Andrew Stumpf

Background and Objectives People living with dementia see autonomy as central to their well-being, and loss of autonomy is one of the things people diagnosed with dementia fear the most. Effective support of autonomy requires us to understand carefully what autonomy is and to structure care plans and health policy in accordance with that understanding. Many recent social scientific studies of autonomy in people with dementia do not carefully operationalize the term “autonomy.” This is problematic because autonomy is a highly ambiguous term that points to a complex reality. We distill from the relevant philosophical and empirical literatures a conceptually clear and empirically informed account that is relevant to the experience of people living with dementia. Research Design and Methods We present a general account of the concept of personal autonomy, drawing on existing philosophical literature. We then test the relevance of this account via a scoping review of empirical research reporting on the experience of personal autonomy in persons living with dementia. Results With the assumption that adequate relational supports are in place, all aspects of our philosophically informed account of personal autonomy (decisional autonomy, authenticity, and executional autonomy) are compatible with the experience of persons living with dementia. Discussion and Implications With adequate relational support, personal autonomy remains an achievable goal even in contexts of moderate to severe dementia. A conception of personal autonomy that is both theoretically and empirically informed can help guide efforts to study and support personal autonomy in persons living with dementia. Keywords: Capacity, Decision-making, Authenticity, Person-centered care, Interdisciplinary

Medical assistance in dying (MAiD) was legalized in Canada following the Carter v. Canada ruling of 2015. In spite of legalization, the ethics of MAiD remain contentious. The bioethical literature has attempted to differentiate MAiD from withdrawing life-sustaining treatment (WLT) in an effort to examine the nature of the moral difference between the two. However, this research has often neglected the firsthand experiences of the clinicians involved in these procedures. By asking physicians if they perceive the major bioethical accounts as clinically useful, we seek to distinguish between aspects of the contemporary bioethical landscape which are useful at the bedside and those which are divorced from the realities faced by clinicians. We applied a qualitative descriptive approach to explore physicians’ experiences and bioethical distinctions in providing MAiD and WLT. Semi-structured interviews were conducted with 21 physicians, and the transcripts were thematically analyzed to identify common patterns and divergences in their perspectives. Three core themes were found: (1) consensus on MAiD’s moral equivalence with WLT despite differences between the practice, (2) discord regarding the use of the term ‘killing’, and (3) disjuncture between bioethical debates and practice. Theme 1 comprised of three sub-themes: (1.1) no moral difference between MAiD and WLT, (1.2) physician versus underlying medical condition as cause of death, and (1.3) relief of suffering. In order to have practical utility for clinical practice, it is essential for bioethicists to engage in dialogue with patients and their medical providers pursuing MAiD or WLT. Theoretical debates that are divorced from the realities of terminal illness do not assist physicians with navigating the ethical terrain of ending a patient’s life. This research captures meaningful accounts regarding MAiD and WLT that is rooted in the lived experience of the providers of these services in order for bioethical debates to have substantive impact in clinical practice and in legislation surrounding future health policies.

This thesis aims to contribute to an answer to the question, “What would a philosophy, and more specifically, an ethics, based on Christ, look like?” My first contention is that we find, in the ethical thinking of Karl Barth and Dietrich Bonhoeffer, two particularly radical and complementary attempts to point toward Christ as the basis or foundation of any genuine ethics. What sets the views of Barth and Bonhoeffer apart from many of the other philosophical and theological approaches to ethics, is the extent to which they seek to take seriously the ethical implications of the gospel – the revelation of God's grace in the Word and work of Jesus Christ – for ethics. My second contention is that, even if we follow neither Barth nor Bonhoeffer in the detailed outworking of the character of a Christologically grounded ethics, we nevertheless cannot avoid facing the radical challenge each of these men poses, in their own related but distinct ways, that in thinking about ethics we must take Christ as our standard and foundation. In the first two chapters, on Barth and Bonhoeffer respectively, I identify the structure and content of their arguments and display their textual basis in the texts most relevant to the topic, namely Barth’s Church Dogmatics and Bonhoeffer’s Ethics. I also present an outline of the character of a Christologically-grounded ethics as each of these theologians derives it from its Christological basis. In the third chapter I examine the cogency of their arguments

