A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is (...) now the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their (...) access to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would. (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts (...) widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as (...) a manifestation of loss aversion and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; (...) and, more controversially, (4) when there are compelling methodological reasons for using placebo, and the research is intended to develop interventions that can be implemented in the population from which trial participants are drawn, and the trial does not require participants to forgo treatment they would otherwise receive. The concept of methodological reasons is essential to assessing the ethics of placebo controls in these controversial last two cases. This article sets out key considerations relevant to considering whether methodological reasons for a placebo control are compelling. (shrink)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy (...) is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers (...) strong counter-arguments to this view that enable us to think in terms of universal standards. (shrink)

This discussion treats a set of familiar social derelictions as consequences of the perversion of a universalistic moral theory in the service of an ill-considered or insufficiently examined personal agenda.The set includes racism, sexism, anti-Semitism, homophobia, and class elitism, among other similar pathologies, under the general heading of discrimination. The perversion of moral theory from which these derelictions arise, I argue, involves restricting its scope of application to some preferred subgroup of the moral community of human beings. -/- The following (...) analysis of higher-order discrimination suggests that we often select the individuals who constitute such subgroups for reasons that we ourselves would reject on moral grounds were we to examine them carefully, but that we choose instead to put our rational resources in the service of avoiding any such examination at all costs. The implication is that arguments that truncate the scope of moral theory in fact justify bestowing the gift of moral treatment on a select few who deserve it no more than the many from whom we withhold it. Therefore, it would be precipitous to conclude that universalistic moral theory can be legitimately restricted in its practical scope of application in any way at all. (shrink)

In 2016, this Journal published an article by Rob Lawlor1 on what we might call the acceptance-refusal asymmetry in competence requirements. This is the view that there can be cases in which a patient is sufficiently competent to accept a treatment ( viz., to give consent to it), but not sufficiently competent to refuse it ( viz., to withhold consent to it). Though the main purpose of Lawlor’s paper was to distinguish this asymmetry from various other asymmetries with which (...) it has sometimes been confused,1 Lawlor also presented a brief case in favour of it. Developing an earlier argument of Ian Wilks’,2 3 Lawlor argued that, when the risks associated with refusing a treatment are graver than those associated with accepting it, a higher level of competence may be required to refuse a treatment than to accept it. This claim could have important implications for the law, since determinations of competence often play a central role in determining the lawfulness of refusing or imposing a treatment (eg, in England and Wales under the Mental Capacity Act 2005). Indeed, the acceptance-refusal asymmetry in competence requirements, or something close to it, has played an important role in court judgments.2 However, Lawlor himself suggests that his conclusion will have practical implications only in a narrow range of cases.3 In this issue, Pickering, Giles Newton-Howes and Simon Walker (henceforth ‘the authors’) respond to Lawlor’s piece.4 They deny that competence requirements should depend on the level of risk associated with a decision, and thus that there is any basis for the acceptance-refusal asymmetry in competence requirements. Part of the authors’ argument involves contesting the way in which Lawlor uses cases to support his view. In one case cited by Lawlor—and drawn from Wilks—we are invited to consider a whether …. (shrink)

During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with (...) serious diseases for which there are no effective treatments, even when doing so is scientifically necessary to test the effectiveness of the treatment. We argue that the duty to rescue will rarely apply. The context of medical research also throws new light on the content of the duty to rescue, since the interests of future patients—who stand to benefit from the fruits of medical research—are relevant to whether the duty applies. (shrink)

It may seem that epistemic and practical rationality weigh reasons differently, because ties in practical rationality tend to generate permissions and ties in epistemic rationality tend to generate a requirement to withhold judgment. I argue that epistemic and practical rationality weigh reasons in the same way, but they have different "default biases". Practical rationality is biased toward every option being permissible whereas epistemic rationality is biased toward withholding judgment's being required.

