“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to (...) autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception (...) of autonomy that is operative in the context of medicine. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

The development of predictive brain implant (PBI) technology that is able to forecast specific neuronal events and advise and/or automatically administer appropriate therapy for diseases of the brain raises a number of ethical issues. Provided that this technology satisfies basic safety and functionality conditions, one of the most pressing questions to address is its relation to the autonomy of patients. As Frederic Gilbert in his article asks, if autonomy implies a certain idea of freedom, or self-government, how can (...) an individual be considered to decide freely if the implanted device stands at the inception of the causal chain producing his decisions? He claims that PBIs threaten persons’ autonomy by diminishing their post-operative experience of self-control. In this commentary, I wish to discuss this claim. Contrary to Gilbert, I will suggest that PBIs do not pose a significant threat to patient’s autonomy, as self-control, but rather to his/her sense of authenticity. My claim is that the language of authenticity, already introduced in the recent bioethical literature, may offer a better way to voice some of the concerns with PBIs that Gilbert recognized. (shrink)

According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this (...) paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices (...) are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for (...) rational choice in alignment with one's values and goals). (shrink)

A number of bioethicists have been critical of the power of the family to “veto” a patient’s decision to posthumously donate her organs within opt-in systems of organ procurement. One major objection directed at the family veto is that when families veto the decision of their deceased family member, they do something wrong by violating or failing to respect the autonomy of that deceased family member. The goal of this paper is to make progress on answering this objection. (...) I do this in two stages. First, I argue that the most plausible interpretation of what happens when a person registers as an organ donor in an opt-in system is that she gives her consent to the state to posthumously remove her organs for transplantation purposes. Call this the Authorization Account. Second, given the Authorization Account, I argue by analogy that when families veto an individual’s decision to donate and the individual’s organs are not in the end removed, neither the doctors nor the family violate the individual’s autonomy in any morally objectionable sense. Call this the Nonremoval Thesis. I argue that since the Nonremoval Thesis is true, we do not violate or fail to respect the autonomy of registered donors when we fail to remove their organs because their family has objected. (shrink)

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s (...) class='Hi'>autonomy is not respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient’s previous values must be in that patient’s best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. (shrink)

The phenomenon of ambivalence is an important one for any philosophy of action. Despite this importance, there is a lack of a fully satisfactory analysis of the phenomenon. Although many contemporary philosophers recognize the phenomenon, and address topics related to it, only Harry Frankfurt has given the phenomenon full treatment in the context of action theory - providing an analysis of how it relates to the structure and freedom of the will. In this paper, I develop objections to Frankfurt's account, (...) all revolving around the charge that his account contains a serious ambiguity between willing and identifying. With such objections in place, I then develop an analysis that avoids the difficulties and ambiguities that Frankfurt's analysis is prey to. I briefly distinguish ambivalence from other types of internal conflict. This paper aims to offer conceptual clarification on the phenomenon of ambivalence, which will then allow for discussions about the normative merits and demerits of ambivalence, the effects of ambivalence on autonomous action, and methods of resolution of ambivalence. (shrink)

Stephen L. Pepper argues that lawyers and clients often act together in ways that their moral convictions would prevent them from acting individually. In an attempt to address this problem, I explore the nature of the attorney's responsibility to help her client reach autonomous decisions. To do this, I review the work of some prominent medical ethicists on a parallel to Pepper's problem in doctor-patient relationships.

This article assesses how autonomy and machine learning impact the existential risk of nuclear war. It situates the problem of cyber security, which proceeds by stealth, within the larger context of nuclear deterrence, which is effective when it functions with transparency and credibility. Cyber vulnerabilities poses new weaknesses to the strategic stability provided by nuclear deterrence. This article offers best practices for the use of computer and information technologies integrated into nuclear weapons systems. Focusing on nuclear command and control, (...) avoiding autonomy and machine learning is recommended as one means to reduce the existential risk of unintended nuclear conflict. (shrink)

