Categorical and Hypothetical Imperatives
Some people are
Kant holds that the fundamental principle of our moral duties is a
categorical imperative. It is an imperative because it is a command
(e.g., “Leave the gun. Take the cannoli.”) More precisely, it
commands us to exercise our wills in a particular way, not to
perform some action or other. It is categorical in virtue of applying
to us unconditionally, or simply because we possesses rational
wills, without reference to any ends that we might or might not
have. It does not, in other words, apply to us on the condition that
we have antecedently adopted some goal for ourselves. Of course,
other imperatives have a similar non-conditional form. For
instance, ‘Answer an invitation in the third person in the third
person’ is an imperative of etiquette, and it is not conditional.
(Foot, 1972, p. 308) It does not apply to you only on the condition
that you have some end that is served by being polite. But this
imperative is not categorical in Kant's sense, since it does not
apply to us simply because we are rational enough to understand
and act on it, or simply because we possess a rational will.
Imperatives of etiquette apply to us simply because prevailing
customs single us out as appropriate objects of appraisal by
standards of politeness, whether we accept those standards or not.
There are ‘oughts’ other than our moral duties, but these oughts are
distinguished from the moral ought in being based on a quite
different kind of principle, one that is the source of hypothetical
imperatives. A hypothetical imperative is a command that also
applies to us in virtue of our having a rational will, but not simply
in virtue of this. It requires us to exercise our wills in a certain way
given we have antecedently willed an end. A hypothetical
imperative is thus a command in a conditional form. But not any
command in this form counts as a hypothetical imperative in
Kant's sense. For instance, ‘if you're happy and you know it, clap
your hands!’ is a conditional command. But the antecedent
conditions under which the command ‘clap your hands’ applies to
you does not posit any end that you will, but consists rather of
emotional and cognitive states you may or may not be in. Further,
‘if you want pastrami, try the corner deli’ is also a command in
conditional form, but strictly speaking it too fails to be a
hypothetical imperative in Kant's sense since this command does
not apply to us in virtue of our willing some end, but only in virtue
of our desiring or wanting an end. For Kant, willing an end
involves more than desiring or wanting it; it requires the exercise
of practical reason and focusing oneself on the pursuit of that end.
Further, there is nothing irrational in failing to will means to what
one desires. An imperative that applied to us in virtue of our
desiring some end would thus not be a hypothetical imperative of
practical rationality in Kant's sense.
The condition under which a hypothetical imperative applies to us,
then, is that we will some end. Now for the most part, the ends we
will we might not have willed, and some ends that we do not will
we might nevertheless have willed. But there is at least conceptual
room for the idea of an end that we must will. The distinction
between ends that we might or might not will and those, if any, we
must will, is the basis for his distinction between two kinds of
hypothetical imperatives. Kant names these “problematic” and
“assertoric”, based on how the end is willed. If the end is one that
we might or might not will — that is, it is a merely possible end —
the imperative is problematic. For instance, “Don't ever take side
with anyone against the Family again.” is a problematic
imperative, even if the end posited here is (apparently) one's own
continued existence. Almost all non-moral, rational imperatives are
problematic, since there are virtually no ends that we must will.
As it turns out, the only (non-moral) end that we must will in
Kant's view (by ‘natural necessity’ he says) is our own happiness.
Any imperative that applied to us because we will our own
happiness would thus be an assertoric imperative. As it turns out,
however, rationality can issue no imperative if the end is
indeterminate, and happiness is an indeterminate end. Although we
can say for the most part that if one is to be happy, one should save
for the future, take care of one's health and nourish one's
relationships, these fail to be genuine commands.
happy without these, and whether you could be happy without
them is, although doubtful, an open question.
Since Kant presents moral and prudential rational requirements as
first and foremost demands on our wills rather than on external
acts, moral and prudential evaluation is first and foremost an
evaluation of the will our actions express, applying to the actions
themselves only derivatively. Thus, it is not an error of rationality
to fail to take the necessary means to one's (willed) ends, nor to fail
to want to take the means; one only falls foul of practical reason if
one fails to will the means. Likewise, while actions, feelings or
desires may be the focus of other moral views, for Kant practical
irrationality, both moral and prudential, focuses on our willing.
