In this article I clarify the concepts of ‘pain’, ‘suffering’. ‘pains of body’, ‘pains of soul’. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis. treatment and research. Next, there is (...) the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfihing these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if anv, should override the right to refuse treatment where pain relief is of paramount concern. (shrink)

The spread of misinformation and fake news raises important problems for our society and for our democracy. From the January 6 attack on the U.S. Capitol to vaccine hesitancy, from suppressing voter turnout to peddling conspiracy theories, we know that these problems are real and need to be taken seriously. While misinformation is not a new problem for democracy, it can spread more quickly and easily because of new media’s design and popularity. Given these problems, it is encouraging that some (...) technology companies are taking steps to reduce the spread of misinformation and fake news on the platforms they manage. Despite this seemingly positive development, some scholars have criticized some interventions designed to combat the spread of misinformation and fake news as paternalistic. For example, a 2019 Facebook intervention called Click-Gap aimed to reduce the amount of low-quality content (including fake news and misinformation) that users see on their NewsFeed. Click-Gap has been criticized as an instance of epistemic paternalism because it was adopted (1) with the goal of improving the epistemic status of its users and (2) irrespective of what the company believed the wishes of its users to be. If interventions like Click-Gap are problematic because paternalistic, those of us interested in the ethics of technology would face a dilemma—either endorse technology companies treating their users paternalistically or endorse their failing to act to combat the spread of misinformation and fake news on their platforms. Both options seem to me to be problematic. While paternalism may sometimes be permissible, I think we should be very hesitant to endorse a paternalistic relationship between technology companies and their users. The relationship does not seem to bear the right sort of structure to one in which paternalism might be appropriate, if it ever is. The second option seems, if anything worse: surely technology companies should not stand by and change nothing about their platforms despite the spread of misinformation and fake news in those spaces. In this paper, I argue that Click-Gap and interventions like it are not paternalistic, contrary to the conclusion of other scholars. Further, I will argue that the focus on paternalism itself is actually a red herring here. While not just any intervention or strategy that purports to reduce fake news and misinformation is permissible, we should want technology companies to take user well-being seriously and be able to take that well-being as a direct reason for action. Their doing so is not paternalistic nor even morally problematic, and it should not be criticized as such. (shrink)

Low back pain (LBP) carries a high risk of chronicization and disability, greatly impacting the overall demand for care and costs, and its treatment is at risk of scarce adherence. This work introduces a new scenario based on the use of a mobile health tool, the Dress-KINESIS, to support the traditional rehabilitation approach. The tool proposes targeted self-manageable exercise plans for improving pain and disability, but it also monitors their efficacy. Since LBP prevention is the key strategy, the (...) tool also collects real-patient syndromic information, shares valid educational messages and fosters self-determined motivation to exercise. Our analysis is based on a comparison of the performance of the traditional rehabilitation process for non-specific LBP patients and some different scenarios, designed by including the Dress-KINESIS’s support in the original process. The results of the simulations show that the integrated approach leads to a better capacity for taking on patients while maintaining the same physiotherapists’ effort and costs, and it decreases healthcare costs during the two years following LBP onset. These findings suggest that the healthcare system should shift the paradigm towards citizens’ participation and the digital support, with the aim of improving its efficiency and citizens’ quality of life. (shrink)

- First book to describe what pain means in vulnerable or special groups of people - Clinical applications described in each chapter - Provides insight into the nature of pain experience across the lifespan -/- This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. -/- Immediate pain warns (...) of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair. -/- Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. -/- This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management. -/- Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019. (shrink)

Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, (...) I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders. (shrink)

The world population is aging rapidly. Fear of falling among the elderly constitute a significant problem in health care. Among community-dwelling elderly, fear of falling is frequent, with prevalence ranging from 3% to 85% % in community-based epidemiologic studies. The aim of this review is to reveal the prevalence and risk factors of fear of falling (FOF) among elderly. The review has identified that age, sex, physical performance, comorbidity, a history of falls, hearing impairment, poor self-related health and depressive symptoms (...) affect fear of falling. The consequences that develop as a result of a fear of falling can include: loss of confidence, decreased quality of life, mobility or activity restriction and the development of deconditioning, leading to loneliness, depression, and anxiety, subsequent falls and physical, psychological and mental function declines. Maintenance of physical function and pain management might be important for older adults with fear of falling. (shrink)

The ability to anticipate events, to foresight, is an adaptive advantage. We humans use it all the time. Animals have a limited access to it. Positioning foresight in human evolution is a complex subject (Suddendorf, 2013). Why and how are humans, and not chimpanzees, performant in anticipating events? We propose here to address that question with an evolutionary scenario that links self-consciousness to anxiety management (Menant, 2018). The scenario positions self-consciousness as “the capability to represent one’s own entity as (...) existing in the environment, like conspecifics are represented as existing” (making “thinking about oneself” possible). The scenario proposes that our pre-human ancestors were capable of some level of identifications with their conspecifics, and that its development has progressively brought our ancestors to represent themselves as existing in the environment like their conspecifics were represented, thus introducing self-consciousness. The scenario also proposes that identifications with suffering conspecifics have been the source of an important anxiety that had to be limited for evolution to continue. Some of our ancestors have not been able to limit that new anxiety. Their mental pain became unbearable. Their evolution was almost stopped, thus initiating the pan-homo split. Developing an ability to anticipate events has been a key contributor to anxiety limitation by providing information about the sufferings to come, and consequently allowing to limit and avoid them. In addition to that role of foresight in human evolution it is worth noticing that the associated chaining of mental events brings to propose foresight as an entry point to the concept of causality in human evolution. Regarding our chimpanzee cousins, the pan-homo split in the scenario positions them as not self-conscious, not capable of anticipation like humans are, and less anxious than humans. Continuations are proposed. (shrink)

