All ethnographies, perhaps, contain some mystery: of how humans understand each other, or the way that words and glances, observations and encounters are turned into insights about what it means to be human at a given moment in history. But Sareeta Amrute’s Encoding Race, Encoding Class: Indian IT Workers in Berlin begins with a proper mystery, a person who has disappeared, and this literally missing body adroitly stages the subsequent exploration of IT workers’ missing bodies in scholarship on cognitive labor. (...) -/- Global software and service is often thought of as “immaterial,” a traffic of ideas in which effort is a matter of the mind, rather than a muscled arm. Without collapsing cognitive and manual labor, Amrute argues that both are nonetheless embodied ––and formidably marked by social difference, in particular post-genomic notions of race, and class. (shrink)

ABSTRACT The emergence of the coronavirus disease 2019 pandemic has wide-ranging implications for the field of professional psychology. As clinical practice has rapidly adapted to ensure continuity of care, doctoral students have encountered unique opportunities for ethics-related competency development across practicum training settings. This article discusses the relevant American Psychological Association Ethics Code standards and additional ethical considerations facing trainees as they navigate their foundational clinical experiences and develop as professional psychologists in light of a pandemic.

Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe (...) different forms of paternalism arising from a reductionist view of personal identity. I outline an Identity Relative Paternalistic Intervention Principle for determining when we should disallow refusal of treatment where the harm will be accrued by a future self, and consider objections including vagueness and non-identity.Identity relative paternalism does not always justify intervention to prevent harm to future selves. However, there is a stronger ethical case for doing so than is often recognised. (shrink)

In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment...

In lieu of an abstract, here is a brief excerpt of the content:"I'd Love to go Off the Grid and Never Come Back"AlishaDisclaimers. The author has chosen to disclose only her first name. All other names have been changed to protect the privacy of the individuals mentioned.I have been a nurse for 18 years. I have dealt with death. I have performed CPR, closed eyes, called families, and bagged bodies. I have taken decedents to the morgue. I knew what I (...) signed up for when I became a nurse, but nothing prepared me for the 2020–2022 pandemic years, and the havoc wreaked on my mental, emotional, spiritual, and physical health. I was then in a managerial position. Patients' accounts of tragedy and families' sorrow, confusion, denial, anger, regret, and fear came across my desk daily at the hospital, nightly to my phone, and over the weekend while at home. In March of 2020, I took responsibility for managing the hospital's morgue, an experience that proved to me that death is no respecter of man.The morgue had the capacity to hold five decedents. It was my responsibility to ensure that we had space for the decedents that were coming in droves. Though our hospital was hit disproportionally by COVID-19, we were unable to secure a refrigerated truck for the overages. Instead, we had to transfer our overflow across town to another hospital no matter the time of day or night. The funeral homes were overwhelmed and could not meet the mass demands, which caused major delays in picking up decedents from the hospital. Most funeral homes took them in body bags straight to the crematory or the cemetery for burial. Many would not open the bags to confirm identities. Instead, they trusted the information I wrote on the [End Page 77] bag in black marker and information on the ID tag attached to the zipper.As the deaths increased and more transfers were made, my social work supervisor Audi and I could barely keep track of the decedents—let alone which families we had reached. We created a process and checklist that had to be signed off before any transfers were made. My director, who supported us, encouraged me to train others to help. However, I felt an intense duty to own this process because of how easy it could be to misidentify someone. Families were losing loved ones daily. They could not be by their side as they took their last breath. The next contact the family had was picking up the decedent's ashes or burying a closed casket. I refused to be responsible for causing additional suffering by losing a loved one's remains. When I made the decision to control the process, I never dreamed I would do this job for three years, nor did I realize the trauma it would cause.One day, a lady named Pam asked us if she could see her mother in the morgue. "Of course not!" I thought. We were not opening body bags for any reason. When I spoke with Pam, she explained that her son had been shot and killed and that her mother witnessed his death. Pam's mother suffered a fatal heart attack after witnessing her grandson's murder."Ma'am, give me a moment," I said. I reviewed the decedent's chart to verify the information and considered what to do. After discussing Pam's request with Audi and my director, we decided to make an exception for this extenuating circumstance and allow Pam to see her mother. Audi and I viewed the decedent to ensure she was presentable. I closed her eyes and cleaned her. When I closed her eyes, a little fluid came out. When we brought Pam in, she noticed and wiped away her mother's "tears," lovingly looking at her. When walking Pam to the front door, she told us about her other son, who had also passed away recently. Remember, we were not supposed to touch anyone at that time "out of an abundance of caution," but with her heart-wrenching situation, we hugged Pam anyway.By the end of April 2020, Audi and I had monitored nearly 100 deaths, coordinating with funeral homes to... (shrink)

