The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

Experimental research is commonly held up as the paradigm of "good" science. Although experiment plays many roles in science, its classical role is testing hypotheses in controlled laboratory settings. Historical science is sometimes held to be inferior on the grounds that its hypothesis cannot be tested by controlled laboratory experiments. Using contemporary examples from diverse scientific disciplines, this paper explores differences in practice between historical and experimental research vis-à-vis the testing of hypotheses. It rejects the claim that historical research is (...) epistemically inferior. For as I argue, scientists engage in two very different patterns of evidential reasoning and, although there is overlap, one pattern predominates in historical research and the other pattern predominates in classical experimental research. I show that these different patterns of reasoning are grounded in an objective and remarkably pervasive time asymmetry of nature. (shrink)

How to formulate the doctrine of relativism -- Evaluating the doctrine of relativism.

In earlier work ( Cleland [2001] , [2002]), I sketched an account of the structure and justification of ‘prototypical’ historical natural science that distinguishes it from ‘classical’ experimental science. This article expands upon this work, focusing upon the close connection between explanation and justification in the historical natural sciences. I argue that confirmation and disconfirmation in these fields depends primarily upon the explanatory (versus predictive or retrodictive) success or failure of hypotheses vis-à-vis empirical evidence. The account of historical explanation that (...) I develop is a version of common cause explanation. Common cause explanation has long been vindicated by appealing to the principle of the common cause. Many philosophers of science (e.g., Sober and Tucker) find this principle problematic, however, because they believe that it is either purely methodological or strictly metaphysical. I defend a third possibility: the principle of the common cause derives its justification from a physically pervasive time asymmetry of causation (a.k.a. the asymmetry of overdetermination). I argue that explicating the principle of the common cause in terms of the asymmetry of overdetermination illuminates some otherwise puzzling features of the practices of historical natural scientists. (shrink)

Pettit and List argue for realism about group agency, while at the same time try to retain a form of metaphysical and normative individualism on which human beings qualify as natural persons. This is an unstable and untenable combination of views. A corrective is offered here, on which realism about group agency leads us to the following related conclusions: in cases of group agency, the sort of rational unity that defines individual rational unity is realized at the level of a (...) whole group; rational unity is never a metaphysical given but always a product of effort and will; just as it can be realized within groups of human beings it can also be realized within parts of human beings, as well as within whole human lives; in cases of group agency, the rational unity that is achieved at the level of the group typically precludes rational unity at the level of its human constituents within their whole lives, though it can be realized within parts of those human lives. Along the way, a contrast is drawn between cases of genuine group agency and the cases of political agency envisaged by Rousseau and Rawls (and by Pettit and List) which leave individual human beings intact as separate agents in their own rights. (shrink)

This paper explores the character of emotion and its value in understanding ethical dilemmas in work organisations. Specifically, we examine the emotional labour of human resource professionals. Through in-depth interviews and diary study, we uncover the emotional and ethical struggles of HRPs as they search for the ‘right thing to do’ in situated interaction. Through the lens of emotion, we chart the process of how the very framing of what is deemed ‘right’ can move from the social to the moral (...) order and vice versa. Based on our findings, we contribute to understanding the linkages between emotional and ethical dilemmas, and how expectations of multiple ‘others’ at the individual, interpersonal and organisational level shape and constrain ethical choices. (shrink)

This article examines the current use of Jesus language in a convenience sample of twenty-five mission statements from Roman Catholic hospitals and health care systems in the United States. Only twelve statements specifically use the words “Jesus” or “Christ” in their mission statements. The author advocates the use of explicit Jesus language and modeling. While the witness of Jesus in the Gospel healing narratives is not the only corrective to current abuses in the health care delivery system, it is foundational (...) to the integrity of Roman Catholic health care identity and mission. An analysis of Gospel healing narratives is used to illustrate the prophetic dimension of Jesus' wisdom, word, and witness. (shrink)