A number of experiences have demonstrated how digital solutions are effective in improving quality of life (QoL) and health outcomes for older adults. Smart Health Age-Friendly Environments (SHAFE) is a new concept introduced in Europe since 2017 that combines the concept of Age-Friendly Environments with Information Technologies, supported by health and community care to improve the health and disease management of older adults and during the life-course. This chapter aims to provide an initial overview of the experiences available not (...) only in Europe, based on the research work of the participants of the International Interdisciplinary Network on Health and Well-being in an Age-Friendly Digital World (NET4Age-Friendly), which could be of interest to preventive, health and social authorities. The chapter reports good practices, pain points, and bottlenecks that may require a collaborative, interdisciplinary research approach to facilitate the transformations towards smart, sustainable, health and age-friendly cities and communities. (shrink)

Warts and verrucas are common skin conditions caused by the human papillomavirus (HPV) infection. They present as raised, rough, or bumpy growths on the hands, feet, or other areas subjected to friction or pressure. Plantar warts exhibit a rough surface with small black dots, while genital warts have a cauliflower-like appearance. Pain or itchiness may accompany these lesions. Factors such as close contact with infected individuals and immune compromise can impact the severity and spread of warts. Diagnosis is primarily (...) based on clinical examination, and referral to a dermatologist may be necessary for uncertain cases. Treatment options range from over-the-counter remedies to professional interventions. Persistent or symptomatic lesions should be evaluated by a healthcare professional. Improved understanding and effective management of warts and verrucas are essential for optimal patient outcomes. (shrink)

Introduction: The incidence of chronic low back pain (LBP) is very high in Bangladesh. There is a high prevalence of psychiatric diseases among chronic low back pain patients. But primary care physicians and specialists do not screen this association. The aims of this study were to evaluate the incidence and pattern of psychiatric diseases in chronic low back pain patients. Materials and methods: A prospective cross-sectional hospital-based study of 135 chronic low back pain patients using simple, (...) direct, standardized questionnaire including history and detailed psychiatric evaluation by a consultant psychiatrist from January to December 2014. Results: A total 69 chronic low back pain patients (51.1%) were diagnosed with psychiatric problems. Predominant group were female (65.9%), above 40 years of age (60.7%). Depression (44.9 %) and anxiety (31.9%) were the major psychiatric illness diagnosed (76.8%). Only 17.4 % patients expects complete cure. Fear of disease outcome was the commonest precipitating factor found (66.6%). With the adjuvant psychiatric management, 81.1% showed improvement clinically. Conclusion: Detecting the level of psychiatric illness among chronic low back pain patients at early stage will improve the treatment outcome. A referral system to psychiatrists by physicians needs to develop to screen the mental disorder symptoms to treat the problem. (shrink)

What does it mean to treat people as equals when the legacies of feudalism, religious persecution, authoritarian and oligarchic government have shaped the landscape within which we must construct something better? This question has come to dominate much constitutional practice as well as philosophical inquiry in the past 50 years. The combination of Second Wave Feminism with the continuing struggle for racial equality in the 1970s brought into sharp relief the variety of ways in which people can be treated unequally, (...) while respecting the formalities of constitutional government. Most obviously, the content of laws can mistreat them by wrongfully assuming that they are either threats to others, or that, like children, they need to be protected from harm through paternalistic limitations on their freedom of action. Or, as those concerned with class inequality have long noted, formal equality can create legal requirements, permissions, and prohibitions whose burdens fall predictably, and often solely, on groups who are already marginalised, and most in need of state protection. (Kairys, David 1990) Above all, what these two great political movements made plain, is that a concern for group inequality and, specifically, group injustice must figure in the formulation and adjudication of individual rights, if legal protections for equality are adequately to combat the causes of inequality. Getting to grips with that challenge, it became obvious, required going beyond the familiar analyses of inequality inherited from Liberalism and Marxism, given the many different ways in which people can be equal or unequal.(Hackett and Haslanger 2006, 3 - 15) In the first part of this chapter, I will seek to illustrate these claims, by focusing on efforts to reframe the theory and practice of constitutional equality given demands for sexual and racial equality. I will then show that analytic philosophy has also come to recognise the various non-reducible dimensions of equality in ways that reinforce the claims of critical legal theory, even as philosophers highlight their disconcerting consequences. If equality has multiple irreducible dimensions, conflicts between the legitimate demands of equality are unavoidable features of law and politics, even in the best possible world, and are likely to be particularly painful when set against a background of historical injustice. The chapter concludes with the challenges to democratic constitutionalism, and the scope for constructive responses to those challenges, which the rapprochement between critical and analytic thinking on equality suggests. (shrink)

Children are routinely treated paternalistically. There are good reasons for this. Children are quite vulnerable. They are ill-equipped to meet their most basic needs, due, in part, to deficiencies in practical and theoretical reasoning and in executing their wishes. Children’s motivations and perceptions are often not congruent with their best interests. Consequently, raising children involves facilitating their best interests synchronically and diachronically. In practice, this requires caregivers to (in some sense) manage a child’s daily life. If apposite, this management (...) will focus partly on a child’s well-being. To be ably executed, an account of children’s well-being will need to be articulated. This chapter focuses on the nature of children’s well-being. It has five sections. The first section clarifies the focus. The second section examines some hurdles to articulating a view of children’s well-being. The third section evaluates some accounts of children’s well-being. The fourth section addresses the view that children possess features essential to them that make their lives on balance prudentially bad for them. The fifth section sums things up. (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)