Rawls offers three arguments for the priority of liberty in Theory, two of which share a common error: the belief that once we have shown the instrumental value of the basic liberties for some essential purpose (e.g., securing self-respect), we have automatically shown the reason for their lexical priority. The third argument, however, does not share this error and can be reconstructed along Kantian lines: beginning with the Kantian conception of autonomy endorsed by Rawls in section 40 of Theory, (...) we can explain our highest-order interest in rationality, justify the lexical priority of all basic liberties, and reinterpret Rawls’ threshold condition for the application of the priority of liberty. Perhaps unsurprisingly, this Kantian reconstruction will not work within the radically different framework of Political Liberalism. (shrink)

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their (...) requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

Scientists have the ability to influence policy in important ways through how they present their results. Surprisingly, existing codes of scientific ethics have little to say about such choices. I propose that we can arrive at a set of ethical guidelines to govern scientists’ presentation of information to policymakers by looking to bioethics: roughly, just as a clinician should aim to promote informed decision-making by patients, a scientist should aim to promote informed decision-making by policymakers. Though this may sound like (...) a natural proposal, I show it offers guidance that conflicts with standard scientific practices. I conclude by considering one cost of the proposal: that it would prevent scientists from acting as advocates in a way that is currently common in certain fields. I accept that the proposal would restrict scientists’ political advocacy rights, but argue that the benefits of adopting it — promoting democratic governance — justify the restriction. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes (...) for which a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may (...) be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources. (shrink)

Jeremy Waldron has recently raised the question of whether there is anything approximating the creative self-authorship of personal autonomy in the writings of Immanuel Kant. After considering the possibility that Kantian prudential reasoning might serve as a conception of personal autonomy, I argue that the elements of a more suitable conception can be found in Kant’s Tugendlehre, or “Doctrine of Virtue”—specifically, in the imperfect duties of self-perfection and the practical love of others. This discovery is important for at (...) least three reasons: first, it elucidates the relationship among the various conceptions of autonomy employed by personal-autonomy theorists and contemporary Kantians; second, it brings to the surface previously unnoticed or undernoticed features of Kant’s moral theory; and third, it provides an essential line of defense against certain critiques of contemporary Kantian theories, especially that of John Rawls. (shrink)

Rawls offers three arguments for the priority of liberty in Theory, two of which share a common error: the belief that once we have shown the instrumental value of the basic liberties for some essential purpose (e.g., securing self-respect), we have automatically shown the reason for their lexical priority. The third argument, however, does not share this error and can be reconstructed along Kantian lines: beginning with the Kantian conception of autonomy endorsed by Rawls in section 40 of Theory, (...) we can explain our highest-order interest in rationality, justify the lexical priority of all basic liberties, and reinterpret Rawls’ threshold condition for the application of the priority of liberty. Perhaps unsurprisingly, this Kantian reconstruction will not work within the radically different framework of Political Liberalism. (shrink)

Desire satisfaction theorists and attitudinal-happiness theorists of well-being are committed to correcting the psychological attitudes upon which their theories are built. However, it is not often recognized that some of the attitudes in need of correction are evaluative attitudes. Moreover, it is hard to know how to correct for poor evaluative attitudes in ways that respect the traditional commitment to the authority of the individual subject's evaluative perspective. L. W. Sumner has proposed an autonomy-as-authenticity requirement to perform this task, (...) but this article argues that it cannot do the job. Sumner's proposal focuses on the social origins of our values and overlooks the deep psychological roots of other evaluative attitudes that are just as problematic for welfare. If subjective theories of welfare are to be at all plausible they may need to abandon or modify their traditional commitment to the authority of the individual subject. (shrink)

Almost everyone who has a limb amputated will experience a phantom limb--the vivid impression that the limb is not only still present, but in some cases, painful. There is now a wealth of empirical evidence demonstrating changes in cortical topography in primates following deafferentation or amputation, and this review will attempt to relate these in a systematic way to the clinical phenomenology of phantom limbs. With the advent of non-invasive imaging techniques such as MEG (magnetoencephalogram) and functional MRI, topographical reorganization (...) can also be demonstrated in humans, so that it is now possible to track perceptual changes and changes in cortical topography in individual patients. We suggest, therefore, that these patients provide a valuable opportunity not only for exploring neural plasticity in the adult human brain but also for understanding the relationship between the activity of sensory neurons and conscious experience. We conclude with a theory of phantom limbs, some striking demonstrations of phantoms induced in normal subjects, and some remarks about the relevance of these phenomena to the question of how the brain constructs a 'body image.'. (shrink)

