The best interest test is the legal mechanism which governs decision making on behalf of adults who lack the capacity to make their own health care treatment decisions. The test has attracted considerable criticism from health professionals, academics, judges and lawyers for being ill-defined and non-specific. The question of what is meant by 'best interests' remains largely unanswered. As a consequence, the test gives medical and legal decision makers considerable discretion to apply their personal value judgements within supposedly value-free philosophical frameworks - unreasoned and opaque decision making processes are the inevitable result. Because of the dominance of supposedly value-free philosophical frameworks, the place of values in decision making is not always fully understood. Reasoning is not possible without values, which stem from our emotions and passions, our upbringing, our religion, our cultures, our processes of socialisation and from our life experiences. Values help us make sense of our daily lives. I argue that law - like any other social institution - is essentially a human, values based construct. I put forward a theory of values-based law which argues for the recognition that laws, rules and conventions are based on, and contain, individual values. Currently, medical and legal decision makers justify grave decisions on behalf of society's most vulnerable citizens without revealing, or even acknowledging the values which drive and inform their decisions. Any opportunities to scrutinise or debate the values driving decisions are lost. Ultimately, values-based law argues that values underlying best interest determinations must be exposed to facilitate honest, transparent and fulsome decision making on behalf of adults who lack capacity. By applying the theory of values-based law, supposedly value-free decision making processes are exposed as insufficient to facilitate fulsome, honest and transparent legal reasoning.

The best interest test is the legal mechanism which governs decision making on behalf of adults who lack the capacity to make their own health care treatment decisions. The test has attracted considerable criticism from health professionals, academics, judges and lawyers for being ill-defined and non-specific. The question of what is meant by 'best interests' remains largely unanswered. As a consequence, the test gives medical and legal decision makers considerable discretion to apply their personal value judgements within supposedly value-free philosophical frameworks - unreasoned and opaque decision making processes are the inevitable result. Because of the dominance of supposedly value-free philosophical frameworks, the place of values in decision making is not always fully understood. Reasoning is not possible without values, which stem from our emotions and passions, our upbringing, our religion, our cultures, our processes of socialisation and from our life experiences. Values help us make sense of our daily lives. I argue that law - like any other social institution - is essentially a human, values based construct. I put forward a theory of values-based law which argues for the recognition that laws, rules and conventions are based on, and contain, individual values. Currently, medical and legal decision makers justify grave decisions on behalf of society's most vulnerable citizens without revealing, or even acknowledging the values which drive and inform their decisions. Any opportunities to scrutinise or debate the values driving decisions are lost. Ultimately, values-based law argues that values underlying best interest determinations must be exposed to facilitate honest, transparent and fulsome decision making on behalf of adults who lack capacity. By applying the theory of values-based law, supposedly value-free decision making processes are exposed as insufficient to facilitate fulsome, honest and transparent legal reasoning.

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Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Communication between doctors and patients in clinical settings is notorious for being difficult. This problem has inspired a wealth of empirical research from a variety of academic fields on the subject of doctor-patient communication. However, very little attention has been paid to the role of modern medicine's intellectual self-image as natural science in interactions within clinical medical settings. The aim of the current study was to philosophically investigate the influence of the medical profession's intellectual self-image on communication between doctors and patients. Jürgen Habermas' work on Universal Pragmatics was used to comment on doctor-patient communication as it is described in the existing empirical research literature. Michel Foucault's work on discourse and power was used to analyse and describe medical discourse and the nature of power in doctor-patient relationships. The outcome of this philosophical analysis leads to the conclusion that modern medicine's intellectual self-image has a pervasive and negative influence on communication between doctors and patients during clinical consultations. This is because medicine's positivist world-view results in an almost exclusive focus on the physical aspects of disease in clinical medicine. The patient's mind and his/her social world are not of great significance from the natural scientific perspective. Medical professionals may thus easily regard their clinical task solely as the physical treatment of physical disorders. They are very likely to consider many communicative activities as unrelated to their clinical task. Inadequate doctor-patient communication can easily affect the quality of medical care and patient outcomes in a negative manner, as well as diminish the quality of the doctor's occupational experience. For