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

This paper presents a puzzle about justification and withholding. The puzzle arises in a special case where experts advise us to not withhold judgment. My main thesis is simply that the puzzle is genuinely a puzzle, and so leads us to rethink some common assumptions in epistemology, specifically assumptions about the nature of justification and doxastic attitudes. Section 1 introduces the common assumptions. Section 2 presents the puzzle case. Section 3 assesses the puzzle case. Section 4 explains the choice (...) we're faced with. Sections 5 and 6 consider and reject some proposed solutions, and in the process refine and clarify the choice we're faced with. Section 7 considers and rejects a miscellany of different proposed solutions. (shrink)

Recent work has argued that there may be cases where no attitude – including withholding – is rationally permissible. In this paper, I consider two such epistemic dilemmas, John Turri’s Dilemma from Testimony and David Alexander’s Dilemma from Doubt. Turri presents a case where one’s only evidence rules out withholding (without warranting belief or disbelief). Alexander presents a case where higher order doubt means one must withhold judgment over whether withholding judgment is rational. In both cases, the (...) authors conclude that no doxastic attitude is warranted. In this paper, I argue against the possibility of these epistemic dilemmas. I argue that withholding cannot be irrational in either case. But meditating on the dilemmas gives us an important – and overlooked – insight into the nature of rational withholding. First, rational withholding is a function of evidence failing to sufficiently support belief or disbelief. As a result, withholding is not symmetrical to belief and disbelief. Second, there can be two distinct grounds for rational withholding. First, propositional withholding, which arises when our evidence does not support belief or disbelief in p. And second, doxastic withholding, which arises when we cannot determine whether our evidence supports belief or disbelief in p. Accepting two grounds of rational withholding licenses a kind of Weak Permissivism. But this Weak Permissivism should not be troubling to anyone. (shrink)

I discuss Turri's puzzle about withholding. I argue that attention to the way in which evidence can justify withholding dissolves the puzzle.

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)

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

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

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

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

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

Science is the basis for managing the affairs of life and human activities, and living without knowledge is a form of wandering and a kind of loss. Using scientific methods helps us understand the foundations of choice, decision-making, and adopting the right solutions when solutions abound and options are numerous. Operational research is considered the best that scientific development has provided because its methods depend on the application of scientific methods in solving complex issues and the optimal use of available (...) resources in various fields, private and governmental work in peace and war, in politics and economics, in planning and implementation, and in various aspects of life. Its basic essence is to use the data provided for the issue under study to build a mathematical model that is the optimal solution. It is the basis on which decision makers rely in managing institutions and companies, and when operations research methods meet with the neutrosophic teacher, we get ideal solutions that take into account all the circumstances and fluctuations that may occur in the work environment over time. One of the most important operations research methods is the linear programming method. Which prompted us to reformulate the linear models, the graphical method, and the simplex method, which are used to obtain the optimal solution for linear models using the concepts of neutrosophic science. In this research, and as a continuation of what we presented previously, we will reformulate the modified simplex algorithm that was presented to address the difficulty that we were facing when applying the direct simplex algorithm. It is the large number of calculations required to be performed in each step of the solution, which requires a lot of time and effort. (shrink)

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

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

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

This paper offers a critical survey and analysis of empirical studies on creativity, with emphasis on how imagination plays a role in the creative process. It takes as a foil the romantic view that, given features like novelty, incubation, and insight, we should be skeptical about the prospects for naturalistic explanation of creativity. It rebuts this skepticism by first distinguishing stages or operations in the creative process. It then works through various behavioral and neural studies, and corresponding philosophical theorizing, that (...) concern the preparation, generation, insight, and evaluation stages of creative processes. The result is not a complete explanation of creativity, but it identifies an explanatory path towards such an explanation, including the features of creativity that motivate that skepticism. (shrink)

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system (...) correctly diagnoses Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force (...) here. As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

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

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and (...) life insurance institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and (...) that it is the patient or the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of revelation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. (shrink)