This article introduces the concept of ‘well-living’ as a transformative framework for reimagining quality of life in the face of current global socio-ecological challenges. Through a reflexive theoretical meta-analysis, it critically examines mainstream and reformist well-being discourses while drawing inspiration from transformative perspectives found in recent post-capitalist and indigenous movements. ‘Well-living’ is portrayed as both a civilizational endeavor and a multifaceted imperative, encompassing dimensions of creativity, liveability, conviviality, and alterity across various scales from individual to international contexts. Central to the (...) ‘well-living’ paradigm are nine key qualities, including harmonious coexistence, aspirational foresight and purposefulness, solidarity, autonomy, authenticity, and integrity, thereby promoting an integrated approach to living in balance with oneself, others, and the natural world. Embracing ‘well-living’ as a goal and process can empower individuals and communities to challenge prevailing global capitalist paradigms, re-establish connections with the interconnected web of life, and strive for a more just, regenerative, and diverse world, accommodating multiple perspectives. Lastly, employing a 'commonist' perspective, the article outlines essential institutional and legislative-policy changes required to actualize the vision of 'well-living.'. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics (...) literature, which focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.

Investigating an actual case that occurred in a New York state hospital where an Orthodox Jewish patient’s legal proxy demands that the clinicians and hospital administrators should provide aggressive treatment with all available technological resources for the seemingly brain-dead patient with a medically futile condition. The authors argue that a health care policy or regulation should be developed to limit patient’s access to technology in critical care. Otherwise, we will be allowing society to issue a carte blanche to (...) religious autonomy by technology abuse. It is argued that religious autonomy should be restricted when its demand exhibits apparent logical absurdity and/or goes against the common survival of the entire population. (shrink)

This work presents the design of an expert system that aims to provide the patient with background for suitable diagnosis of some of the eye diseases. The eye has always been viewed as a tunnel to the inner workings of the body. There are many disease states that may produce symptoms from the eye. CLIPS language is used as a tool for designing our expert system. An initial evaluation of the expert system was carried out and a positive feedback was (...) received from the users. (shrink)

Brain-related diseases are among the most difficult diseases due to their sensitivity, the difficulty of performing operations, and their high costs. In contrast, the operation is not necessary to succeed, as the results of the operation may be unsuccessful. One of the most common diseases that affect the brain is Alzheimer’s disease, which affects adults, a disease that leads to memory loss and forgetting information in varying degrees. According to the condition of each patient. For these reasons, it is important (...) to classify memory loss and to know the patient at what level and his assessment of Alzheimer's disease through CT scans of the brain. In this thesis, we review ways and techniques to use deep learning classification to classifying the Alzheimer's Disease The proposed method used to improve patient care, reduce costs, and allow fast and reliable analysis in large studies. The model will be designed using Python language for implementing the system, which is very useful for doctors, classifying the Alzheimer's Disease, was used. The model used 70% from image for training and 30% from image for validation, our trained model achieved an accuracy of 100% on a held-out test set. (shrink)

This abstract is a synopsis of the paper "An Expert System for Diagnosing Whooping Cough Using CLIPS." The bacterium Bordetella pertussis causes whooping cough, a highly infectious respiratory ailment with several phases of symptoms. An accurate and timely diagnosis is critical for effective treatment and the avoidance of future transmission. The construction of an expert system for detecting whooping cough using the CLIPS (C Language Integrated Production System) architecture is highlighted in this abstract. The expert system provides standardized and systematic (...) evaluation, which reduces the chance of misdiagnosis and improves patient outcomes. Maintenance and upgrades are required to keep the system current with growing medical knowledge. More study in this area has the potential to advance expert systems in identifying and managing a variety of medical disorders. (shrink)

Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp (...) and Childress’s theory, this article develops a non-ideal authenticity-based conceptualization of personal autonomy. Factors that indicate inauthentic decision-making are explicated, and the full concept is defended from three expected objections. The theory is then tested on a paradigm case which has concerned theorists and practitioners for some time, namely the possible inauthenticity of anorexia nervosa patients’ decision-making. It is concluded that the theory seems to be fruitful in analyses of the degree of autonomy of patients’ decision-making, and that it succeeds in providing reliable action-guidance in practical contexts. (shrink)