Kant describes the will as operating on the basis of subjective
volitional principles he calls ‘maxims’. Hence, morality and other
rational requirements are demands that apply to the maxims that
motivate our actions. The form of a maxim is ‘I will A in C in
order to realize or produce E’ where ‘A’ is some act type, ‘C’ is
some type of circumstance, and ‘E’ is some type of end to be
realized or achieved by A in C. Since this is a principle stating only
what some agent wills, it is subjective. (A principle for any rational
will would be an objective principle of volition, which Kant refers
to as a practical law.) For anything to count as human willing, it
must be based on a maxim to pursue some end through some
means. Hence, in employing a maxim, any human willing already
embodies the form of means-end reasoning that calls for evaluation
in terms of hypothetical imperatives. To that extent at least, then,
anything dignified as human willing must be rational.
The categorical imperative
The categorical imperative helps us to know which actions are
obligatory and which are forbidden. Hypothetical imperatives are
conditional: ‘If I want x then I must do y’. These imperatives are
not moral. For Kant, the only moral imperatives were categorical:
‘I ought to do x”, with no reference to desires or needs.
There are three categorical imperatives.
1. The universal law – All moral statements
should be general laws, which apply to
everyone under and circumstances. There
should be no occasion under which an
exception is made.
2. Treat humans as ends in themselves –
Kant argues that you should never treat
people as a means to some end. People
should always be treated as ends in
themselves. This promotes equality.
3. Act as if you live in a kingdom of ends –
Kant assumed that all rational agents were
able to deduce whether an argument was
moral or not through reason alone and so, all
rational humans should be able to conclude
the same moral laws.
 Childhood seizures: much more benign than previously thought.
When a small child goes into a fever-induced seizure, parents often view this frightening event as an
indication of brain damage. But mounting evidence show that these seizures are far less threatening than previously
believed.
Each year thousands of children experience what doctors
refer to as febrile seizures, or seizures precipitated by a fever. They are the most common type of seizure, occurring
in 2 to 4% of children. About one third of children who have a febrile seizure will have a recurrence.
Until the 1970s, febrile seizures were thought to be a form of epilepsy which justified the routine
prescription of the anticonvulsant barbiturate, phenobarbital. The drug was to be taken continuously for years.
Research has since demonstrated that the risk of epilepsy following a febrile seizure is very slight. In 1980, a
consensus conference of experts developed guidelines aimed at reducing the use of phenobarbital by determining the
limited circumstances in which the drug's benefit might outweight its risks.
Today, doctors are more aware of the risks of continuous phenobarbital therapy in young children,
including decreased attention span and impairment of learning and memory. By now, two large-scale studies have
identified febrile seizures as "a benign syndrome distinct from, although associated with, epilepsy."
Until recently, researchers concentrated on how to determine which children would develop epilepsy
following a febrile seizure, but a new study has changed the focus to the neglected issue of who will suffer a
recurrence. Anne T. Berg, Ph.D., of the Yale School of Medicine, and colleagues from several medical centers
designed a study to determine the predictors of a recurrence by examining the illness during which the seizure
occurred (New England Journal of Medicine, 15 October 1992).
They collected information about 347 children, aged one month to ten years, who were brought to the
emergency room for a first-time febrile seizure. Medical records were reviewed, the parents were interviewed, and
the children were followed for an average of 20 months. Seven of the children had been given continuous treatment
with phenobarbital. In three other cases, parents were told to give phenobabital to their children only in the event of
another fever, despite the fact that published studies have shown this to be ineffective.
Dr. Berg found that 94 of the 347 children had recurrent febrile seizures. The two strongest predictors of
recurrence were a shorter duration of fever prior to the seizure and a lower temperature. With each degree of
increase in temperature, from 101F to 105F, the risk of recurrence at one year declined by 5%. Thus, children with
temperatures of 101F had a 35% chance of recurrence and those with 105F had a 13% chance. Children whose
initial seizure occurred under the age of 18 months and those with family history of febrile seizures were found to be
more likely to experience a recurrence.
"Febrile seizures do not increase the risk of death, injury, mental retardation, or cerebral palsy in these
children," wrote John M. Freeman, M.D., of the Johns Hopkins Medical Institutions, in an editorial that
accompanied the study. "The only medical consequences of an initial febrile seizure are a greater chance of having
further febrile seizures and a slight risk of later epilepsy (2% by seven years of age)."