Semanticists face substitution challenges even outside of contexts commonly recognized as opaque. Jennifer M. Saul has drawn attention to pairs of simple sentences - her term for sentences lacking a that-clause operator - of which the following are typical: -/- (1) Clark Kent went into the phone booth, and Superman came out. (1*) Clark Kent went into the phone booth, and Clark Kent came out. -/- (2) Superman is more successful with women than Clark Kent. (2*) Superman is more successful (...) with women than Superman. -/- She challenges us to explain why the upper and lower sentences in each pair differ, or at least appear to differ, in their truth-values and hence truth-conditions. This appearance of substitution failure is inherently puzzling. Moreover, it is taken by Saul to generate a dilemma for anyone hostile to direct reference accounts of that-clause constructions. Direct reference theorists regard the appearance of substitution failure in that-clause contexts as mere appearance, to be dealt with pragmatically rather than semantically. -/- Critics of such accounts need to say something about simple-sentence cases. If they choose to allow that intuitions of substitution failure can be over-ridden and explained away pragmatically in simple-sentence cases but not in that-clause cases, they lay themselves open to the charge of operating a double standard. But if they do not choose this option, they must offer a semantic explanation of apparent substitution failure in simple-sentence cases - no easy task, it turns out. Other respondents to Saul's challenge have sought to provide elaborate semantic treatments. In contrast, this paper proposes a far simpler pragmatic explanation of intuitions of substitution failure in simple sentences, an explanation that deploys no more resources than are to be found in Grice's 'Logic and Conversation'. Ironically, this proposal turns out to be incompatible with a direct reference perspective. So if it is, as I maintain, the most plausible treatment of simple-sentence cases available, Saul's initial thought gets turned around 180 degrees: the phenomenon she has drawn attention to ends up representing a challenge to supporters of direct reference theories. (shrink)

It is a familiar story that, where Kant humbly draws a line beyond which cognition can’t reach, Husserl presses forward to show how we can cognize beyond that limit. Kant supposes that cognition is bound to sensibility and that what we experience in sensibility is mere appearance that does not inform us about the intrinsic nature of things in themselves. By contrast, for Husserl, it makes no sense to say we experience anything other than things in themselves when we enjoy (...) sensory perception. Kant’s conception, then, by doing just that, is nonsensical. I argue that Husserl’s account does not deliver on its promise. Things as they are in themselves are just as cognitively out of reach on Husserl’s understanding of them as they are on Kant’s. Further, the charge of nonsense Husserl raises against Kant’s conception of things in themselves applies—indeed, with greater force—to his own. (shrink)

Embodiment and mindfulness interventions provide a range of benefits for individuals living with trauma yet a lack of clarity surrounds their integration in group work practice. This article provides a framework for the integration of embodiment and mindfulness interventions in group settings for trauma. While such interventions can be utilised in primary trauma processing and open process group psychotherapy, this article provides particular guidance for the more general integration of these tools in structured format resourcing groups. Attention is given to (...) the value and features of a phasic, staged integration of these interventions for specialised trauma-oriented group work. This article details how mindfulness and embodiment interventions support participants to cultivate the capacity to counter experiential avoidance and reorient attention towards the present moment, consequently increasing bodily and affective self-awareness. This serves to reduce patterns of reactivity, thereby supporting symptom stabilisation, improved reflective and mentalising ability, and cultivation of the self- and co-regulatory capacities necessary for trauma-processing group work. These interventions also possess supportive implications for the facilitator’s wellbeing, the formation and cohesiveness of the group, and, crucially, the norming process, both implicit and explicit. Attention is given also to safety considerations, including contraindications of mindfulness practices with certain trauma presentations, and the necessary screening requirements and exclusion criteria in the formation of a trauma-oriented group. (shrink)

Siblings ought to treat one another specially – in other words, siblings qua siblings ought to treat one another in ways that they need not treat others. This paper offers a theory of why this is the case. The paper begins with some intuitive judgments about how siblings ought to treat one another and some other normative features of siblinghood. I then review three potential theories of why siblings ought to treat one another specially, adapted from the literature on filial (...) piety: the gratitude theory, the friendship theory, and the special goods theory. In each case, these theories fail to explain some of the intuitive judgments about how siblings ought to treat one another. The paper then proposes a familial belonging theory. The institution of the family has certain goals, which impose normative demands on family members. I suggest that one such family goal is that every member feel familial belonging towards every other member, a goal which grounds the ways in which siblings ought to treat one another specially. (shrink)

The prevalence of workaholism in Western populations is approximately 10%,although estimates vary considerably according to how “workaholism” is defined.There is growing consensus that workaholism is a bona fide behavioral addiction that exists at the extreme end of the work-engagement continuum and causes similar negative consequences to other behavioral addictions such as salience, conflict, tolerance, withdrawal symptoms,and mood modification. Other more specific consequences include burnout, work compulsion,work–family conflict, impaired productivity, asociality,and psychological/somatic illness.