this reason I conclude that medicine's natural scientific intellectual self-image is not appropriate for the task of providing medical care to individual patients. Two additional reasons support this conclusion, namely the misidentification of clinical medicine as a natural science and the inappropriateness of a scientific conception of truth for the context of doctor-patient interactions. The implications of these conclusions are that the intellectual self-image and world-view of modern medicine should change to better agree with the nature of clinical practice and to make room for the psychological and social dimensions of the patient's life within health care. The medical profession should also revise its conception of science to a theory that acknowledges that interpretive reasoning and knowledge without guaranteed certainty are legitimate elements of science. I advocate for consciousness among the medical profession of the reality of medical discourse and its effects on doctors, patients and on their interaction with one another. / AFRIKAANSE OPSOMMING: Kommunikasie tussen dokters en pasiënte in kliniese omgewings is daarvoor berug om moeilik te wees. Hierdie probleem het 'n magdom empiriese navorsing vanuit 'n verskeidenheid van akademiese velde omtrent dokter-pasiënt kommunikasie geïnspireer. Baie min aandag word egter gewy aan die rol van moderne geneeskunde se intellektuele selfbeeld as 'n natuurwetenskap in interaksies in kliniese mediese omgewings. Die doel van die huidige studie was om die invloed van die mediese professie se intellektuele selfbeeld op kommunikasie tussen dokters en pasiënte filosofies te ondersoek. Jürgen Habermas se werk oor Universele Pragmatiek (Universal Pragmatics) is gebruik om kommentaar te lewer oor dokter-pasiënt kommunikasie soos wat dit beskryf word in die empiriese navorsingsliteratuur. Michel Foucault se werk oor diskoers en mag is gebruik om mediese diskoers en die aard van mag in dokter-pasiënt verhoudings te ontleed en te beskryf. Hierdie filosofiese ontleding gee aanleiding tot die gevolgtrekking dat moderne geneeskunde se intellektuele selfbeeld 'n deurdringende en negatiewe invloed op kommunikasie tussen dokters en pasiënte gedurende kliniese konsultasies het. Die rede hiervoor is dat geneeskunde se positivistiese wêreldbeskouing lei tot 'n byna uitsluitlike fokus op die fisiese aspekte van siekte in kliniese geneeskunde. Die pasiënt se verstand en gees (mind) en sy/haar sosiale wêreld is nie van groot belang vanuit die natuurwetenskaplike perspektief nie. Persone in die mediese beroep mag hul kliniese taak dus maklik as bloot die fisiese behandeling van fisiese afwykings beskou. Dit is baie waarskynlik dat hulle vele kommunikatiewe aktiwiteite as onverwant tot hul kliniese taak beoordeel. Ontoereikende dokter-pasiënt kommunikasie kan die kwaliteit van mediese sorg en pasiënte se gesondheidsuitkomste maklik negatief beïnvloed, en ook die kwaliteit van die dokter se ervaring van sy/haar beroep verlaag. Om hierdie rede maak ek die gevolgtrekking dat geneeskunde se natuurwetenskaplike intellektuele selfbeeld nie toepaslik is vir die opdrag om mediese sorg aan individuele pasiënte te lewer nie. Twee verdere redes ondersteun hierdie gevolgtrekking, naamlik die verkeerdelike identifikasie van kliniese geneeskunde as 'n natuurwetenskap en die onvanpastheid van 'n wetenskaplike konsepsie van waarheid vir die konteks van dokter-pasiënt interaksies. Die implikasies van hierdie gevolgtrekkings is dat die intellektuele selfbeeld en wêreldbeskouing van moderne geneeskunde moet verander om beter ooreen te stem met die aard van die kliniese praktyk en om ruimte te maak vir die sielkundige en sosiale dimensies van die pasiënt se lewe in gesondheidsorg. Die mediese professie moet ook haar konsepsie van die wetenskap hersien na 'n teorie wat erken dat interpreterende redenasie en kennis sonder gewaarborgde sekerheid, geregverdigde elemente van die wetenskap is. Ek pleit vir bewustheid onder die mediese professie van die realiteit van mediese diskoers en die effek daarvan op dokters, pasiënte en op hul interaksie met mekaar.

The purpose of this study is to examine philosophical hermeneutics as a referent for student understanding of Nature-of-Science (NOS) concepts. Rather than focus on a prescriptive set of canons used in addressing NOS pedagogy in K-12 schools, this study seeks to explicate a descriptive set of principles based on Hans Georg-Gadamer’s theory of interpretation that has the potential for developing dispositions necessary for understanding. Central among these are the concepts of fore-structure, prejudice, temporal distance, and history of effect, all of which constitute part of the whole of the hermeneutic circle as envisaged by Gadamer. As such, Gadamer’s hermeneutics is contrasted with Cartesian epistemology and its primacy of method, the Enlightenment’s prejudice against prejudice, the modernist/progressive tendency to consider all situations as problems to be solved by relegating all forms of knowledge to techné, and the subjective nature of interpretation inherent in a hermeneutics of suspicion. The implication of such a conceptual analysis for NOS pedagogy is that student understanding is considered not so much as a cognitive outcome dependent on a series of mental functions but rather as an ontological characteristic of Dasein (being-human) that situates learning in the interchange between interpreter and text. In addition, the philosophical foundations implicit in addressing student understanding of NOS found in many curricular reform efforts and pedagogical practices in science education are questioned. Gadamer’s hermeneutics affords science education a viable philosophical framework within which to consider student understanding of the development of scientific knowledge and the scientific enterprise.