With the publication of A Theory of Justice in 1971, John Rawls not only rejuvenated contemporary political philosophy but also defended a Kantian form of Enlightenment liberalism called “justice as fairness.” Enlightenment liberalism stresses the development and exercise of our capacity for autonomy, while Reformation liberalism emphasizes diversity and the toleration that encourages it. These two strands of liberalism are often mutually supporting, but they conflict in a surprising number of cases, whether over the accommodation of group difference, the (...) design of civic education, or the promotion of liberal values internationally. During the 1980’s, however, Rawls began to jettison key Kantian characteristics of his theory, a process culminating in the 1993 release of Political Liberalism and completing the transformation of justice as fairness into a Reformation liberalism. -/- Reconstructing Rawls argues that this transformation was a tragic mistake because it jeopardized the most important features of his theory, viz. the lexical priorities of right, liberty, and fair equality of opportunity as well as the difference principle. Controversially, this book contends that Rawls’s so-called “political turn,” motivated by a newfound interest in diversity and the accommodation of difference, has been unhealthy for autonomy-based liberalism and has pushed liberalism more broadly towards cultural relativism, be it in the guise of liberal multiculturalism or critiques of cosmopolitan distributive-justice theories. The book then demonstrates that the central elements of justice as fairness can only be defended within the context of a Kantian Enlightenment liberalism and that Rawls’s hope for a more pluralistic grounding for his theory, endorsed by a wide variety of belief systems present in modern democratic societies, is illusory. -/- Reconstructing Rawls is the first book to systematically compare Rawls’s and Kant’s theories and the first to offer an internal critique and reconstruction of justice as fairness, reconceiving it as a comprehensive, universalistic Kantian liberalism. By doing so, it gives us both the vision of a liberal world order—“a republicanism of all states, together and separately,” as Kant put it—and a mode of justification addressed to all men and women, not as members of particular nations, races, and faiths, but as human beings, as citizens of the world. In short, it reclaims Rawls for the Enlightenment. (shrink)

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

Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition, or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. (...) Moreover, many of the common objections to an Autonomy Only view fail once we understand the extent of the autonomy condition’s requirements—in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law, and therefore poses an important challenge to this widely accepted view on justified PAD. (shrink)

Many scholars, including G. A. Cohen, Daniel Attas, and George Brenkert, have denied that a Kantian defense of self-ownership is possible. Kant's ostensible hostility to self-ownership can be resolved, however, upon reexamination of the Groundwork and the Metaphysics of Morals. Moreover, two novel Kantian defenses of self-ownership (narrowly construed) can be devised. The first shows that maxims of exploitation and paternalism that violate self-ownership cannot be universalized, as this leads to contradictions in conception. The second shows that physical coercion against (...) rational agents involves a profound status wrong--namely, their treatment as children or animals--and that this system of differential status and treatment (including self-ownership rights for rational agents) can be morally justified by our capacity for autonomy. (shrink)

Background: Increasing resistance of Pseudomonas aeruginosa to ciprofloxacin in ICU/burn units has created a problem in the treatment of infections caused by this microorganism. -/- Methods: Fifty P. aeruginosa strains were isolated from burn patients hospitalized in the Kerman Hospital during May 1999-April 2000 and were tested for in-vitro sensitivity to different antibiotics by disc diffusion breakpoint assay. The isolates were subjected to minimum inhibitory concentration (MIC) test by agar dilution method. Existence of the plasmids was also investigated in the (...) isolates. -/- Results: Thirty-four patients infected with ciprofloxacin strains showed MIC of 8 mg/ml [p<0.001]. Sixteen patients were infected with sensitive strains exhibiting MIC range of 0.0125-0.125 ± 0.033 mg/ml. The isolates were also also resistant to other antibiotics [p<0.001]. Plasmid isolation and agarose gel electrophoresis (0.7%) revealed three plasmid bands in strains 8 and 16, and one band in strain 35. -/- Conclusion: The emergence of ciprofloxacin resistance of P. aeruginosa in burn patients is alarming since this antibiotic has only recently been introduced onto the market in Iran. One important observation was that some isolates exhibited cross resistance to other antibiotics. Furthermore, some strains were carriers of plasmids which might have acted as the potential source of acquired resistance in the hospital setting. -/- . (shrink)

Many believe that paternalism is less wrong in intimate relationships. In this paper, we argue that this view cannot be justified by appeal to (i) beneficence, (ii) shared projects, (iii) vulnerability, (iv) epistemic access, (v) expressivism, or (vi) autonomy as nonalienation. We finally provide an error theory for why many may have believed that paternalism is less wrong in intimate relations.