Some (Podro, Lopes) think that sometimes our experience of pictures is ‘inflected’. What we see in these pictures involves, somehow, an awareness of features of their design. I clarify the idea of inflection, arguing that the thought must be that what is seen in the picture is something with properties which themselves need characterising by reference to that picture’s design, conceived as such. I argue that there is at least one case of inflection, so understood. Proponents of inflection have claimed (...) great significance for the phenomenon. But what might that significance be? Inter alia, I consider Lopes’s proposal that inflection solves a central problem in pictorial aesthetics, the ‘puzzle of mimesis’. I argue that the puzzle, and the proposed solution, both turn on aspects of Lopes’s conception of seeing-in. Other accounts of seeing-in can make no sense of either. I further argue that the phenomenon of inflection itself puts pressure on the sort of account Lopes offers. Thus it is hard to offer a view which both holds that inflection occurs and is able to make clear sense of why it matters. (shrink)

Many existing biomedical vocabulary standards rest on incomplete, inconsistent or confused accounts of basic terms pertaining to diseases, diagnoses, and clinical phenotypes. Here we outline what we believe to be a logically and biologically coherent framework for the representation of such entities and of the relations between them. We defend a view of disease as involving in every case some physical basis within the organism that bears a disposition toward the execution of pathological processes. We present our view in the (...) form of a list of terms and definitions designed to provide a consistent starting point for the representation of both disease and diagnosis in information systems in the future. (shrink)

The IPAP Schizophrenia Algorithm was originally designed in the form of a flow chart to help physicians optimise the treatment of schizophrenic patients. We examined the current version from the perspective of recent work on terminologies and ontologies thereby drawing on the resources of Basic Formal Ontology, and this with the objective to make the algorithm appropriate for Semantic Web applications. We found that Basic Formal Ontology is a rich enough theory to represent all the entities involved and that (...) applying the theory to the IPAP schizophrenia algorithm results in a representation that can be used by software agents to perform monitoring and control in a referent tracking environment. (shrink)

According to some critics, if biology is a kind of reverse engineering for the nature, it is quite poorly prepared for the task. Thus, the issue is more likely with its ontology. Multiple hypotheses and conjectures found in papers on methodological issues claim that living systems should be viewed as complex networks of signal-transmitting paths, both neural and non-neural, that feature modularity and feedback circuits and are prone to emergent properties and increasing complexity. If so, we are on the eve (...) of a new stage in computer models development where not only computers are used to emulate life, but life itself is construed as a complex network of interacting natural computers. (shrink)

Some Comments on de Melo-Martin and Harris.

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

The article analyses the concept of indirect discrimination, arguing first that existing conceptualisations are unsatisfactory and second that it is best understood as equal treatment that is disadvantageous to the discriminatees because of their group-membership. I explore four ways of further refining the definition, arguing that only an added condition of moral wrongness is at once plausible and helpful, but that it entails a number of new problems that may outweigh its benefits. Finally, I suggest that the moral wrongness (...) of indirect discrimination is best accounted for in terms of the harm it does to discriminatees, and sketch three ways in which it may do so. I conclude that the analysis provides both a clearer understanding of the concept of indirect discrimination as well as indirect support for a harm-based account of the wrongness of discrimination, while suggesting that our moral obligations qua non-discrimination may be more extensive than is frequently assumed. (shrink)

Though it is evident that seriously and irreversibly defective infants are born in Poland, as well as in other socialist countries we do not know really what is the existing medical practice concerning their treatment or non-treatment. No representative empirical investigations were conducted with respect to it. We believe, however, that for the majority of doctors this is not a genuine moral problem at all. They feel simply morally, legally, and professionally obliged to treat those unhappy creatures without (...) any regard to economic and moral cost of treatment. It is highly plausible that this attitude is common to all socialist countries. All the factors mentioned in this paper (religion, ideology, medical education, paternalism, remembrance of Nazi doctors’ criminal practice, the legal situation, and the health care system) have a direct influence on the moral beliefs and attitudes of doctors in socialist countries. And even in those countries in which there are different religious traditions (like the Soviet Union, Yugoslavia, or the German Democratic Republic) there is a deeply-entrenched belief that preserving any human life is the principal and absolute duty of a doctor, one which must be fulfilled at any cost. We should also keep in mind that in this part of the world hardly any distinction at all is made between euthanasia and ordinary murder. (shrink)