The brief introductory chapter attempts to motivate the project by pointing to the intuitive appeal and importance of the notion of an object, and the need – for the sake of progress in at least two important debates in ontology – to replace this notion with a series of related notions of individuals of different sorts. Section One of Chapter Two aims to accomplish two primary tasks. The first is to clarify the intensions of three often employed but ambiguous categorical terms: ‘individual’, ‘particular’ and ‘object’, with emphasis on the third, which is often taken to be of particular philosophical significance. I carry out this clarificatory task by weighing various positions in the literature and arguing for explications of each notion that are maximally economical and neutral, that is, explications which overlap as little as possible with other important ontological notions and do not require us to take a stand on any apparently intractable debates. The second task of 2.1 is to delineate the various ontological distinctions that will be turned, in Chapter Four, into the “dimensions” of which the ontological framework I will be advocating there is composed. The delineation of these distinctions takes place naturally in the course of attempting to characterize the notion of an object and to distinguish it from the notions of an individual and a particular, in spite of the fact that objects are both individuals and particulars. In the second section of Chapter Two I illustrate the centrality of the notion of an object in Ontology by showing how that notion figures in the debate over the existence of artifacts. I argue that progress in this debate has been hindered by the way it has been framed, and that seeing the issue as concerning not whether artifacts exist but whether artifacts are objects enables us to better appreciate and accommodate the different perspectives of the debate’s participants. At the same time, this way of dissolving the dispute makes clear that existence is not limited to entities that fall under the relevant concept of an object, foreshadowing the pluralistic ontological framework to be developed in Chapter Four. Chapter Three pronounces on a second debate in ontology, in which three positions concerning the correct ontological assay of the class of intrinsically unified independent concrete particulars are in competition with each other. My conclusion is that none of the three positions succeeds, since each faces fairly serious difficulties. I suggest that the root of our inability to locate the correct ontological assay is the inclination to treat all ontologically significant entities as objects in the indicated sense, and the corresponding inclination to attempt to give an ontological assay that covers all objects, neglecting important differences between distinct types of individuals. Chapter Four begins by displaying in greater detail the considerations that make the notion of an object appear to be indispensible. However, the results of the second section of Chapter Two and of the entirety of Chapter Three have already shown two areas in which the notion of an object tends to lead to confusion. So a tension emerges between the prima facie necessity of the notion and the reasons we have found for thinking that this notion either is itself problematic or at least tends to cause problems for other issues in Ontology. The remainder of Chapter Four consists in explaining my strategy for moving forward. Briefly, this strategy involves replacing the notion of an object with a series of concepts applicable to individuals of various types. Each of the components belonging to a given “individual-concept” is drawn from one or another side of one of the ontological distinctions that together form an overall ontological framework, and which components are involved is a matter to be determined by examining the conceptual demands imposed by the various practices which we engage in, that require us to appeal to individuals of the type in question. The resulting “pluralistic” ontological framework provides a way of situating and relating types of individuals that both avoids the confusions that the single general concept of an object leads to, and is capable of indicating the varying degrees of “ontological robustness” or “object-like-ness” of any given type of individual. I conclude by suggesting how the framework I am advocating can be elaborated on and put to use in further research.

I propose a novel compatibilist interpretation of Leibniz’s mature views concerning what is metaphysically basic. Drawing on a compatibilist reading of Aristotle on primary substance in the Categories and Metaphysics Z, I argue that Leibniz is working with two complementary ways of being metaphysically basic—one applying to immaterial monads, the other to corporeal substances. Although corporeal substances derive their status as basic from their dominant monads, they are nevertheless fully real, unified, and genuinely capable of acting. This perspective respects Leibniz’s idealist tendencies and his commitment to the reality of bodies without attributing inconsistency to his considered views. View HTML Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.Harmonizing Leibniz’s OntologyVolume 51, Issue 3ANDREW D. H. STUMPF DOI: https://doi.org/10.1017/S0012217312000704Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. Harmonizing Leibniz’s OntologyVolume 51, Issue 3ANDREW D. H. STUMPF DOI: https://doi.org/10.1017/S0012217312000704Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. Harmonizing Leibniz’s OntologyVolume 51, Issue 3ANDREW D. H. STUMPF DOI: https://doi.org/10.1017/S0012217312000704Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission.

The moral significance of the distinction between killing and allowing to die has played a key role in debates about euthanasia and physician assisted suicide. Since the withdrawal of life-sustaining treatment is held as morally permissible in the medical community, it follows that if there is no morally significant difference between killing and allowing to die, then there is no morally significant difference between withdrawing life-sustaining treatment or administering a lethal injection to end a patient’s life. Consistency then requires that voluntary active euthanasia (VAE) is also morally permissible. The debates over whether the distinction is morally significant have carried on for decades with little hope of consensus. We begin by surveying the literature to identify common argumentative strategies used in defending or rejecting the distinction’s significance. We observe, based on our review, that many of these strategies operate in ways that are conceptually removed from the concrete clinical situation of physicians involved in practices that lead to patient death (by withdrawal of treatment or VAE). We conclude by arguing for a novel way of moving the debate forward indicated by our reading of the literature, namely, by paying careful attention to the moral experience of physicians involved in end-of-life interventions to understand how they experience these practices. Exploring physician experience can reveal how the distinction may or may not be useful for moral deliberation and can provide the needed context to theorize about the distinction in a more empirically informed and practically useful way.

_Ancient Philosophy: A Companion to the Core Readings_ is designed as an approachable guide to the most important and influential works of ancient philosophy. The book begins with a brief overview of ancient Greek mythology and the pre-Socratic philosophers. It then examines a number of the most important works from Plato and Aristotle, including _Euthyphro_, _Meno_, _Republic_, the _Categories_, the _Physics_, and the _Nicomachean Ethics_, before concluding with a brief look at Hellenistic philosophy and the origins of Neoplatonism. Readers who might otherwise struggle with the original texts will find an exceedingly helpful guide in Stumpf’s clear explanations and analyses. Numerous diagrams and images are provided to aid in comprehension.