An ethics primer for nurses and nursing students that advances a vision for a holistic Christian notion of health and explores what Christian faith means, on a practical level, for the practice of nursing.

I am grateful to the commentators for their deep engagement with the issues raised in my paper. They raise a number of important challenges and questions about the use of frailty i...

To what extent should parents be allowed to use reproductive technologies to determine the characteristics of their future children? Is there something morally wrong with choosing what their sex will be, or with trying to 'screen out' as much disease and disability as possible before birth? Stephen Wilkinson offers answers to such questions.

abstract This paper examines, from a philosophical point of view, the ethics of the role of the family and the deceased in decisions about organ retrieval. The paper asks: Who, out of the individual and the family, should have the ultimate power to donate or withhold organs? On the side of respecting the wishes of the deceased individual, the paper considers and rejects arguments by analogy with bequest and from posthumous bodily integrity. It develops an argument for posthumous autonomy based (...) on the liberal idea of self‐development and argues that this establishes a right of veto over donation. It claims, however, that whether the family's power to veto would conflict with posthumous autonomy rights depends on how it comes about. On the side of respecting the family's wishes, the paper first considers an argument from family distress. This supports a contingent, non‐rights‐based reason for the family's power that is trumped by the deceased's rights. It then outlines and criticises an argument based on family autonomy. The conclusion is that the individual has the right to veto the family's wish to donate and that, while the family has no right to veto the individual's wishes to donate, it can legitimately acquire this power and has done so in practice. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we (...) distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

One of the most contentious ethical issues in the neonatal intensive care unit is the withdrawal of life-sustaining treatment from infants who may otherwise survive. In practice, one of the most important factors influencing this decision is the prediction that the infant will be severely intellectually disabled. Most professional guidelines suggest that decisions should be made on the basis of the best interests of the infant. It is, however, not clear how intellectual disability affects those interests. Why should intellectual disability (...) be more important than physical disability to the future interests of an infant? Is it discriminatory to base decisions on this? This paper will try to unravel the above questions. It seems that if intellectual disability does affect the best interests of the child it must do so in one of three ways. These possibilities will be discussed as well as the major challenges to the notion that intellectual disability should have a role in such decisions. The best interests of the child can be affected by severe or profound intellectual disability. It is, though, not as clear-cut as some might expect. (shrink)

Nishida's starting point -- Radical empiricism and pure experience -- Fichte, the neo-Kantians, and Bergson -- Nishida's later philosophy: the logic of place and self-contradictory identity.

Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite (...) health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients’ right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence, as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment. (shrink)

Current models of auditory verbal hallucinations tend to focus on the mechanisms underlying their occurrence, but often fail to address the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking why, given that there are AVHs, they have the properties that they have. One such property, which has been largely overlooked and which we will focus on here, is why the voices are often experienced as coming from agents, (...) and often specific, individualised agents. In this article, we argue not only that the representation of agents is important in accurately describing many cases of AVH, but also that deeper reflection on what is involved in the representation of agents has potentially vital consequences for our aetiological understanding of AVH, namely, for understanding how and why AVHs come about. (shrink)

Radical feminism has critiqued heterosexuality both as a primary means through which people are constituted as women and as men, and as inherently oppressive for women. Two recent developments challenge this critique: the concept of “virgin” heterosexuality, a form of heterosexuality in which the performance of heterosexual sex, with or without sexual intercourse, is voluntarily chosen, and “queer” heterosexuality, a concept derived from postmodernist and queer theory, which does not only reinscribe, but also actively subverts and disrupts, oppressive categories of (...) gender and sexual orientation. This article analyzes the attempts made in “virgin” and “queer” theory to rehabilitate heterosexuality, and finds both fundamentally flawed from a radical feminist perspective. It ends by considering why such rehabilitatory attempts are currently being made, and what they reveal about heterosexuality. (shrink)

Transplantation is a medically successful and cost-effective way to treat people whose organs have failed--but not enough organs are available to meet demand. T. M. Wilkinson explores the major ethical problems raised by policies for acquiring organs. Key topics include the rights of the dead, the role of the family, and the sale of organs.