Ayahuasca is a plant-based brew of indigenous Amazonian origin. It has psychedelic, anti-inflammatory, neuroprotective, cytotoxic, and anti-parasitic effects, which are primarily due to monoamine oxidase inhibitors (MAOIs) and N,N-dimethyltryptamine (DMT). This article describes the case of a woman in her late thirties with complex trauma due to severe, years-long sexual abuse in early childhood, resulting in a decades-long chronic condition involving suicidality. She was diagnosed with bipolar disorder and borderline personality disorder, but refused to accept either of them. She presented (...) with delusional parasitosis and deep dissociation. Despite being severely psychotic in private, she appeared high-functioning in public, hiding most of her symptoms. -/- In her mid-thirties, she participated in an ayahuasca ceremony in a legal setting. It resolved her suicidality, eliminated her social isolation, and reduced her shame related to her early trauma. Nine more ceremonies alleviated her distress further. Her abuser also participated in an ayahuasca ceremony and confirmed her memories of childhood abuse. -/- The first interview was conducted 1.5 years after her first ceremony, and a follow-up interview 2.5 years later. She had experienced sixteen additional ceremonies, recognized the validity of her bipolar disorder diagnosis, and believed her early trauma to be its sole cause. Her core trauma remained partially unresolved, but her dissociative symptoms continued to decrease. She had observed several other instances of psychosis and bipolar disorder in which ayahuasca had resulted in positive effects. This case study contributes to a better understanding of the use of ayahuasca in bipolar disorder and severe traumatization. It also reviews the current state-of-the-art in the treatment of bipolar disorder using low-dose ayahuasca, and a case in which bipolar disorder was resolved with LSD. -/- doi: 10.13140/RG.2.2.21294.18243. (shrink)

Background: Mint is a grassy, perennial plant, belonging to the oral platoon, fast growing and spreading, its leaves are green in color, fragrant, tart, refreshing, square-shaped leg, bifurcated, erect, ranging in height from (10 - 201 cm). Home to Europe and Asia. The mint plant has many benefits, the most important of which are pain relief, treatment of gallbladder disorders, the expulsion of gases, anti-inflammatory, and relaxing nerves. While the mint plant is the ideal option for the start of (...) gardens, it is prone to some common diseases that affect the plant's growth. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment. Methods: In this paper, the design of the proposed Expert System was produced to help Farmers and those interested in agriculture in diagnosing many of the Mint diseases such as Mint rust, Verticillium wilt, Anthracnose, Powdery mildew, Black Stem Rot, Stem and stolon canker, Septoria leaf spot. The proposed expert system presents an overview of mint diseases are given, the cause of diseases outlined and the treatment of disease whenever possible is given out. CLIPS Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Mint diseases diagnosis expert system was evaluated by Agricultural Students at AL Azhar University and some friends interested in agriculture and they were satisfied with its performance. Conclusions: The proposed expert system is very useful for Farmers and those interested in agriculture. (shrink)

PTSD is a common mental health disorder among students across the globe that manifests after encountering traumatic events. This study explored the nexus between poverty and PTSD among students. This review employed a scoping review lens to examine the nexus between PTSD and poverty among students. Literature search was conducted in online databases such as PubMed, Google Scholar, Scopus, and Semantic Scholar. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) extension for scoping reviews (PRISMA-SCR) for (...) study selection and data extraction. Poverty is a significant factor that predisposes individuals to the development of post-traumatic stress disorder after experiencing a traumatic event, as determined by this review. In addition, this review discloses that psychological treatments such as Trauma Focused Behavioural Therapy, Cognitive Behavioural Therapy for PTSD, narrative exposure therapy among others have been identified as effective for treating PTSD; however, the cost of treatment has been found to be unaffordable among poor individuals. This study also revealed that there is a dearth of empirical studies that focus specifically on students' PTSD and Poverty or studies conducted in educational settings with reference to PTSD and poverty. In light of this, this study recommends that future research should investigate the relationships between PTSD and poverty among students. (shrink)