ABSTRACT A new ‘political philosophy’ is indispensable to the ‘post-Corona world,’ and this paper tries to analyze the future of ‘liberal democracy’ in it. It shows that ‘liberal democracy’ faces a ‘global crisis’ that has begun before, but the ‘novel Coronavirus pandemic,’ as a setback for it, strongly encourages that crisis. ‘Liberalism’ and ‘democracy,’ which had long been assumed by ‘political philosophers’ to go together, are now becoming decoupled, and the ‘liberal values’ of ‘democracy’ are eroding. To find why and (...) how, this paper analyzes ‘authoritarianism,’ ‘totalitarianism,’ and the evils and propensities of ‘democracy’ that bring about further erosions of ‘liberal values.’ There may be difficult trade-offs to be made between ‘liberal’ and ‘authoritarian’ ‘values’ - and, after the experience of ‘Coronavirus,’ this paper shows the ‘illiberal or authoritarian democracy’ may become stronger. -/- KEYWORDS: democracy, liberalism, liberal democracy, illiberal democracy, the novel Coronavirus pandemic, Covid-19, authoritarianism, totalitarianism. -/- EXTENDED ABSTRACT For almost a century in West, ‘democracy’ has meant ‘liberal democracy’-a political system marked not only by ‘free and fair elections,’ but also by ‘liberal values.’ ‘Liberalism’ applied to the problem of the limits of the criminal law would require commitment to the presumption in favor of ‘liberty.’ If the word ‘liberal’ is to have any utility in this context, it should refer to one who has so powerful a commitment to ‘liberty’ that she is motivated to limit the number of acknowledged liberty-limiting or coercion-legitimizing principles as narrowly as possible. So, she only believes in ‘harm-principle’ as the morally relevant reason for criminal prohibitions. ‘Offense principle’ and ‘paternalistic’ and ‘moralistic’ considerations, when introduced as support for penal legislation, have no weight at all. So, it means ‘autonomy’ and ‘self-regarding vs. other-regarding actions distinction’ based on which the human is the owner of her mind and body and everything consenting adults do is beyond the realm of morality and law. It leads to ‘individual’ ‘basic rights and liberties’ such as ‘basic rights and liberties’ of ‘speech,’ ‘religion,’ and ‘property’ and ‘collective’ ‘basic rights and liberties’ such as ‘basic rights and liberties of assembly,’ ‘civil society,’ ‘political pluralism,’ ‘democratic institutions,’ and ‘non-governmental organizations.’ ‘Liberalism’ also believes in ‘equality of conditions, ‘equal and free participatory rights in political decision making,’ and ‘collective self-governance.’ It also believes in the ‘rule of law,’ a ‘separation of powers,’ and ‘checks and balances.’ However, even under fair and free elections, the elected leaders can be ‘populists,’ ‘ultra-nationalists,’ ‘racists,’ ‘fascists,’ and ‘authoritarians’ who do not respect ‘inviolable basic rights and liberties,’ and suppress ‘minorities.’ Democratically elected leaders can routinely ignore constitutional limits on their power and deprive their citizens of ‘basic rights and liberties.’ The two strands of ‘liberal democracy’ have been coming apart in the world, and the ‘liberal’ elements of ‘democracy’ have been fraying and eroding even before the ‘novel Coronavirus pandemic.’ Even before the Coronavirus hit, there was already much discussion of a crisis of ‘liberal democracy.’ In particular, there has been a debate about whether ‘liberalism’ and ‘democracy,’ which had long been assumed to go together, were becoming decoupled. This paper shows ‘liberal democracy’ faces a ‘global crisis’ that had begun before the ‘novel Coronavirus pandemic.’ It also analyzes ‘authoritarianism,’ ‘totalitarianism,’ ‘liberalism,’ and ‘democracy’ and shows that Covid-19 is a setback for ‘liberal democracy.’ What is striking about the current moment is that many of the ‘liberal’ elements of ‘democracy’ are so far holding up under immense pressure. ‘Illiberal democracies’ seemed to be emerging in many countries. This model of ‘illiberal democracy,’ in which elections continue to be held but some individual rights and liberties are curtailed, may emerge stronger from this new crisis. In that sense, the ‘pandemic’ may become a challenge not only to ‘democracy’ as such but also to ‘liberal democracy’ in particular – in other words, a system of popular sovereignty together with guaranteed basic rights, such as freedom of association and expression and checks and balances on executive power. ‘Authoritarian’ procedures may succeed in mitigating the spread of the ‘Coronavirus,’ but the world now faces another problem: that when the virus recedes, many ‘liberal democracies’ will be far less ‘liberal’ or ‘democratic’ than they were before. In times of crisis, ‘liberal values’ have been ignored temporarily in the name of executive power. However, the ‘temporary’ can become ‘permanent.’ In addition, if citizens lose their faith in the legitimacy of ‘liberal democracy’ as the best form of government, and think ‘liberal democracy’ cannot function effectively during a crisis, and ‘authoritarian regimes’ manage the crisis more decisively, the world will slide towards ‘illiberal or authoritarian democracy,’ and many ‘liberal democracies’ will be at grave risk of failure. There may now be difficult trade-offs to be made between those basic rights and security - and, after the experience of Covid-19, many citizens may choose security. (shrink)