RésuméLa philosophie autochtone du XVIIe siècle et des siècles précédents est souvent considérée comme irrécupérable en raison du manque d’œuvres existantes. Il y a au moins deux raisons pour lesquelles ce point de vue est erroné. Premièrement, cela néglige le rôle que les traditions orales ont joué dans la préservation de la pensée des peuples autochtones d'Amérique du Nord. Deuxièmement, certains penseurs autochtones ont vu leurs opinions philosophiques enregistrées par des interlocuteurs européens peu de temps après le contact. Avec ces (...) sources, les mêmes techniques que celles utilisées pour récupérer les opinions de philosophes comme le sophiste Prodicus, dont les œuvres sont perdues, peuvent être appliquées aux penseurs autochtones. En reconstruisant une partie de la philosophie de Kondiaronk, je montre comment cela peut être fait. (shrink)

This article makes the case for a contemporary philosophy of Islam to help Muslims surmount the challenges of postmodernity and to transcend the hiatuses and obstacles that Muslims face in their interaction and relationships with non-Muslims. It argues that the philosophy of critical realism so fittingly underlabours for the contemporary interpretation, clarification and conceptual deepening of Islamic doctrine and practice as to suggest and necessitate the development of a distinctive Islamic critical realist philosophy, social and educational theory and world-view, specifically (...) suited for this purpose. This approach is called Islamic critical realism. (shrink)

In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to (...) objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms). (shrink)

_Bodies for Sale: Ethics and Exploitation in the Human Body Trade _explores the philosophical and practical issues raised by activities such as surrogacy and organ trafficking. Stephen Wilkinson asks what is it that makes some commercial uses of the body controversial, whether the arguments against commercial exploitation stand up, and whether legislation outlawing such practices is really justified. In Part One Wilkinson explains and analyses some of the notoriously slippery concepts used in the body commodification debate, including exploitation, (...) harm and consent. In Part Two he focuses on three controversial issues outlining contemporary regulation and investigating both the moral issues and the arguments for legal prohibition. (shrink)

Decisions about how and where they deliver their baby are extremely important to pregnant women. There are very strong ethical norms that women’s autonomy should be respected, and that plans around birth should be personalised. However, there appear to be profound challenges in practice to respecting women’s choices in pregnancy and labour. Choices carry risks and consequences—to the woman and her child; also potentially to her caregivers and to other women.What does it mean for women’s autonomy to be respected in (...) obstetrics? How should health professionals respond to refusals of treatment or requests for care outside normal guidelines? What are the ethical limits to autonomy? In this clinical ethics round table, service users, midwives, obstetricians, philosophers and ethicists respond to two hypothetical cases drawn from real-life scenarios. (shrink)

The Le Quesne test of character compatibility uses pairwise comparisons of characters to detect homoplasy in phylogenetic character data. If a pair of characters fails this test we can conclude that a minimum of a single extra step is required by the pair of characters. The rationale of the Le Quesne test is extended to comparisons of triplets of characters. The triplet homoplasy test can reveal that that there is a minimum of four extra steps across a triplet of characters (...) and thus that there are at least two extra steps associated with one of the characters. The triplet homoplasy test can thus detect higher orders of homoplasy than can be detected by the pairwise Le Quesne test. The possibility of quartet and other higher-order homoplasy tests is discussed. The utility of higher-order homoplasy tests is discussed. It is suggested higher-order homoplasy tests have potential uses analogous to the uses of the Le Quesne test, particularly with respect to data exploration. (shrink)