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

In an effort to construct a plausible theory of experience-based welfare, Wayne Sumner imposes two requirements on the relevant kind of experience: the information requirement and the autonomy requirement. I argue that both requirements are problematic.First, I argue (very briefly) that a well-know case like ‘the deceived businessman’ need not support the information requirement as Sumner believes. Second, I introduce a case designed to cast further doubt on the information requirement. Third, I attend to a shortcoming in Sumner’s theory (...) of welfare, namely that it is unclear which of later and informed assessments are to be treated as authoritative when it comes to the evaluation of a person’s welfare. Finally, I suggest that, in combination with ‘welfarism’ (to which Sumner subscribes, and which has it that welfare is all that matters from a moral viewpoint), the information requirement entail morally troublesome conclusions: e.g. the conclusion that, from a moral point of view, we should, other things being equal, only to be concerned with the alternative that makes one person slightly better off in respect of welfare instead of also being morally concerned with the alternative that makes one person very happy. (shrink)

In our dealings with young children, we often get them to do or think things by arranging their environments in certain ways; by dissembling, simplifying, or ambiguating the facts in answer to their queries; by carefully selecting the states of affairs, behavior of others, and utterances to which they shall be privy. We rightly justify these practices by pointing out a child's malleability, and the necessity of paying close attention to formative influences during its years of growth. This filtering of (...) influences is necessary, we point out, if children are ever to reach a degree of maturity and inner stability that will enable them to understand and cope adequately with the complexities, contradictions, and difficulties of the world from which we now seek to shield them. Thus a child's eventual state of competence, maturity, and autonomy adequately justifies our current practices of manipulation and selection of his environment: such practices are rightly held to be ultimately in the child's best interests as an adult. There is no future state of things with reference to which the Utilitarian night justify his policy of secrecy and manipulation, and in light of which this policy night eventually be dispensed with and commonly validated, in retrospect, as a means to the worthwhile goal of moral maturity. That is, there is no point at which the attitude of the Utilitarian to the rest of the community can develop past the analogous attitude of the parent towards the child; no point at which the Utilitarian might eventually bear to others a relationship of mutual acknowledgement and respect as mature, autonomous, moral adults. The consistent Utilitarian, then, largely regards himself as if he were the only adult in a community of children. (shrink)

Abstract: This research explores the application of artificial neural networks (ANNs) in predicting cancer using a synthetically generated dataset designed for research purposes. The dataset comprises 10,000 pseudo-patient records, each characterized by gender, age, smoking history, fatigue, and allergy status, along with a binary indicator for the presence or absence of cancer. The 'Gender,' 'Smoking,' 'Fatigue,' and 'Allergy' attributes are binary, while 'Age' spans a range from 18 to 100 years. The study employs a three-layer ANN architecture to develop a (...) predictive model. The achieved accuracy of 97.24% and a low loss value of 0.02 indicate promising performance. Further analysis involves a comprehensive examination of the confusion matrix, precision, recall, and F1 score metrics, along with the ROC curve and AUC score, to provide a detailed understanding of the model's strengths and weaknesses. Additionally, considerations for cross-validation, hyperparameter tuning, and interpretability are discussed. It is emphasized that while the synthetic nature of the dataset allows for controlled experimentation, results should be cautiously interpreted and validated on authentic clinical data before extrapolation to real-world medical scenarios. This research serves as a valuable contribution to the exploration of predictive models for cancer detection, encouraging continued investigation and development in the field. (shrink)

Five arguments are presented in favour of the proposal that people who opt in as organ donors should receive a tax break. These arguments appeal to welfare, autonomy, fairness, distributive justice and self-ownership, respectively. Eight worries about the proposal are considered in this paper. These objections focus upon no-effect and counter-productiveness, the Titmuss concern about social meaning, exploitation of the poor, commodification, inequality and unequal status, the notion that there are better alternatives, unacceptable expense, and concerns about the veto (...) of relatives. The paper argues that none of the objections to the proposal is very telling. (shrink)