Drawing from Bakhtin and Habermas, I will show how the different voices in Gordimer's novel seem to be enacting a democratic public sphere in which no voice is granted authority over others – a public sphere which carries the promise of countering the social and political hierarchies established by the racist South African regime. The promise, however, turns out to be an illusion. As I will demonstrate, the possibility of an Enlightenment bourgeois public sphere which the novel seems to be (...) gesturing at is being irreparably undermined by racism. In a country where the Enlightenment aspiration to universalism and equality before the law are glaringly contravened by racism, Rosa Burger is painfully aware of her inability to fully access the predicament of the blacks. As such, Burger’s daughter remains only Burger’s daughter, and the children of Soweto the children of Soweto; at no point in the novel do they truly intermingle. Despite the fact that both are fighting racism – and the novel is devoted to the “coming-of-age” of both kinds of children – Rosa Burger remains only the daughter of a Bürger at the end of the novel, not the daughter of South Africa, much less to say the daughter of Black South Africa. She has finally “come into her own,” but the “self” she manages to realize is at best that of a disillusioned bourgeois individual (that of a disillusioned Bürger, so to speak) – a “self” that recalls Hegel’s “beautiful soul.” To appropriate György Lukács’s language, Bürger’s Daughter could be described as “modern bourgeois literature bear[ing] witness against bourgeois society.”. (shrink)

We propose a pluralist account of content for predictive processing systems. Our pluralism combines Millikan's teleosemantics with existing structural resemblance accounts. The paper has two goals. First, we outline how a teleosemantic treatment of signal passing in predictive processing systems would work, and how it integrates with structural resemblance accounts. We show that the core explanatory motivations and conceptual machinery of teleosemantics and predictive processing mesh together well. Second, we argue this pluralist approach expands the range of empirical cases to (...) which the predictive processing framework might be successfully applied. This is because our pluralism is practice-oriented. A range of different notions of content are used in the cognitive sciences to explain behaviour, and some of these cases look to employ teleosemantic notions. As a result, our pluralism gives predictive processing the scope to cover these cases. (shrink)

Is the history of philosophy primarily a contribution to PHILOSOPHY or primarily a contribution to HISTORY? This paper is primarily contribution to history (specifically the history of New Zealand) but although the history of philosophy has been big in New Zealand, most NZ philosophers with a historical bent are primarily interested in the history of philosophy as a contribution to philosophy. My essay focuses on two questions: 1) How did New Zealand philosophy get to be so good? And why, given (...) that is so good (a point I am at pains to establish), has it apparently had so slight a cultural impact within New Zealand itself? Did we get the wrong Anderson – the uninspiring William, who was Professor at Auckland, rather than his talented younger brother John, who had such a huge cultural influence as Professor of Philosophy at Sydney? Perhaps but that can only be part of the story since we managed to attract even bigger stars, (notably Karl Popper) as well as breeding bigger talents of our own (Prior, Baier, Bennett, Mulgan, Hursthouse, Waldron and many more). Do we export our best talent? Sometimes – but the stars that stay and the stars who arrive don’t seem to have much impact in New Zealand itself however brightly they shine in the international philosophical firmament. Is it too esoteric? Perhaps, but esoteric philosophy can still have a cultural impact, witness, Moore, Popper and the younger Anderson. Is it, like many of New Zealand’s cultural products (from romance novels to movies), primarily intended for an international audience? That’s a large part of the answer but only a part. Another part of the answer is that philosophy HAS had a cultural impact but that impact is not readily apparent. For NZ philosophers have been less keen to push their ideological barrows and more keen to produce critical thinkers, and critical thinkers don’t all think alike. The logician George Hughes was apparently a life-changing teacher not because he had a nostrum but because he taught people to think. As one of his students said ‘the only ism you believe in is the syllogism’. On the whole the history of New Zealand Philosphy is a ‘From Log Cabin to White House’ tale, ‘From colonial obscurity through struggle and adversity to philosophical excellence’. But there are shadows in the picture. Some departments have nearly come to grief through bureaucratic and political misadventures, and it is hard to resist the suspicion that there is often an element of hostility to philosophers on the part of both university bureaucrats and fellow-academics. I speculate as to why this is the case (we are too argumentative and don’t confine our argumentative tendencies to the cloister) but conclude with some upbeat reflections. on the future of New Zealand Philosophy. (shrink)

Paternalistic interventions restrict individuals’ liberty or autonomy so as to guide their decisions towards options that are more beneficial for them than the ones they would choose in the absence of such interventions. Although some philosophers have emphasised that there is a case for justifiable paternalism in certain circumstances, much of contemporary moral and political philosophy works from a strong presumption against paternalistic interventions. However, Richard Arneson has argued that there are egalitarian reasons that support the case for (...) class='Hi'>paternalism: paternalistic interventions can protect poor decision-makers from making ‘bad’ choices, thus preventing inequalities between them and those with better decision-making skills. This paper seeks to clarify and advance our understanding of the egalitarian argument for paternalism. Arneson’s argument adds an important and often neglected dimension to the debate about paternalism but also raises a number of questions about equality, paternalism and the relationship between the two. (shrink)

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these (...) powers, my version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