Covering both practical and theoretical aspects of strategic management, this three-volume work brings the complex topic down to earth and enables readers to gain competitive business advantages in their marketplace. This clear, insightful, and interesting work covers all aspects of strategic management, including chapters that discuss SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, the Resource-Based View, transaction cost economics, and real options theory. Unlike other books, this three-volume work examines strategic management from different perspectives, effectively interweaving seemingly disparate subdisciplines, such (...) as entrepreneurship and international business, with specialized foci, such as creativity, innovation, and trust. Incorporating information from contributors as varied as a proprietor of a worldwide motorcycle business to one of the most published scholars in the field of international strategic management, the practical and theoretical perspectives presented in Strategic Management in the 21st Century will benefit business strategists, professors of strategic management, and graduate students in the field. (shrink)

An attempt is made in this paper to analyze the purely formal nature of information-theoretic concepts. The suggestion follows that such concepts, used to supplement the logical and mathematical structure of the language of science, represent an addition to this language of such a sort as to allow the use of a unitary language for the description of phenomena. (The alternative to this approach must be certain multi-linguistic and mutually untranslatable descriptions of related phenomena, as with the various versions of (...) Complementarity). This conception is tested for the specific case of Heisenberg's Uncertainty Principle, in order to show that, with the assumption of a suitable and intuitively satisfactory definition of the quantity of information contained in a measurement, the Heisenberg Principle becomes an informational restriction arising from the formal properties of the symbols of a given language rather than as a "law" of nature. (shrink)

The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units (ICUs) within many health systems, including the National Health Service in the UK. The (...) experience of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save. There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates? There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …. (shrink)

In a well known British case, the relatives of a dead man consented to the use of his organs for transplant on the condition that they were transplanted only into white people. The British government condemned the acceptance of racist offers and the panel they set up to report on the case condemned all conditional offers of donation. The panel appealed to a principle of altruism and meeting the greatest need. This paper criticises their reasoning. The panel’s argument does not (...) show that conditional donation is always wrong and anyway overlooks a crucial distinction between making an offer and accepting it. But even the most charitable reinterpretation of the panel’s argument does not reject selective acceptance of conditional offers. The panel’s reasoning has no merit. (shrink)

Life-sustaining treatment is sometimes withdrawn or withheld from critically ill newborn infants with poor prognosis. Guidelines relating to such decisions place emphasis on the best interests of the infant. However, in practice, parental views and parental interests are often taken into consideration.In this paper I draw on the example of newborn infants with severe muscle weakness (for example spinal muscular atrophy). I provide two arguments that parental interests should be given some weight in decisions about treatment, and that they should (...) be given somewhat more weight in decisions about newborns than for older children. Firstly, the interests of the infant and of parents intersect, and are hard to separate. Parents’ views about treatment may be relevant to an assessment of the infant’s interests, and they may also affect those interests. Secondly, the interests of the infant in her future are relatively reduced by her developmental immaturity. In some situations parents’ welfare interests outweigh those of the infant. However, I argue that this would not justify treatment limitation except in the setting of severe impairment. (shrink)

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.In this paper we consider and evaluate a range of ways (...) to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation.We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care.Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. (shrink)

Which is better: a guarantee of a modest amount of moral value, or a tiny probability of arbitrarily large value? To prefer the latter seems fanatical. But, as I argue, avoiding such fanaticism brings severe problems. To do so, we must decline intuitively attractive trade-offs; rank structurally identical pairs of lotteries inconsistently, or else admit absurd sensitivity to tiny probability differences; have rankings depend on remote, unaffected events ; and often neglect to rank lotteries as we already know we would (...) if we learned more. Compared to these implications, fanaticism is highly plausible. (shrink)

The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...) findings, both because of the acknowledged limitations of survey methodology, and because survey conclusions cannot, in themselves, yield answers about what the right threshold should be for providing or withholding treatment.2 In this brief response, we are going to address head-on the important ethical question raised within our survey – when life is worth living for an infant. We follow-up on the suggestion of two commentators that the presence or absence of “relational potential” might be ethically important to report in studies of the outcome of severely impaired infants,3 and to whether parental requests for treatment should be supported.4 The notion of “relational potential” was introduced by John Arras in a 1984 commentary.5 Arras was responding to the Baby Doe Regulations and a …. (shrink)