In spite of its everyday connotations, the term independence as republicans understand it is not a celebration of individualism or self-reliance but embodies an acknowledgement of the importance of personal and social relationships in people’s lives. It reflects our connectedness rather than separateness and is in this regard a relational ideal. Properly understood, independence is a useful concept in addressing a fundamental problem in social philosophy that has preoccupied theorists of relational autonomy, namely how to reconcile the idea of (...) individual human agency with the inevitable and necessary influence of other people, both directly and indirectly. I derive my account from the work of Mary Wollstonecraft and Catharine Macaulay, whose contributions have remained largely overlooked by current republican theorists. I have three purposes in this chapter. First, I set out the relational character of independence. Secondly, I outline a republican approach to the problem of structural social threats to agency. Finally, I hope to establish the basis for a fruitful dialogue between republicans and relational autonomy theorists on the requirements and dynamics of individual agency and freedom in oppressive social situations. I identify three distinctive features of the internal logic of freedom as independence that give it a relational character: it always locates the person within a community; there is a mediating role played by the notion of arbitrariness in connecting individual and collective perspectives; a causal relationship exists linking each person’s freedom as independence such that that the dependence of one class of persons jeopardizes the independence of the whole community. (shrink)

An education for cultural coherence tends to the child’s well-being through identity construction and maintenance. Critics charge that this sort of education will not bode well for the future autonomy of children. I will argue that culturally coherent education, provided there is no coercion, can lend itself to eventual autonomy and may assist minority children in countering the negative stereotypes and discrimination they face in the larger society. Further, I will argue that few individuals actually possess an entirely (...) coherent identity; rather, most of us possess hybrid identities that lend themselves to multiple, not necessarily conflicting allegiances. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

In this article, I present some worries about the possible impact of global efforts to aid the needy in some of the world’s most desperate regions. Among the worries I address are possible unintended negative consequences that may occur elsewhere in a society when aid agencies hire highly qualified local people to promote their agendas; the possibility that foreign interests and priorities may have undue influence on a country’s direction and priorities, negatively impacting local authority and autonomy; and the (...) related problem of outside interventions undermining the responsiveness of local and national governments to their citizens. -/- Another issue I discuss is the possibility that efforts to aid the needy may involve an Each-We Dilemma, in which case conflicts may arise between what is individually rational or moral, and what is collectively rational or moral. Unfortunately, it is possible that if each of us does what we have most reason to do, morally, in aiding the needy, we together will bring about an outcome which is worse, morally, in terms of its overall impact on the global needy. -/- The article ends by briefly noting a number of claims and arguments that I made in my 2017 Uehiro Lectures regarding how good people should respond in a world of need. As I have long argued, I have no doubt that those who are well off are open to serious moral criticism if they ignore the plight of the needy. Unfortunately, however, for a host of both empirical and philosophical reasons, what one should do in light of that truth is much more complex, and murky, than most people have realized. (shrink)

Coronavirus is a viral irresistible sickness brought about by SARS- COV2. Its clinical signs and side effects are on an expansive range going from asymptomatic to serious confusions like multi-organ disappointment, thromboembolism, and extreme pneumonia with respiratory disappointment. More awful results and higher death rates have been accounted for in the old, individuals with co-morbidities, and malnourished people. Sustenance is central to acceptable wellbeing and safe capacity. It frames an essential segment of therapy modalities for different intense and persistent infections, (...) particularly where a causative therapy isn't yet perceived. Despite the fact that reviews tending to the part of explicit supplements in COVID-19 are still at a beginning phase, accessible proof recommends that addressing the necessities of a variety of large scale and miniature supplements (energy, proteins, fats, nutrients A, D, E, C, B nutrients, iron, selenium, zinc, and so forth) Additionally, supplements are Immune System Might Promote Recovery for Mild COVID-19 Patients Impact of Coronavirus on Education in India Review 466 determinants of the sythesis of the gut microbiota that thusly impacts the attributes of safe reactions in the body. (shrink)