What makes paternalism wrong? I give an indirect answer to that question by challenging a recent trend in the literature that I call the exclusionary strategy. The exclusionary strategy aims to show how some feature of the paternalizee’s normative situation morally excludes acting for the paternalizee’s well-being. This moral exclusion consists either in ruling out the reasons for which a paternalizer may act or in changes to the right-making status of the reasons that (would) justify paternalistic intervention. I argue (...) that both versions of the exclusionary strategy fail to explain the wrongness of paternalism and that they struggle to accommodate the mainstream view that paternalism is only pro tanto wrong. Their failure consists either in being implausibly strong expressions of antipaternalism or in struggling to spell out the scope of exclusion in an uncomplicated way. After discouraging this exclusionary strategy, I suggest we can capture what is appealing about it—as well as avoiding its pitfalls—by sketching a philosophical model in which we compare the weights of reasons for and against paternalistically interfering. To precisify this sketch, I introduce some conceptual tools from the literature on practical reasoning—in particular, the concept of modifiers—and suggest that these tools offer a better starting point for figuring out what makes paternalism (pro tanto) wrong. (shrink)

From the refusal of some parents to apply some vaccines to their children, in this work we will show that to act properly it is not enough with a good intellectual justification to validate a belief as accurate, it will be necessary to take into account also the systematic actions in relation to which we are constituted, as well as the feelings that accompany those actions. We begin by exposing the notion of belief that Villoro presents from authors such as (...) Braithwaite and Bain. Next, we briefly explain the topic of the justification of beliefs and then articulate it with some of the controversies related to the application of vaccines. Later, we turned to Hume to show the role of imagination in relation to pleasure and pain in decision making. Finally, we present an outline of the discussion about paternalism in the application of vaccines. (shrink)

The military-industrial complex, military operations, and wars are major contributors to exacerbating both climate change and biodiversity crises. However, their environmental impacts are often shadowed due to national security reasons. The current paper aims to go through the devastating impacts of military operations and wars on climate change and biodiversity loss and challenges that hinder the inclusion of military-related activities into environmental crisis mitigation efforts. The information blind spot induced by concerns about national security reasons jeopardizes the efforts to involve (...) the military-industrial complex and military operations in the global climate and biodiversity agendas. Besides that, many military-related challenges, such as specificity of operational requirements and lifecycles, dependence on fossil fuels, complex supply change, inadequate civilian technologies and innovations, and requirements of structural changes, can hinder emission reduction. Meanwhile, wars and conflicts not only threaten to drain all human and material resources available to tackle environmental problems but also inflict long-lasting destructions, pains, and trauma that can lead to hatred and distrust among nations and parties. With the rising hatred and distrust, global agreement and commitment to address climate change and biodiversity will hardly be achieved. Thus, promoting peace is the humanistic and planetary conscience. (shrink)

Theories have been formulated to address the problem of evil [“The concept of Evil”. Stanford Encyclopedia of Philosophy]. We look here at a possible origin of human evil in pre-human times by using an evolutionary scenario for self-consciousness based on identifications with conspecifics [“Proposal for an evolutionary approach to self-consciousness”. Menant 2014]. The key point is that these identifications have also taken place with suffering or endangered conspecifics, thus creating in the minds of our ancestors a huge anxiety increase, a (...) mental pain unbearable if not limited. To limit it our ancestors could have reduced the sufferings and dangers, or reduced the identification, or limited the conspecificity. Reducing the sufferings and dangers was straightforward as it also brought in evolutionary advantages (collaboration, imitation, communication, ToM, ...), with some pleasant feeling coming with the reduction of anxiety. But the two other possibilities may have produced very different outcomes. Reducing the identifications and limiting the conspecificity did reduce the mental pain and correspondingly produce some pleasure. But it has also lowered the emotional attachment to conspecifics as well as the care given to them. Conspecifics were then left alone with their sufferings. And as the process led to less mental pain, our ancestor were naturaly led to associate some pleasure to these sufferings of conspecifics. All this may have introduced in the mind of our ancestors the possibility to reduce anxiety and mental pains also by accepting and valorizing the sufferings of others, thus making evil deeds a potential source of pleasure. We propose these mechanisms as possible sources of psychology of evil in human evolution. These mechanisms now belong to our human nature where evil projects can become a means for limiting the unconscious anxiety present in our human minds. Such positioning of self-consciousness and human evil under a common evolutionary nature is new and needs more developments. Continuations are proposed. (shrink)

Here I pursue two main aims: (1) to articulate and defend a Kantian conception of duties to self, and (2) to explore the ramifications of such duties for the moral justification of paternalism. I conclude that there is a distinctive reason to resent paternalistic intercessions aimed at assisting others in fulfilling their duties to self (or the self-regarding virtues necessary thereunto), based on the fact that the goods realized via their fulfillment are historical, i.e., their value depends on an (...) individual's casual contribution to their fulfillment. (shrink)

This paper argues that participation in an intimate relationship can generate additional or stronger reasons for one to act paternalistically toward the intimate. Moreover, participation in such a relationship can also weaken or cancel some of the presumptive reasons of respect one would otherwise have not to interfere. The paper also reflects, more generally, on the nature of intimate relationships, the normative significance of paternalism, and the normative differences between paternalism in larger-scale institutional contexts and paternalism in (...) closer, interpersonal ones. -/- . (shrink)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in (...) her Natural Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