This study is an historical-philosophical analysis of art education in elementary, secondary, and normal schools in the United States from 1883 to 1910 as revealed through the Journal of Proceedings and Addresses of the National Education Association. Its purposes are to define and describe the role, practices, and status of art education as related to or influenced by selected philosophies, psychologies, theories of learning, and research, along with other prevalent factors such as the scientific, industrial movements, and mores of the period. Art education was found in an admitted state of infancy as the period began. 1883 marked its initial separation from the Manual Training Department and first recognition as an entity. This study of its status traces growth and improvement to a point of tentative public acceptance, and re-attachment of the Art Department to the Manual Training Department as an equal partner. Evidence presented seemed to indicate that progress had been made by art education in several important ways. School administrators had recognized that art did have a legitimate role in education, and a national organization had been formed to act as a forum. A uniform course of study had been presented, and current research in mental development had been considered. The scope of art instruction had been broadened to better serve educational and practical needs. Facilities had been improved, and there was a growing number of trained teachers and supervisors.

En partant et en s'appuyant sur l’approche de Walter Benjamin et la question d’aura dans l’œuvre cinématographique, cette thèse se propose d'analyser deux films tunisiens, «Les silences du palais" de M. Tletli et "Baba Aziz" de N. Khmir. Le choix d'un tel corpus repose sur des exigences auratiques dans le mode d'appréhension des deux cinéastes, notamment dans leurs approches esthétiques, explorant tous les systèmes formels dans un ordre sensible où reigne le visible et le sonore dans une parfaite harmonie. En tenant compte des aspects formels des deux films, l'on a essayé de les décomposer à travers les différentes séquences où l'on a noté que ces analyses sont sensiblement orientées par l’adaptation du concept de «l'aura» dans un sens de mise en jeu entre absence/présence. Nous proposons une relecture que nous espérons originale, mettant les deux films à l’épreuve de nouveaux égards. Au fond, les analyses dans ce travail ont pour objectif de voir dans quelle mesure la question auratique dicte la mise en scène des deux cinéastes du corpus, malgré les exigences techniques et artistiques qu'impose la praxis filmique. Aussi, il est bien question de montrer la pluralité des codes auratiques et l’importance de déchiffrement dans l'approche analytique de la séquence cinématographique. / Based on Benjamin Walter‘s approach and the question of aura in cinematographic works, this thesis aims at analyzing two Tunisian films “the Silences of the Palace” directed by M. Tletli and “Baba Aziz” by N. Khmir. The selection of the two films stems from an aura of expectations within the two filmmakers’ apprehension and more specifically their aesthetic approaches which explore in a sensitive manner all the formal systems, and where the visual and acoustics reign in perfect harmony. Taking into account the formal aspects of these two films, a thorough analysis of different sequences where the question of aura is identified and the issue of presence and absence is brought into play. This new reading is hopefully to be original for further considerations. Indeed the aim of this work is to see how far the question of aura within the two filmmakers predetermines direction in spite of the technical and artistic requirements dictated by filmmaking. It is also of paramount importance to show the different aura codes and the decoding strategy in the analytical approach of cinematographic sequences.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The current dissertation has as its main objective an exposition and critical analysis of Charles Kielkopf's translation of the Standard Deontic Logic (SDL) into a normal alethic logic, and the resulting construction of a system of deontic logic that captures Kantian fundamental concepts and principles such as the concept of causal necessity and the formulations of the Categorical Imperative concerning Kingdom of Nature and Kingdom of Ends. Since this process results in an interpretation of aspects of the Kantian philosophy, it has been chosen, initially, a presentation in general lines of these concepts and, considering the difficulties regarding the applicability of a translation process between deontic and ontic principles, it was done necessary also an exhibition concerning the problem of the inferential barriers, as well as of his more immediate consequence, i. e., Jörgensen's Dilemma. In a second moment, it was also made a characterization of normal modal systems, deontic ones and alethic ones, as well as of the notions of translation between logics and of Dawson modelling. The final chapter consists of a critical examination of Kielkopf's proposal, which uses Dawson modelling to develop a deontic logic based on the alethic system K1. Such Dawson modelling