Addressing the question of whether drugs are ever appropriate after an initial febrile seizure, Dr. Freeman writes:
"Perhaps, rarely and briefly, for days or weeks, while the physician provides the parents with reassurance and
accurate information, thus helping to calm their anxiety. Perhaps oral or rectal diazepam [Valium] could be made
available for use during a prolonged seizure or if the child is far from medical care. Making such treatment available
may be reassuring, and the treatment would rarely be used."
The new study also showed that, contrary to popular medical belief, anticonvulsant drugs are not indicated
for specialized groups of children like those with a family history of epilepsy and/or neurodevelopmental
abnormalities, such as cerebral palsy and dyslexia. Both groups show no higher risk of recurrence. Although
children with neurodevelopmental abnormalities are at high risk for epilepsy, there is no evidence that treating their
first seizure will make any difference.
Dr. Freeman closed his editorial by expanding his point about the need for information and reassurance. "I
believe it is finally time to stop prescribing medication and to begin providing families with solid information and
reassurance about the consequences and outcomes of febrile seizures. It is time to recognize that initial febrile
seizures are benign and do not require treatment, just as we are learning that initial afebrile seizures [without fever]
are benign and do not require medical intervention. Perhaps we should acknowledge that the best treatment for the
child who has a first seizure--febrile or afebrile--is not necessarily to prescribe medication, but rather to sit with the
family and talk."
 Effect of an upper respiratory tract infection on upper
airway reactivity
N. Nandwani, J. H. Raphael and J. A. Langton
University Department of Anaesthesia, Leicester Royal Infirmary, Leicester LE1 5WW
Patients presenting for elective anaesthesia and surgery may be suffering with, or recovering
from, a recent upper respiratory tract infection (URTI). It is a frequent clinical problem as to
whether to postpone surgery in such patients as they may be more likely to suffer adverse
respiratory events related to administration of general anaesthesia. Using dilute ammonia vapour
as a chemical stimulus, we measured upper airway reactivity in 11 healthy volunteers (six males),
mean age 39.8 (range 30-58) yr, who had symptoms of an URTI. Volunteers were recruited 24-
72 h after symptoms first began, and followed-up at regular intervals for the next 8 weeks.
Measurements of upper airway reactivity were made on the following days (+/- 24h) after
commencement of URTI symptoms: 3, 6, 9, 15, 20 and 27. Additional measurements were
obtained 56 days after symptoms first began, and these were regarded as baseline measurements.
Upper airway reactivity was increased on days 3, 6 and 9 compared with baseline measurements
(P < 0.01, Wilcoxon). There was no significant change in airway reactivity from day 15 onwards,
by which time 10 of the 11 subjects were completely devoid of symptoms. All subjects were
asymptomatic by day 20 and remained so until the study ended on day 56. We conclude that
upper airway reactivity was increased during the acute phase of an URTI, and that this appeared

to be related to the presence of symptoms.

Objective: >Advise to increase fluid intake.
the patient manifested: >Loosen clothing.
> febrile temp = 39°C >Administer IV fluids at prescribed rate. Monitor regulation rate
>flushed skin and warm to touch frequently.
> convulsion >Administer antipyretics as ordered.
> RR = 34 bpm >To obtain baseline date.
the patient may manifest: >To note for progress and evaluate effects of hyperthermia.
> high fever >To decrease or totally diminish pain.
> weakness >Reduces metabolic demands or oxygen.
Hyperthermia Short term: >To promote surface cooling.
After 4 hours of nursing interventions, the patient’s temperature >To help decrease body temperature.
will decrease from 39°C to normal range of 36.5°C to 37°C. >To provide proper ventilation and promote release of heat
Long Term: through evaporation.
After 2 days of nursing interventions, the patient will be able to be >To promote fluid management.
free of complications and maintain core temperature within normal > Antipyretics lower core temperature.
range. Short term:
>Assess underlying condition and body temperature. The patient’s temperature shall have decreased from 39°C to
>Monitor and recorded vital signs. normal range of 36.5°C to 37°C.
>Remove unnecessary clothing that could only aggravate heat. Long Term:
>Promote adequate rest periods. The patient shall have been able to be free of complications and
>Provide TSB maintain core temperature within normal range.