Are there any deep or systematic connections between paternalism and people's rights? Perhaps the connection is definitional: part of what makes an action or policy paternalistic is that it violates a right. Or perhaps the connection is normative: paternalism is (always? often? only sometimes?) morally problematic because it violates people's rights (even if we don't define "paternalism" in terms of a rights violation). My main goal in this paper is to argue for the normative connection. Part of (...) the task will be to explain exactly what the normative connection is. That will involve answering the questions embedded in the claim as well as offering an account of the right(s) that is (are) connected to paternalism's normative status. (shrink)

This paper is based on a criterion recently proposed by Richard Fumerton for demarcating philosophy of mind and cognitive science. I suggest to extend it to a demarcation criterion between philosophy and science in general, and put it in the context of the historical changes of boundaries between the philosophical and the scientifi c fi eld. I point to a number of philosophical claims and approaches that have been made utterly obsolete by the advancement of science, and conjecture that a (...) similar thing may happen in the future with today’s philosophy of mind: under the supposition that cognitive science manages to progress very successfully in a certain direction, our concepts for mental states could change, and the type of philosophical interest we put in them, thus reshaping thewhole debate on the subject. (shrink)

This paper challenges the two aims of Michael Cholbi’s Rational Will View (RWV) which are to (1) offer an account of why paternalism is presumptively or pro tanto wrong and (2) relate the relative wrongness of paternalistic interventions to the rational powers that such interventions target (Sections 1 and 2). Some of a paternalizee’s choices harm their future selves in ways that would be wrong if they were done to others. I claim this challenges Cholbi’s second aim (2) because (...) the cases his account deems particularly wrong turn out to be not to be as wrongful as expected (Section 3). When this second aim is challenged, it has knock-on effects on the capacity of the RWV to discern which cases of paternalism are generally more wrongful than others, which undermines Cholbi’s first aim (1). I consider responses on behalf of Cholbi’s view but conclude that the account is insufficient on its own to vindicate its two aims (Section 4). Finally, I draw on recent work that adopts ideas from the practical reasoning literature to help determine paternalism’s wrongness (Section 5). I argue this helps Cholbi’s view withstand my objections, but we must remain skeptical of why interceding with rational powers is particularly wrong. (shrink)

Defends Kantian paternalism: Interference with an individual’s liberty for her own sake is justified absent her actual consent only to the extent that such interference stands a reasonable chance of preventing her from exercising her liberty irrationally in light of the rationally chosen ends that constitute her conception of the good. More specifically, interference with an individual’s liberty is permissible only if, by interfering, we stand a reasonable chance of preventing that agent from performing actions she chose due to (...) distorted reasoning and which would result in that agent’s rationally chosen ends not being as fully realized as they would have been had she so acted. -/- Applied to suicide intervention Kantian paternalism implies that such intervention is justified to the extent that it prevents a person from ending her life when, due to distorted reasoning, she engages in suicidal behavior that is at odds with her rationally chosen ends. (shrink)

Childhood looms large in our understanding of human life as it is a phase through which all adults have passed. Childhood is foundational to the development of selfhood, the formation of interests, values and skills and to the lifespan as a whole. Understanding what it is like to be a child, and what differences childhood makes, are essential for any broader understanding of the human condition. The Routledge Handbook of the Philosophy of Childhood and Children is an outstanding reference source (...) to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising over thirty chapters by a team of international contributors the Handbook is divided into five parts: ¿ Being a child ¿ Childhood and moral status ¿ Parents and children ¿ Children in society ¿ Children and the state. Questions covered include: What is a child? Is childhood a uniquely valuable state, and if so why? Can we generalize about the goods of childhood? What rights do children have, and are they different from adults¿ rights? What gives people a right to parent? What role, if any, ought biology to play in determining who has the right to parent a particular child? What kind of rights can parents legitimately exercise over their children? What roles do relationships with siblings and friends play in the shaping of childhoods? How should we think about sexuality and disabilility in childhood, and about racialised children? How should society manage the education of children, and what values should inform such practices? What is a good school? How are children¿s lives affected by being taken into social care? The Routledge Handbook of the Philosophy of Childhood and Children is essential reading for students and researchers in philosophy of childhood, political philosophy and ethics as well as those in related disciplines such as education, psychology, sociology, social policy, law, social work, youth work, neuroscience and anthropology. (shrink)

I first provide an analysis of Joel Feinberg’s anti-paternalism in terms of invalidation of reasons. Invalidation is the blocking of reasons from influencing the moral status of actions, in this case the blocking of personal good reasons from supporting liberty-limiting actions. Invalidation is shown to be distinct from moral side constraints and lexical ordering of values and reasons. I then go on to argue that anti-paternalism as invalidation is morally unreasonable on at least four grounds, none of which (...) presuppose that people can be mistaken about their own good: First, the doctrine entails that we should sometimes allow people to unintentionally severely harm or kill themselves though we could easily stop them. Second, it entails that we should sometimes allow perfectly informed and rational people to risk the lives of themselves and others, though they are in perfect agreement with us on what reasons we have to stop them for their own good. Third, the doctrine leaves unexplained why we may benevolently coerce less competent but substantially autonomous people, such as young teens, but not adults. Last, it entails that there are peculiar jumps in justifiability between very similar actions. I conclude that as liberals we should reject anti-paternalism and focus our efforts on explicating important liberal values, thereby showing why liberty reasons sometimes override strong personal good reasons, though never by making them invalid. (shrink)

Recent work by Stout and colleagues indicates that the neural correlates of language and Early Stone Age toolmaking overlap significantly. The aim of this paper is to add computational detail to their findings. I use an error minimisation model to outline where the information processing overlap between toolmaking and language lies. I argue that the Early Stone Age signals the emergence of complex structured representations. I then highlight a feature of my account: It allows us to understand the early evolution (...) of syntax in terms of an increase in the number and complexity of models in a cognitive system, rather than the development of new types of processing. (shrink)