The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents (...) if necessary for her protection. Indeed, there is a legal obligation for health professionals to report suspected harm, and for authorities to protect the child's wellbeing. We ask whether such contradictory responses are justified. Should the law intervene where a pregnant woman's actions risk serious and preventable fetal injury? The argument for legal intervention to protect a fetus is sometimes linked to the concept of ‘fetal personhood’ and the moral status of the fetus. In this article we will suggest that even if the fetus is not regarded as a separate person, and does not have the legal or moral status of a child, indeed, even if the fetus is regarded as having no legal or moral status, there is an ethical and legal case for intervening to prevent serious harm to a future child. We examine the arguments for and against intervention on behalf of the future child, drawing on the example of excessive maternal alcohol intake. (shrink)

Two challenges that face popular self-monitoring theories (SMTs) of auditory verbal hallucination (AVH) are that they cannot account for the auditory phenomenology of AVHs and that they cannot account for their variety. In this paper I show that both challenges can be met by adopting a predictive processing framework (PPF), and by viewing AVHs as arising from abnormalities in predictive processing. I show how, within the PPF, both the auditory phenomenology of AVHs, and three subtypes of AVH, can be accounted (...) for. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Toward a Fictionalist Psychiatry?Sam Wilkinson, PhD (bio)I am deeply sympathetic to what Giulio Ongaro (2024a, 2024b, 2024c) writes in these three excellent interlocking papers. I will argue that there is a slightly more efficient way of approaching these issues. It involves adopting fictionalism rather than externalism (although fictionalism can accommodate externalist insights). Fictionalism is something that Ongaro briefly, and approvingly, mentions, in the final paper, but there is (...) an implicit realism in the initial approach. I am not sure there is much disagreement, however, and perhaps we end up in the same place, having approached from different starting points. The fictionalist approach is largely compatible with all of the substantive things Ongaro wants to say, but is, strictly speaking, in tension with the most natural interpretation of externalism, namely, construed as a form of descriptivism and realism (two notions I unpack later).Externalism, Evaluativism, and Social IntegrationA major theme of the first paper is that mainstream internalist Western psychiatry is bad at integrating the social dimension of mental illness. I agree. Furthermore, recent externalistic (enactive and predictive processing) approaches, while better, are still lacking in that they collapse the “social” into the “psychosocial.” Again, I agree. But my diagnosis (excuse the pun) is slightly different. The social dimension of illness concerns in large part the evaluative nature of illness, not the need to descriptively, causally capture a complex, objectively real phenomenon called “illness.”Having said this, in integrating this evaluative social dimension, we need to tread carefully lest we fail to meet the “demarcation challenge” (Murphy, 2008). This concerns the challenge of demarcating different kinds of problem. Humans have always had problems, for which they have needed help, accommodation, allowances made, and so on, but how do you distinguish mental health problems, from other kinds of problems? How do you distinguish money woes, or marital strife, both of which certainly cause unhappiness, or even psychological states that look like psychiatric symptoms (e.g., anxiety, low mood), from properly mental health problems?The biomedical “internalist” says: Easy! Either there is something objectively wrong with you, or there is not. However, notice that this is exactly [End Page 337] what externalists can say too, to the extent that they are trying to describe and define disorder in value-free terms. The only difference is that the internalist will talk about what is wrong within the biological boundaries of the organism, whereas the externalist will go beyond that.Externalism about a particular phenomenon, if it is to be a non-trivial position, needs to be sensitive to the distinction between cause and constitution (or what Adams & Azaiwa [2001] call “coupling-constitution confusion”). We see this in externalism about the mind in general. In the Extended Mind Hypothesis (Clark & Chalmers 1998), the claim is not that Otto’s notebook causally contributes to Otto’s mind (his belief about where MOMA is). Nobody would deny that. The interesting claim is that the notebook is constitutive of his belief: it is literally part of his mind. Similarly, nobody is denying that external (e.g., social) factors cause mental health problems, the question is: Do they constitute those problems? Externalism takes this question seriously and answers in the affirmative, at least in some cases. But the articulation of this has to be nuanced.Suppose I have crippling anxiety over financial concerns. Anxiety can be a mental health problem, but if, in this case, you transferring money into my bank account makes my anxiety disappear, then one might think this is not a mental health problem. It is a money problem. Or is it? Enter fictionalism (Wilkinson, 2022).Fictionalism is the view that calling someone mentally ill is not describing them as having a particular property, but involves something like engaging in a fiction, a fiction that has been constructed in order to encourage certain courses of action. According to fictionalism, given the facts, there is a lot of wiggle room about how we are to think of, and respond to, people’s problems.To borrow some insights from meta-ethics, when we examine normative discourse (one canonical domain being ethics) we can ask: what does the discourse do? And what... (shrink)

