood and having been bullied at school, as well as income insecurity and excessive workload in adulthood. Eventually, she was violently raped, which induced an obvious post-traumatic stress disorder and exacerbated her depression, incapacitating her. In the course of approximately five years, she was prescribed ten different anti-depressive medications and seventeen other medications, including various antipsychotic medications and lithium. These failed to provide an anti-depressive effect but resulted in 'massive' adverse effects instead, including 60% weight gain and psychotic hallucinations. Eventually, esketamine spray treatment at a private outpatient clinic resolved her depression in a single session. A weekly re-administration process was ongoing. -/- In this case, repeated esketamine administration alleviated depression by producing accumulating corrective emotional experiences without the need to re-experience previous traumatizing events. In a few months to a year, the transient but accumulating anti-depressive effect typically leads to the resolution of depression in most cases, if the patients' living conditions no longer constantly re-traumatize them. It is necessary to adopt ketamine more widely as an emergency measure while more effective, non-addictive alternatives and complements are prepared for adoption. The cost of this specific pilot program implementation was unscalable, but costs can be reduced by approximately 90% by modifying the implementation details. Ketamine and its more effective alternative, 5-MeO-DMT, can serve a major role in facilitating a rebirth of public and private mental healthcare systems, with treatment efficacy multiplied and treatment costs simultaneously reduced. (shrink)

Sentences containing definite descriptions, expressions of the form ‘The F’, can be formalised using a binary quantifier ι that forms a formula out of two predicates, where ιx[F, G] is read as ‘The F is G’. This is an innovation over the usual formalisation of definite descriptions with a term forming operator. The present paper compares the two approaches. After a brief overview of the system INFι of intuitionist negative free logic extended by such a quantifier, which was presented in (...) (Kürbis 2019), INFι is first compared to a system of Tennant’s and an axiomatic treatment of a term forming ι operator within intuitionist negative free logic. Both systems are shown to be equivalent to the subsystem of INFι in which the G of ιx[F, G] is restricted to identity. INFι is then compared to an intuitionist version of a system of Lambert’s which in addition to the term forming operator has an operator for predicate abstraction for indicating scope distinctions. The two systems will be shown to be equivalent through a translation between their respective languages. Advantages of the present approach over the alternatives are indicated in the discussion. (shrink)

Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted (...) a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how (...) clinicians use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender (...) affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (shrink)

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, (...) that is, individuals who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research (...) suggests that practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

One of the most important theories in linear programming is the dualistic theory and its basic idea is that for every linear model has dual linear model, so that solving the original linear model gives a solution to the dual model. Therefore, when we solving the linear programming model, we actually obtain solutions for two linear models. In this research, we present a study of the models. The neutrosophic dual and the binary simplex algorithm, which works to find the optimal (...) solution for the original and dual models at the same time. The importance of this algorithm is evident in that it is relied upon in several operations research topics, such as integer programming algorithms, some nonlinear programming algorithms, and sensitivity analysis in linear programming. (shrink)

This article describes a case of a teenager with early complex trauma due to chronic domestic violence. Cannabis use triggered auditory hallucinations, after which the teenager was diagnosed with an acute schizophrenia-like psychotic disorder. Antipsychotic medication did not fully resolve symptoms. Eventually the teenager chose to self-medicate with LSD in order to resolve a suicidal condition. The teenager carried out six unsupervised LSD sessions, followed by an extended period of almost daily use of inhaled low-dose DMT. Psychotic symptoms were mostly (...) resolved after approximately one year. Subsequent cannabis use caused a transient relapse. -/- While his psychosis may have been due to cannabis use in the presence of a genetic predisposition, LSD and DMT did not promote psychotic symptoms in this case, and resolved the suicidal condition in one session. Additional high-dose LSD sessions and low-dose DMT sessions appeared to resolve the symptoms related to the early complex trauma. Alternatively, if psychosis is understood as a massive defense system resulting from early complex trauma, and if his psychotic symptoms were partially due to such trauma, psychedelics appeared to transcend this defense system, providing access to traumatic memories in order to allow for an integrative treatment effect. -/- Information was acquired from medical record excerpts provided by the patient, a semi-structured retrospective video interview, and follow-up interviews a year later. The present case suggests a need for further studies on the relationship between psychedelics and psychotic disorders, the feasibility of supervised vs unsupervised settings for various situations, and alternative therapeutic models for utilizing the hyperaware-hypersensitive state induced by psychedelics. With regard to self-treatment, a harm reduction approach should be adopted. Low-risk psycholytic self-treatment protocols could be developed for future use in public health care systems. (shrink)

Normal interpersonal treatment is often based on the existence of the rational nature of both the agent and the target of the treatment, and their relationship is reciprocal and mutual. However, when the rational person confronts the irrational person, such as the mentally retarded or vegetative person, the reciprocal relationship cannot be maintained because the targeted person loses his or her rational capacity. But this inequality does not deprive the object of action of the right to be treated (...) rationally, because people treat the irrationally disabled not according to the principle of reason but according to the principle of emotion - specifically, the principle of love. The principle of love often disregards the specific conditions of the object of treatment and still treats them reasonably. Thus, the emotional principle has a broader application in interpersonal treatment. (shrink)

Schizophrenia is often associated with other physical and mental problems. Generalized anxiety disorder is notably one of the comorbid disorders which is often linked to schizophrenia. The association of polythematic delusions and of ideas resulting from generalized anxiety disorder complicates the exercise of the corresponding cognitive therapy, for the resulting ideas are most often inextricably intertwined. In what follows, we endeavour to propose a methodology for the differential treatment of polythematic delusions inherent to schizophrenia when combined with ideas originating (...) from generalized anxiety disorder. We propose, with regard to the corresponding content of delusions, an analysis which allows under certain conditions, to separate the content associated with polythematic delusions and the one that relates to generalized anxiety disorder, in order to facilitate the exercise of the corresponding cognitive therapy. (shrink)