That all pleasure is good and all pain bad in itself is an eternally true ethical principle. The common claim that some pleasure is not good, or some pain not bad, is mistaken. Strict particularism (ethical decisions must be made case by case; there are no sound universal normative principles) and relativism (all good and bad are relative to society) are among the ethical theories we may refute through an appeal to pleasure and pain. Daniel Dennett, Philippa (...) Foot, R M Hare, Gilbert Harman, Immanuel Kant, J. L. Mackie, and Jean-Paul Sartre are among the many philosophers addressed. (shrink)

Pain may appear to undermine the radically intentionalist view that the phenomenal character of any experience is entirely constituted by its representational content. That appearance is illusory. After categorizing versions of pain intentionalism along two dimensions, I argue that an 'objectivist' and 'non-mentalist' version is the most promising, if it can withstand two objections concerning what we say when in pain, and the distinctiveness of pain. I rebut these objections, in a way available to both opponents (...) of and adherents to the view that experiential content is entirely conceptual. (shrink)

Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely (...) on such appeals. I argue that in cases where an agent will undergo a significant alteration in their evaluative outlook – ‘evaluative shift’ – three central, persuasive objections to paternalism lose their force, and offer a prima facie case for paternalism in some of these cases. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism may be justified. (shrink)

Insufficient vaccination coverage is an important public health problem in many countries, since it leads to the loss of herd protection and the resurgence of previously exterminated diseases. However, policies of mandatory childhood vaccination capable of raising vaccination rates continue to be controversial. In this article I review the arguments for mandatory childhood vaccination, setting out the strongest teleological argument in favour, and then critically examining the two strongest potential objections: paternalism and the parental prerogative. I argue that the (...) challenge of paternalism fails because it confuses the identities of those subject to restricted liberty and those who autonomously dissent, and because non-vaccination imposes risks on others. I argue that the challenge of a parental prerogative fails because it cannot be intuitively or theoretically supported in a form that would make it permissible to impose risks on others. I conclude that in lieu of further and more plausible objections at least some policies of mandatory childhood vaccination are morally permissible. (shrink)

Thaler and Sunstein advocate 'libertarian paternalism'. A libertarian paternalist changes the conditions under which people act so that their cognitive biases lead them to choose what is best for themselves. Although libertarian paternalism manipulates people, Thaler and Sunstein say that it respects their autonomy by preserving the possibility of choice. Conly argues that libertarian paternalism does not go far enough, since there is no compelling reason why we should allow people the opportunity to choose to bring disaster (...) upon themselves if sometimes they will make the wrong decision. She defends 'coercive paternalism'. The present paper argues that errors in reasoning are not due only to cognitive biases. People also make errors because they have an insufficient level of general intelligence. Intelligence is distributed on a continuum. Those who fall on higher levels of the continuum have greater abilities, in certain contexts, to reason about both their own and others' interests. Coercive paternalism may sometimes be appropriate to prevent less intelligent people from engaging in self-destructive behavior due to errors of reasoning. (shrink)

The essential difficulty about Computer Ethics' (CE) philosophical status is a methodological problem: standard ethical theories cannot easily be adapted to deal with CE-problems, which appear to strain their conceptual resources, and CE requires a conceptual foundation as an ethical theory. Information Ethics (IE), the philosophical foundational counterpart of CE, can be seen as a particular case of environmental ethics or ethics of the infosphere. What is good for an information entity and the infosphere in general? This is the ethical (...) question asked by IE. The answer is provided by a minimalist theory of deseerts: IE argues that there is something more elementary and fundamental than life and pain, namely being, understood as information, and entropy, and that any information entity is to be recognised as the centre of a minimal moral claim, which deserves recognition and should help to regulate the implementation of any information process involving it. IE can provide a valuable perspective from which to approach, with insight and adequate discernment, not only moral problems in CE, but also the whole range of conceptual and moral phenomena that form the ethical discourse. (shrink)

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and intrusive. Severe punishment is disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well as (...) the only justifiable solution to the problem of drink driving. A policy of universal alcohol interlocks, in all cars, has been proposed by several political parties in Sweden and is supported by the National Road Administration and the 2006 Alcohol Interlock Commission. This article assesses two possible moral objections to a policy of universal interlocks: (i) that it displaces the responsibility of individual drivers and (ii) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. Given the expected technological development, the proposed policy seems a commendable health promotion measure for the near future. (shrink)

This article investigates the hitherto under-examined relations between affirmative action, paternalism and respect. We provide three main arguments. First, we argue that affirmative action initiatives are typically paternalistic and thus disrespectful towards those intended beneficiaries who oppose the initiatives in question. Second, we argue that not introducing affirmative action can also be disrespectful towards these potential beneficiaries because such inaction involves a failure to adequately recognize their moral worth. Third, we argue that the paternalistic disrespect involved in affirmative action (...) is alleviated when the potential beneficiaries’ preferences against such initiatives are adaptive. We conclude that although there is a relevant sense in which paternalistic affirmative action is disrespectful, it may well be more disrespectful not to pursue such policies. (shrink)