Migraine is a complex neurological disorder characterized by recurrent moderate to severe headaches, accompanied by additional symptoms such as nausea, sensitivity to light and sound, and visual disturbances. Accurate and timely diagnosis of migraines is crucial for effective management and treatment. However, the diverse range of symptoms and overlapping characteristics with other headache disorders pose challenges in the diagnostic process. In this research, we propose the development of an expert system for migraine diagnosis using artificial intelligence and the CLIPS (C (...) Language Integrated Production System) framework. The expert system utilizes a rule-based inference engine to analyze patient-reported symptoms and provide reliable diagnoses or probability scores indicating the likelihood of migraine. The knowledge base of the expert system is designed based on expert knowledge obtained from medical professionals specializing in migraines. The collected knowledge is translated into a structured format suitable for the CLIPS inference engine, incorporating rules and facts to represent the diagnostic criteria and associated symptoms. The system prompts users to provide relevant information about their symptoms, medical history, and potential triggers. It applies the defined rules and facts to evaluate the likelihood of migraine and generate accurate diagnoses or probability scores. Preliminary evaluation results demonstrate the potential of the expert system as a valuable tool for diagnosing migraines. A dataset of anonymized patient records with confirmed migraine cases was used to test the system. The diagnoses generated by the expert system were compared against the known diagnoses, and a high level of accuracy was observed, with 90% of cases correctly diagnosed as migraines. These results highlight the effectiveness and reliability of the system in assisting medical professionals in the diagnosis of migraines. The proposed expert system offers several advantages for migraine diagnosis. It leverages the collective knowledge and expertise of experienced migraine specialists, providing a standardized and consistent approach to diagnosis. The system can handle large amounts of patient data and effectively analyse complex relationships between symptoms, risk factors, and diagnostic criteria. Furthermore, it offers real-time feedback and recommendations, supporting medical professionals in their clinical decision-making process. Future work involves refining the expert system based on feedback from medical experts, expanding the knowledge base to encompass a wider range of symptoms and risk factors, and conducting further evaluations to enhance its accuracy and applicability in clinical settings. The development of an expert system for migraine diagnosis has the potential to improve the diagnostic process, leading to more effective management and treatment strategies for individuals suffering from migraines. (shrink)

Abstract: The analytical, comparative cross-sectional study was conducted to assess the thyroid profiles and modified lipid profiles levels among Sudanese patients with coronary heart disease performed on forty-one patients with coronary heart disease as test group collected from Sudan Heart Center, Al rebat teaching hospital and Al mawada hospital in Khartoum state, during the period between November 2017 and May 2018. Furthermore, the test group compared with forty-one apparently healthy volunteers as control group was selected with the same inclusion criteria. (...) Spectrophotometeric methods were used for measurement of lipid profile. Thyroid hormones (T3 &T4) and thyroid stimulating hormone were measured by using Sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Moreover, statistical package for social science (SPSS version 23) computer software was used for data analysis. The study clearly demonstrated that there was statistically significant decrease in T3, and significant increase in T4 levels in test group compared to control with (P. value 0.047) for T3, and (P. value 0.002) for T4.Nonetheless, the result of this study indicated a significant elevation in mean of total cholesterol, low density lipoprotein-cholesterol levels and significant decrease in high density lipoprotein –cholesterol in test group compared to control (P.value 0.000). In conclusion Coronary heart diseases patients have significantly low Triiodothyronine, elevated Thyroxin, and normal Thyroid Stimulating Hormone levels, with significantly higher Total Cholesterol, Low Density Lipoprotein-Cholesterol concentrations, and lower HighDensity Lipoprotein-Cholesterol concentrations. (shrink)

This article re-exams the old tension between the philosopher and the city. Reading Ibn Bājja’s Governance of the Solitary and Nietzsche’s Thus Spoke Zarathustra against the background of Plato’s Republic, I argue that they both embrace several key aspects of Platonic political philosophy: the assumption that philosophical natures can grow spontaneously in sick cities, the ideal of the philosopher legislator and the correlative project of founding a virtuous new regime. Yet in preparation for this final task, each prescribes a regimen (...) of solitude for philosophers, so that they might preserve their own health and autonomy. While this spiritual exercise at first appears merely temporary and provisional—aimed at the cultivation of a philosopher ruler and the eventual establishment of a healthy political regime —I argue that both Ibn Bājja and Zarathustra ultimately abandon their Platonic ambitions and opt instead for the apolitical contemplative life. (shrink)