allows the definition of a deontic modalities in terms of iterated alethic modalities, therefore this model constitutes a way of avoiding the problems regarding inferential barriers. The development of an alternative for attribution of logical status to deontic concepts doesn't constitute, however, in an innovative aspect of this proposal, such aspect can be founded in the use made by Kielkopf of his formal model as a tool for the investigation of philosophical concepts, such as the Kantian concepts already mentioned. / A presente dissertação tem como objetivo uma apresentação da proposta de Charles Kielkopf, de tradução da lógica deôntica standard em uma lógica normal alética e de seus resultados quanto à construção de um sistema de lógica deôntica que capture conceitos e princípios kantianos como necessidade causal e as formulações do Imperativo Categórico acerca do Reino da Natureza e do Reino dos Fins. Uma vez que este processo resulta em uma interpretação de aspectos da filosofia kantiana, optou-se inicialmente por uma apresentação em linhas gerais destas concepções e, tendo em vista as dificuldades referentes a aplicabilidade de um processo de tradução entre princípios deônticos e ônticos, fez-se necessária também uma exposição acerca do problema das barreiras inferenciais, bem como de sua conseqüência mais imediata, a saber, o Dilema de Jörgensen. Num segundo momento, também foi feita uma caracterização dos sistemas modais normais, tanto deônticos quanto aléticos, bem como da noção de tradução entre lógicas e dos modelos de Dawson. O capítulo final consiste justamente num exame crítico da proposta de Kielkopf, o qual faz uso dos modelos de Dawson para desenvolver uma lógica deôntica a partir do sistema lógico K1. Tais modelos de Dawson permitem a definição de uma lógica deôntica em termos de modalidades aléticas iteradas, com o que este modelo constitui-se em uma maneira de evitar os problemas referentes às barreiras inferenciais. O desenvolvimento de uma alternativa para a atribuição de um status lógico a concepções deônticas não constitui, contudo, o aspecto inovador desta proposta, tal aspecto encontra-se justamente na utilização por Kielkopf, de seu modelo formal como uma ferramenta para a investigação de concepções filosóficas, no caso, as concepções kantianas já citadas.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The current dissertation is the result of an investigation about the semantic of deontic logic. Restricting to the propositional version, the work had as the main objective of study some lectures of the philosopher J. Hintikka which semantic proposal for deontic logic includes a re-interpretation of an important notion in Kant s philosophy: the notion of a Kingdom of Ends. Kant also figures in the Hintikka proposal through the illustration of one of the results of his matter, it means, the distinction between logical and deontic consequence, from which the so called Kant s Principle is an example. Having as the objective the exposition of this proposal, it has chosen to situate it in a discussion about the convenience of formalizations has a tool of philosophical analysis. Therefore, the proposal of Hintikka figures as an example of formalization which the results can have relevant philosophical features. The general exposition of the Kantian formulations of the Categorical Imperative, especially the formulation of the Kingdom of Ends (the subject matter of the first chapter), it has as an aim to point the most relevant features in Kantian practical philosophy for doing the analysis that accomplishes on the third chapter. / A presente dissertação é o resultado de uma investigação acerca da semântica para lógica deôntica standard. Restringindo-se à versão proposicional da mesma, o trabalho teve como principal objeto de estudo alguns textos do filósofo J. Hintikka, cuja proposta de semântica para lógica deôntica inclui a reinterpretação de uma noção importante da filosofia de I. Kant: a noção de Reino dos Fins. Kant também figura na proposta de Hintikka pela ilustração de um dos resultados de sua abordagem, a saber, a distinção entre conseqüência lógica e conseqüência deôntica, da qual o assim chamado princípio de Kant é um exemplo. Tendo como objetivo a exposição desta proposta, optou-se por situá-la em uma discussão a respeito da conveniência da formalização enquanto ferramenta de análise filosófica. Sendo assim, a proposta de Hintikka figura como um exemplo de formalização cujos resultados podem ter características filosóficas relevantes. A exposição geral sobre as formulações kantianas do Imperativo Categórico, em especial a formulação do Reino dos Fins (tema do primeiro capítulo), tem como objetivo justamente apontar as características de maior relevância na filosofia prática de Kant para o trabalho de análise que se efetiva no terceiro capítulo da dissertação.

With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of a framework that supports the combination of analytic methods. PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable. The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis. The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed. Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity.