During the French Revolution, the comparative geographer Jean-Denis Barbié du Bocage lost his patron, his job, and (most importantly) his access to source materials. Working for ministry map depots, however, he was able to forge new alliances and, by acting as a broker between different actors and interests, mobilize new networks of accumulation inside France and across central and eastern Europe. In these new centers of accumulation, Barbié translated the meanings and the significance of the objects he (...) collected to fit the interests of the different constituencies in his network: including French politicians, diplomats and consuls, Greek merchants and Enlightenment scholars. The strength of the ‘mobiles’ he collected was their mutability, the ease with which they could be repurposed. Such translations shifted Barbié’s own assumptions about the ways in which old and new information could be combined both in his work for the government and in his private antiquarian scholarship. (shrink)

Requests for support in professional changes are getting more and more numerous. Regarding jobs concerned with caring for others, therapeutic education needs to be spread into new approaches requiring social and human sciences (Tourette-Turgis, 2015 ; Chalmel, 2015). These requests lead to alterations in professional practices and changes in educational devices. This chapter deals with a direct observation of effective practices addressed to young patients and also implies the training of nurses through experiences. It also discusses ways of scientific collaboration (...) between female researchers in different scientific fields of the medical body leading the latter to alter their practices by creating pedagogic instruments or new tools for training. This inventive conception deriving from these exchanges leaning on experiences and skills previously built up and linked together to help devices development. Our contribution deals with and discusses the transformation of state nurses functions through these analyses and towards actions which do not only concern body care but a way of teaching healthy life style. The themes under study concerns the passing on and transferring experiences and responsibility when directing cessions from cardiology education to the therapeutic education nurse. (shrink)

The didactic proposal of the post-constructivist (Grossi, 2005), takes into account the relationship between the subject, reality, others and the Other interior and considers the learning potential of all students. Its theoretical foundation is, among other things, the principle that learning is a social phenomenon, and that the spatial organization of the class, in groups of adults, promotes the teaching-learning process. Post-constructivism is a didactic proposition that allows us to respond to the purpose of teaching all students. This article on (...) group work in post-constructivism aims to analyze the change in posture of teachers, and the professional development that follows, and which demonstrates a break with the traditional form of education. The trick of the identified researcher is then to take up in a teacher training, through the aulic groups in the Geempa class and the weekly study group, the scientific approach of post-constructivism. (shrink)

This paper discusses the life and scientific work of José Vicente Barbosa du Bocage, a nineteenth-century Portuguese naturalist who carved a new place for zoological research in Portugal and built up a prestigious scientific career by securing appropriate physical and institutional spaces to the discipline. Although he was appointed professor of zoology at the Lisbon Polytechnic School, an institution mainly devoted to the preparatory training of military officers and engineers, he succeeded in creating the conditions that allowed him to (...) develop consistent research in zoology at this institution. Taking advantage of the reconstruction and further improvement of the building of the Lisbon Polytechnic, following a violent fire in 1843, Bocage transferred a natural history museum formerly located at the Academy of Sciences of Lisbon to his institution, where he conquered a more prestigious place for zoology. Although successive governments were unwilling to meet Bocage’s ambitions for the Zoological Section of the newly created National Museum of Lisbon, the collaborators he found in different parts of the Portuguese continental territory and colonial empire supplied him the specimens he needed to make a career as a naturalist. Bocage ultimately became a renowned specialist in Southwestern African fauna thanks to José de Anchieta, his finest collaborator. Travels to foreign museums, and the establishment of links with the international community of zoologists, proved fundamental to build up Bocage’s national and international scientific reputation, as it will be exemplified by the discussion of his discovery of Hyalonema, a specimen with a controversial identity collected off the Portuguese coast. (shrink)

Historical studies on the relationship between science and diplomacy tend to focus on events since World War II and on initiatives for the maintenance of peace or to achieve cooperation over contentious matters. This article presents the case of José Vicente Barbosa du Bocage (1823–1907), a Portuguese zoologist who had formal diplomatic responsibilities in a context of competition for the colonization of Africa in the nineteenth century. He used his knowledge in African geography to implement colonial and diplomatic strategies (...) that aimed at outcompeting rival powers. The development of a network of actors with scientific, colonial, and diplomatic expertise was crucial for the negotiations that involved the partition of the Congo basin, which resulted in victories for Portugal that surpassed the country's marginal political relevance at the international level and had long‐lasting consequences. (shrink)

L'apparition de la poupée Barbie en 1959 ­ c'est-à-dire la substitution d'une poupée femme à une poupée enfant ­ marque une rupture dans la socialisation des petites filles. Pur produit des années 1950, la poupée Barbie s'adapte à toutes les décennies qui suivent car elle est avant tout le symbole d'une société de consommation qui sait récupérer toutes les modes, même celles qui paraissent les plus avancées. Elle est aussi le symbole du simulacre dans un monde qui est de plus (...) en plus le monde du faux-semblant. (shrink)

This paper explores how João de Andrade Corvo and José Vicente Barbosa du Bocage, two nineteenth-century Portuguese naturalists, were able to reach prominent political positions in their country by means of their work in, respectively, botany and agriculture, and zoology. The authority they derived from their scientific activities and the knowledge they acquired in the process, favored by their proximity to particular political quarters, elevated them to important governmental offices, in the context of which they implemented policies that reinforced (...) Portugal’s identity as an imperial nation. The colonial policies and agreements signed by Corvo and Bocage aimed at securing Portuguese colonial territories, which, aside from their economic relevance, constituted a symbol of power that reinforced the sovereignty of a small nation in a Europe dominated by the rule of increasingly vaster and stronger states. In spite of their different scientific careers and personal interests, both naturalists played key roles in Portuguese foreign affairs and colonial negotiations of the late nineteenth century, especially during the Scramble for Africa. (shrink)

Lucie Aubrac, co-fondatrice du mouvement Libération, est une de nos héroïnes de la Résistance qu'il n'est plus nécessaire de présenter. Les spectaculaires évasions qu'elle organisa pour arracher son mari, Raymond Aubrac, des mains de Klaus Barbie notamment, font partie de la légende. Elle-même en fit le récit en 1984 dans un ouvrage intitulé Ils partiront dans l'ivresse (Seuil). Une bande dessinée américaine avait déjà, dans les années 1950, immortalisé l'histoire de « Lucie to the Res...

Au-delà d’une bataille écologique tenace pour l’abandon du projet d’aéroport, le bocage de Notre-Dame des Landes a constitué un terrain d’expérimentation pour transformer l’occupation militante en droit pérenne d’usage des terres. Les « zadistes » se sont battus pour devenir agriculteurs et exploiter collectivement la terre au service d’une agriculture « écolo et non Monsanto ». Ils ont parié sur le fait de mener une bataille sur le droit face à l’administration et, en échange de fiches de projets, ont (...) obtenu des baux ruraux individuels de neuf ans, comme les paysans résistants et les paysans cumulards, qui exploitaient les terres avant la préemption. Le rêve éveillé est devenu réalité, même si l’un des principes de base initiaux, « la terre en commun », a subi des altérations. (shrink)

Bioethicists often draw sharp distinctions between hope and states like denial, self-deception, and unrealistic optimism. But what, exactly, is the difference between hope and its more suspect cousins? One common way of drawing the distinction focuses on accuracy of belief about the desired outcome: Hope, though perhaps sometimes misplaced, does not involve inaccuracy in the way that these other states do. Because inaccurate beliefs are thought to compromise informed decision making, bioethicists have considered these states to be ones where intervention (...) is needed either to correct the person’s mental state or to persuade the person to behave differently, or even to deny the person certain options. In this article, we argue that it is difficult to determine whether a patient is really in denial, self-deceived, or unrealistically optimistic. Moreover, even when we are confident that beliefs are unrealistic, they are not always as harmful as critics contend. As a result, we need to be more permissive in our approach to patients who we believe are unrealistically optimistic, in denial, or self-deceived—that is, unless patients significantly misunderstand their situation and thus make decisions that are clearly bad for them, we should not intervene by trying to change their mental states or persuade them to behave differently, or by paternalistically denying them certain options. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...) of medical ethics. At the same time, JME aims to be a premiere home for ground-breaking scholarship on the ethical issues raised by COVID-19. Toward this end, we have a number of papers that are freely available online and for which production has been fast-tracked.1–5 A challenge for authors who want to write about the pandemic is the rapidly evolving nature of the situation and the time it takes for journal content to be reviewed and published, even when fast-tracked. For that reason, all authors who would like to submit a paper on the pandemic can also submit a post to the JME blog prior to submitting a full paper to the journal. Those interested in writing for the JME blog should contact one of its editors, Hazem Zohny or Mike King. Over the last 3 weeks, 30 high-quality commentaries on the pandemic have been posted to the blog. These posts are circulated widely via the JME Twitter and Facebook feeds and have stimulated significant …. (shrink)

In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

Just last week (October 4, 2022), the U.S. White House released a blueprint for an A.I. Bill of Rights, consisting of “five principles and associated practices to help guide the design, use, and de...

In his article “Nudging and Informed Consent,” Shlomo Cohen (2013) argues, among other things, that 1) “to the extent that the nudge-influenced decision making is rational—in whatever sense,” there...

In the article “Informed Consent: What Must be Disclosed and What Must be Understood?” Joseph Millum and Danielle Bromwich argue that informed consent requires satisfaction of certain disclosure an...

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)

An original examination of the relevance of behavioral economics for the practice of medical ethics.

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

This book analyzes Hannah Arendt's later thought, putting it in dialogue with her other writings and notes on Immanuel Kant's Critique of Judgment to outline Arendt's theory of judgment for the twentieth century.

This article presents factors and criteria of interview in auto-confrontation with an objective of professional didactic, which we frequently conduct in our collaborative researches, when we analyze the activity. Our aim is to initiate reflections and debates about the status conferred to auto-confrontation in a process of research and about the issue answers by such method in professional training. Observing that auto-confrontation is discussing in human and social sciences as a tool of investigation, as a method or as scientific object, (...) we try to identify dimensions that make it to be both a method of investigation and a tool of professional training. Since we explain why auto-confrontation considering in theoretical context of professional didactic constitutes a tool for professional involvement, and that, in such case, it integration in vocational training engineering is relevant. (shrink)

The past four decades of research in the social sciences have shed light on two important phenomena. One is that human decision-making is full of predicable errors and biases that often lead individuals to make choices that defeat their own ends (i.e., the bad choice phenomenon), and the other is that individuals’ decisions and behaviors are powerfully shaped by their environment (i.e., the influence phenomenon). Some have argued that it is ethically defensible that the influence phenomenon be utilized to address (...) the bad choice phenomenon. They propose that “choice architects” learn about the various ways in which choices can be influenced and directed by the environment, and then work to design environments, broadly construed, that influence individuals towards choices that make them better off. Those who advocate intentionally creating choice environments that lead people to better choices believe that doing so is ethically permissible because (1) it makes people better off, and (2) it does so in a way that is entirely compatible with individual liberty. The evaluation of these two claims is the main focus of this paper. (shrink)

How does one represent the Holocaust? What does it mean to visualize it? Despite Theodor Adorno's famous injunction that there can be no poetry after the Holocaust, the past half century has produced repeated attempts to impart that which has been considered beyond the limits of representation. From Steven Spielberg's Schindler's List, Claude Lanzmann's epic documentary project _Shoah_, to Art Spiegelman's _Maus_, the visual domain has emerged as a fruitful venue for representing those horrible times. _Visual Culture and the Holocaust_ (...) takes that domain as its focus. It considers the increasing number of works that claim to give us access to the Holocaust, asking for whom these images are intended and how effective they are at promoting remembrance and understanding. Barbie Zelizer has gathered essays from a group of internationally renowned scholars representing a broad range of disciplines to consider both the traditional and the unconventional ways in which the Holocaust has been visually represented. In addressing film, painting, photography, museum exhibits, television, the Internet, and the body itself as venues for these representations, the essays explore the abilities of these different genres to testify to the tragedy, particularly in relation to the horrific historical fact they seek to translate. _Visual Culture and the Holocaust_ substantially enhances what we know of the visual representation of the Holocaust. An introduction by the editor provides an important historical and theoretical overview of these efforts as well as a context in which these accomplishments may be understood. (shrink)

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw (...) conclusions about what we do (or do not) owe them. This paper argues that at best the concept of “personhood” is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. (shrink)

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview . Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of “construct validity” and “conceptual validity” (...) and a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The idea of a ‘right to mental integrity’, sometimes referred to as a ‘right against mental interference,’ is a relatively new concept in bioethics, making its way into debates about neurotechnological advances and the establishment of ‘neurorights.’ In this paper, we interrogate the idea of a right to mental integrity. First, we argue that some experts define the right to mental integrity so broadly that rights violations become ubiquitous, thereby trivialising some of the very harms the concept is meant to (...) address. Second, rights-based framing results in an overemphasis on the normative importance of consent, implying that neurointerventions are permissible in cases where people consent to have their mental states influenced or read off, a confidence in consent that we argue is misguided. Third, the concept often collapses the ethics of brain inputs and brain outputs, potentially resulting in a loss of important conceptual nuance. Finally, we argue that the concept of a right to mental integrity is superfluous—what is wrong with most violations of mental integrity can be explained by existing concepts such as autonomy, manipulation, privacy, bodily rights, surveillance, harm and exploitation of vulnerabilities. We conclude that bioethicists and policy-makers ought to either make use of these concepts rather than arguing for the existence of a new right, or they need to avoid making rights violations ubiquitous by settling on a narrower and more rigorous definition of the right. (shrink)

This paper deals with the ethics of using knowledge about a person’s particular psychological make-up, or about the psychology of judgment and decision-making in general, to shape that person’s decisions and behaviors. Various moral concerns emerge about this practice, but one of the more elusive and underdeveloped concerns is the charge of manipulation. It is this concern that is the focus of this paper. I argue that it is not the case that any of the practices traditionally labeled as “manipulation” (...) are ipso facto morally wrong, nor is it even the case that any of these practices always has a single wrong making feature (e.g., infringement on autonomy) that is always present but may be outweighed by other morally relevant factors and be all things considered ethically permissible or morally right. I argue that the moral status depends on the extent to which the instance of influence (1) threatens or promotes autonomy, (2) has good aims and virtuous overtones or bad ones, and (3) fulfills or fails to fulfill duties, obligations, and expectations that arise out of the relationship between the influencer and influenced. I will explain in detail the moral relevance of these factors, showing why each is necessary, criteria for evaluation each, and demonstrating how they work in specific cases. (shrink)

This month’s issue of _Journal of Medical Ethics_ features a symposium on ‘neuro rights’ and the ‘right to mental integrity’. Medical ethics and the law have long recognised bodily rights—motivating requirements that patients give informed consent before medical interventions are performed on them or before research is conducted on them. Rapid advancements in neuroscience and neurotechnology are raising new questions about the boundaries of bodily rights, whether they extend to the mind or the brain, or whether we need new concepts (...) and rights to apply to the mental sphere. As Farahany 1 writes in her recent (2023) book, ‘The Battle for Your Brain’, the global market for consumer neurotechnology is growing rapidly, expecting to reach US$21 billion by 2026. A growing number of people are using personal neurotechnology that allows them to visualise and track their emotions, levels of alertness and concentration, as well as their actual brain... (shrink)

In an April 2023 article in JAMA Pediatrics, ‘Life Support System for the Fetonate and the Ethics of Speculation’, authors De Bie, Flake and Feudtner critique bioethicists for practising what they call ‘speculative ethics’. The authors refer to a 2017 article that they published on the Extra-uterine Environment of Neonatal Development (EXTEND) system. This system was able to keep fetonatal (newborn, but in a fetal physiological state) lambs alive outside of the parent lamb’s womb for 4 weeks. The article has (...) been accessed almost 300 000 times and received significant media attention. It also resulted in an explosion in the bioethics literature about ‘the ethics of the artificial womb’. However, the authors bemoan, these ethics discussions focused largely on unrealistic use cases of the new technology—from elective shortening of pregnancies to complete ectogenesis. The authors dubbed these discussions as ‘a technically and developmentally naive, yet sensationally speculative, pipe dream’. The use case of the EXTEND technology that is most realistic involves supporting extremely premature newborns (23–24 weeks). Other probable uses include supporting infants in later gestational ages (25–28 weeks) with pathological conditions, potentially allowing for surgeries or other therapeutics to be delivered without imposing risks on pregnant patients. To …. (shrink)

This book review essay points to some of the more novel and controversial contributions of A Theory of Bioethics, by Joseph Millum and David DeGrazia (Cambridge University Press, 2021), such as their account of moral status. With a remarkable breadth of topics, the book is characterized by philosophical care and nuance and by spelling out the implications of the authors’ theorizing for real‐world, pressing questions, for instance, about the implications of Millum and DeGrazia's theoretical work on moral status for embryo (...) research, animal research with mice and apes, and human‐brain organoids. (shrink)

Cinema and Surveillance: The Asymmetric Gaze shows how key modern filmmakers challenge and disturb the relation between film and surveillance, medium and message. Assembling readings of films by Harun Farocki, Michael Haneke, and Fritz Lang, the book considers surveillance in such different domains as urban life, religious doctrine, and law enforcement. With surveillance present in the modern world as both a technological phenomenon and a social practice, the author shows how cinema, as a visual medium, presents highly sophisticated analyses of (...) surveillance. He suggests that "surveillance" is less an issue to be tackled from a secure spectatorial position than an experience to be rendered, an event to be dealt with. Far from offering a general model of spectatorship, the book explores how narrative moments of surveillance are complicated by specific spectatorial responses. In its intersection of well-known figures and a highly topical issue, this book will have broad appeal, especially, but not exclusively, among students and scholars in film studies, media studies, German studies, European studies, art history, and political theory. (shrink)

In their article “The Concept of Voluntary Consent,” Robert Nelson and colleagues (2011) argue for two necessary and jointly sufficient conditions for voluntary action: intentionality, and substantial freedom from controlling influences. They propose an instrument to empirically measure voluntariness, the Decision Making Control Instrument. I argue that (1) their conceptual analysis of intentionality and controlling influences needs expansion in light of the growing use of behavioral economics principles to change individual and public health behaviors (growing in part by the designation (...) of “The Science of Behavior Change” as a new National Institutes of Health [NIH] Roadmap Activity); and (2) that their measure of voluntariness that relies on self-perceived intentionality and extent of control is unreliable, given findings from behavioral economics and cognitive science that show that our perceptions about the intentionality and control of our own and others’ decisions and actions are remarkably skewed and un-insightful. (shrink)

As the COVID-19 pandemic rages on, this June 2021 issue of the JME contains several articles addressing pandemic-related ethical issues, including, discrimination against persons with disabilities,1 collective moral resilience,2 and stress in medical students due to COVID-19.3 It also contains a critical appraisal of the most recent WHO guidance document on the management of ethical issues during an infectious disease outbreak.4 This June issue of JME also addresses several important clinical ethics issues: covert administration of medication in food,5 educational pelvic (...) exams under anesthesia,6 consent to cancer screening,7 care of critically ill newborns when the birth mother is unwell,8–10 and ethical considerations related to recruiting migrant workers for clinical trials.11 Perhaps what is most unique about this issue is its Feature …. (shrink)