Preimplantation genetic diagnosis and some prenatal screening programmes have been criticized for being 'eugenic'. This paper aims to analyse this criticism and to evaluate one of the main ethical arguments lying behind it. It starts with a discussion of the meaning of the term 'eugenics' and of some relevant distinctions: for example, that between objections to eugenic ends and objections to certain means of achieving them. Next, a particular argument against using preimplantation genetic diagnosis to 'screen out' disability is considered, (...) one based on the Equal Value Principle, which says that we should value disability and non-disability equally. It is argued that present practice and policy probably do violate the Equal Value Principle, but that this principle is itself unsound. (shrink)

Since 2000, 11 human uterine transplantation procedures (UTx) have been performed across Europe and Asia. Five of these have, to date, resulted in pregnancy and four live births have now been recorded. The most significant obstacles to the availability of UTx are presently scientific and technical, relating to the safety and efficacy of the procedure itself. However, if and when such obstacles are overcome, the most likely barriers to its availability will be social and financial in nature, relating in particular (...) to the ability and willingness of patients, insurers or the state to pay. Thus, publicly funded healthcare systems such as the UK9s National Health Service (NHS) will eventually have to decide whether UTx should be funded. With this in mind, we seek to provide an answer to the question of whether there exist any compelling reasons for the state not to fund UTx. The paper proceeds as follows. It assumes, at least for the sake of argument, that UTx will become sufficiently safe and cost-effective to be a candidate for funding and then asks, given that, what objections to funding there might be. Three main arguments are considered and ultimately rejected as providing insufficient reason to withhold funding for UTx. The first two are broad in their scope and offer an opportunity to reflect on wider issues about funding for infertility treatment in general. The third is narrower in scope and could, in certain forms, apply to UTx but not other assisted reproductive technologies (ARTs). The first argument suggests that UTx should not be publicly funded because doing so would be inconsistent with governments’ obligations to prevent climate change and environmental pollution. The second claims that UTx does not treat a disorder and is not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy. (shrink)

Many critics have suggested that international paid surrogacy is exploitative. Taking such concerns as its starting point, this article asks: how defensible is the claim that international paid surrogacy is exploitative and what could be done to make it less exploitative? In the light of the answer to, how strong is the case for prohibiting it? Exploitation could in principle be dealt with by improving surrogates' pay and conditions. However, doing so may exacerbate problems with consent. Foremost amongst these is (...) the argument that surrogates from economically disadvantaged countries cannot validly consent because their background circumstances are coercive. Several versions of this argument are examined and I conclude that at least one has some merit. The article's overall conclusion is that while ethically there is something to be concerned about, paid surrogacy is in no worse a position than many other exploitative commercial transactions which take place against a backdrop of global inequality and constrained options, such as poorly-paid and dangerous construction work. Hence, there is little reason to single surrogacy out for special condemnation. On a policy level, the case for prohibiting international commercial surrogacy is weak, despite legitimate concerns about consent and background poverty. (shrink)

This paper addresses a potential contradiction between the two primary philosophical traditions that inform Gibsonian ecological psychology: the phenomenological and pragmatist traditions. These two traditions exhibit potentially contradictory intuitions about the epistemic role of direct perception. This epistemic role of direct perception was famously problematized by Sellars’ critique of the myth of the given (1956; 1997), and we draw on it here to serve as a test case for the Gibsonian synthesis of phenomenology and pragmatism. While ecological psychology’s emphasis on (...) the firstperson perspective of organisms shares in the legacy of the phenomenological tradition, it also tends to assume direct experience as a given, something basic and foundational to knowledge. Pragmatism, on the other hand, is generally suspicious of experience as a foundational given. We argue that Gibson’s successful synthesis of these two traditions is also what makes his theory of affordances less susceptible to the myth of the given than some phenomenological approaches to perception. Namely, on the Gibsonian account of perception is always part of an action-perception cycle that takes place in and through embodied action and therefore no one act of perception functions as an epistemic given. (shrink)