We discuss the crucial, but easily missed, link between paternalism and incarceration. Legal paternalists believe law should be used to help individuals stay healthy or moral or become healthier or morally better. Criminal laws are paternalistic if they make it illegal to perform some action that would be bad for the actor to do, regardless of effects on others. Yet, one result of such laws is the punishment, including incarceration, of the very same actors—also clearly bad for them even (...) if meant to be rehabilitative. Therein lies an oddity: paternalist criminal law—and thepresumably rehabilitativepunishments that serve as responses to infringements of such laws—is meant to help the actor but in fact has the opposite effect on net. Incarceration is particularly problematic on this front as it harms the alleged criminal in ways that go beyond the harm they would have caused themselves. Incarceration also may undermine the actor’s ability to improve his decision-making abilities or his moral character. The effects of the punishment also drift to others—family and friends, as well as business associates, of the punished. Paternalists, inasmuch as they are motivated by beneficence or concern about moral character, must account for all of these costs as threats to well-being and the conditions for acting morally. Given the link between paternalism and incarceration, we propose that if we are to take seriously the problem of over-incarceration in the U.S., we must reconsider the use of paternalism in criminal law; we sketch several alternatives. We believe paternalists should support our resistance to incarceration and seriously consider these alternatives. (shrink)

Hutto and Myin claim that teleosemantics cannot account for mental content. In their view, teleosemantics accounts for a poorer kind of relation between cognitive states and the world but lacks the theoretical tools to account for a richer kind. We show that their objection imposes two criteria on theories of content: a truth-evaluable criterion and an intensionality criterion. For the objection to go through, teleosemantics must be subject to both these criteria and must fail to satisfy them. We argue that (...) teleosemantics meets the truth-evaluable criterion and is not required to meet the intensionality criterion. We conclude that Hutto and Myin’s objection fails. (shrink)

The free energy principle is notoriously difficult to understand. In this paper, we relate the principle to a framework that philosophers of biology are familiar with: Ruth Millikan’s teleosemantics. We argue that: systems that minimise free energy are systems with a proper function; and Karl Friston’s notion of implicit modelling can be understood in terms of Millikan’s notion of mapping relations. Our analysis reveals some surprising formal similarities between the two frameworks, and suggests interesting lines of future research. We hope (...) this will aid further philosophical evaluation of the free energy principle. (shrink)

In this paper, I examine whether Wenar's Bloody Oil ( 2016) succeeds in providing a theory able to accommodate the statist commitment to peoples’ sovereignty without dismissing the cosmopolitan concern regarding a just global market. Contextualising Blood Oil within the broader debate on global justice and resource ownership, I focus on some specific aspects of Wenar’s Clean Trade scheme and explain why it comes to quite radical conclusions. Yet, if these conclusions are taken seriously, Clean Trade seems too demanding from (...) the point of view of a statist account of justice. For cosmopolitans, too, the lack of normative justification for any alleged national resource sovereignty might weaken this position, especially for those who might oppose arguments to justify different forms of resource ownership. I will therefore discuss two problems with Wenar’s theory. First, I will show that, in spite of its statist premises, Wenar’s radical conclusions hardly pass the test of anti-paternalism. Is the Clean Trade scheme able to accommodate the demand of pluralism emerging in the Society of Peoples? Second, I focus on an issue that is neglected in Wenar’s book and which refers directly to the normative basis of resources ownership. I argue that this is a crucial issue, especially in contexts where the traditional idea of national sovereignty is contested, which often occurs in resource-cursed societies. (shrink)

This paper argues that the concept of paternalism is currently overextended to include a variety of actions that, while resembling paternalistic actions, are importantly different. I use the example of Japanese physicians’ non-disclosures of cancer diagnoses directly to patients, arguing that the concept of maternalism better captures these actions. To act paternalistically is to substitute one's own judgement for that of another person and decide in place of that person for his/her best interest. By contrast, to act maternalistically is (...) to decide for another person based on a reasonable understanding of that person's own preferences. The concept of maternalism allows for a more thorough assessment of the moral justification of these types of actions. I conclude that it is possible, at least in principle, to justify Japanese physicians’ non-disclosures, and that this justification must be based on an understanding of these actions as maternalistic. (shrink)

This paper examines distinctive discourse properties of preposed negative 'yes/no' questions (NPQs), such as 'Isn’t Jane coming too?'. Unlike with other 'yes/no' questions, using an NPQ '∼p?' invariably conveys a bias toward a particular answer, where the polarity of the bias is opposite of the polarity of the question: using the negative question '∼p?' invariably expresses that the speaker previously expected the positive answer p to be correct. A prominent approach—what I call the context-management approach, developed most extensively by (...) Romero and Han (2004)—attempts to capture speaker expectation biases by treating NPQs fundamentally as epistemic questions about the proper discourse status of a proposition. I raise challenges for existing context-managing accounts to provide more adequate formalizations of the posited context-managing content, its implementation in the compositional semantics and discourse dynamics, and its role in generating the observed biases. New data regarding discourse differences between NPQs and associated epistemic modal questions are introduced. I argue that we can capture the roles of NPQs in expressing speakers’ states of mind and managing the discourse common ground without positing special context-managing operators or treating NPQs as questions directly about the context. I suggest that we treat the operator introduced with preposed negation as having an ordinary semantics of epistemic necessity, though lexically associated with a general kind of endorsing use observed with modal expressions. The expressive and context-managing roles of NPQs are explained in terms of a general kind of discourse-oriented use of context-sensitive language. The distinctive expectation biases and discourse properties observed with NPQs are derived from the proposed semantics and a general principle of Discourse Relevance. (shrink)