> ‘The fact about himself that the bullshitter hides, on the other hand, is that the truth-values of his statements are of no central interest to him; what we are not to understand is that his intention is neither to report the truth nor conceal it. It is just this lack of connection to a concern with truth—this indifference to how things really are—that is the essence of bullshit.’1 > —Harry Frankfurt In his paper, Nudging, informed consent, and bullshit, William (...) Simkulet accuses doctors of being bullshitters when they knowingly influence patient decision making through means other than argument and reasoning, that is, through ‘nudges.’ In these instances, he contends that they care little about patient understanding or communicating the truth about the options and, instead, care only about presenting alternatives in ways that cause patients to do what the physicians think they should do.2 However, doctors can intend to enhance patient understanding at the same time that they try to influence patients’ choices. Consider a physician who wants her patient to get a vaccine. …. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact (...) that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

In their paper, “Behavioral Equipoise: A Way to Resolve Ethical Stalemates in Clinical Research, “ Peter Ubel and Robert Silbergleit (2011) propose that we adopt another principle, the principle of behavioral equipoise, whereby RCTs are also morally justified in cases where they are expected to address the controversy, disagreement, or behavioral resistance surrounding a particular treatment. Adopting this ethical standard would allow for research to move forward and, as a result, for the resolution of stalemates between clinicians who hold opposing (...) views. There are two points that I would like to make in terms of objections to Ubel and Silbergleit’s argument, and then I want to emphasize what I think is particularly valuable about their argument. First, I dispute the move from the claim that the principle of clinical equipoise creates (or does not resolve) stalemates to the conclusion that adopting the principle of behavioral equipoise would dissolve stalemates. My second objection concerns the distinctness of the concept of behavioral equipoise fromthe concept of clinical equipoise. That said, I do think that Ubel and Silbergleit make an important point, and that is that one cause of equipoise is the behavioral and psychological factors of those responding to data. (shrink)

'The problem of the twentieth-century is the problem of the color-line.' Originally published in 1903, The Souls of Black Folk is a classic study of race, culture, and education at the turn of the twentieth century. With its singular combination of essays, memoir, and fiction, this book vaulted W. E. B. Du Bois to the forefront of American political commentary and civil rights activism. The Souls of Black Folk is an impassioned, at times searing account of the situation of African (...) Americans in the United States. Du Bois makes a forceful case for the access of African Americans to higher education, memorably extols the achievements of black culture (above all the spirituals or 'sorrow songs'), and advances the provocative and influential argument that due to the inequalities and pressures of the 'race problem', African American identity is characterized by 'double consciousness'. This edition includes a valuable appendix of other writing by Du Bois, which sheds light on his attitudes and intentions. ABOUT THE SERIES: For over 100 years Oxford World's Classics has made available the widest range of literature from around the globe. Each affordable volume reflects Oxford's commitment to scholarship, providing the most accurate text plus a wealth of other valuable features, including expert introductions by leading authorities, helpful notes to clarify the text, up-to-date bibliographies for further study, and much more. (shrink)

Richard Thaler and Cass Sunstein define a nudge as “any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates’ decision‐making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision‐making in the context of (...) pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well‐known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision‐making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision‐making authority; (2) nudging can help fulfill pediatric clinicians’ obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents’ decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. (shrink)

Review of Jürgen Link, Normalismus und Antagonimus in der Postmoderne. Krise, New Normal, Populismus, Göttingen: Vandenhoeck & Ruprecht 2018.

Ms. P. is in the ICU with respiratory failure and sepsis. She has been on a ventilator for almost a week, and now has impending kidney failure. Her children, who have been taking turns at the bedsi...