In recent decades, the governance of food safety, food quality, on-farm environmental management and animal welfare has been shifting from the realm of ‘the government’ to that of the private sector. Corporate entities, especially the large supermarkets, have responded to neoliberal forms of governance and the resultant ‘hollowed-out’ state by instituting private standards for food, backed by processes of certification and policed through systems of third party auditing. Today’s food regime is one in which supermarkets impose ‘private standards’ along the (...) food supply chain to ensure compliance with a range of food safety goals—often above and beyond those prescribed by government. By examining regulatory governance in Australia, Norway and the United Kingdom we highlight emerging trajectories of food governance. We argue that the imposition of the new private forms of monitoring and compliance continue the project of agricultural restructuring that began with government support for structural adjustment schemes in agriculture and that these are most evident in the UK and Australia where neoliberalism is an entrenched philosophy. However, despite Norway’s identity as a social democracy, we also identify neoliberal ‘creep’ into the system of food governance. Small-scale producers in all three nations are finding themselves increasingly subject to governance through private, market-based mechanisms that, to varying degrees, are dominated by major supermarket chains. The result is agricultural restructuring not through the traditional avenues of elected governments, but via non-elected market operatives. (shrink)

Recent research into climate shocks and what this means for the on-farm production of food revealed mixed and unanticipated results. Whilst the research was triggered by a series of catastrophic, climate related disruptions, Australian beef producers interviewed for the study downplayed the immediate and direct impacts of climate shocks. When considering the changing nature of production under shifting climatic conditions, producers offered a commentary on the digital technology and data which interconnected with climate solutions deriving from both on and off (...) the farm. Perceptions of digital technologies were mixed. Some viewpoints outlined how data driven climate solutions supported on farm planning and decision making, helping to manage climate risks and shocks. However, alongside these narratives, concerns were raised about satellite-based sustainability surveillance and their implications for producer agency. These concerns include the data-informed actions of non-farming third parties, such as bank loan call-ins for properties perceived to be a climate risk, remote surveillance of ground cover, and the commercial re-appraisal of pastoral lands as carbon sinks. Digital solutions to climate shocks thus emerge as inherently ambivalent, a response to shocks and a potential catalyst for renewed crisis. Drawing upon the theoretical lens of relationality, we argue that digital data are increasingly entangled with other material and non-material elements that may disrupt and/or reconfigure the management of farming and with that, the future security of food production. In some instances, data-based solutions to climate risks and shocks present even greater risks to producer agency than climate risks and shocks themselves. (shrink)

It is generally assumed that group agency must be a social phenomenon because it involves interactions among many human beings. This assumption overlooks the real metaphysical nature of agency, which is both normative and voluntarist. Construed as a normative phenomenon, individual agency arises wherever there is a point of view from which deliberation and action proceed in accord with the requirements that define individual rationality. Such a point of view is never a metaphysical given, but is always a product of (...) rational activities that aim to satisfy the requirements that define individual rationality. When such a deliberative point of view is forged within a whole human life, there is a single agent of human size. But such points of view can also be forged within parts of human lives so as to constitute multiple agents within them; and they can also be achieved within groups of human lives so as to constitute group agents that literally deliberate and act as one. If such a group agent were a social phenomenon, then its agency would simultaneously be the agency of many even as it was also the agency of one. In that case, its deliberations and actions would have to proceed from many separate deliberative points of view, at the same time that they also proceeded from a single deliberative point of view. A correct account of rational agency shows that this is not necessarily so, and indeed, not typically so. Moreover, if it were so much as possible for this to be so, it would require special conditions of the sort that Rousseau identified in his account of the general will. But this special case is not a good model on which to understand the cases of group agency that are most often discussed in the philosophical literature. They are more appropriately viewed as cases in which the condition of individual agency is realized at the level of a group, than as cases of social agency per se. (shrink)

In the technical literature of computer science, the concept of an effective procedure is closely associated with the notion of an instruction that precisely specifies an action. Turing machine instructions are held up as providing paragons of instructions that "precisely describe" or "well define" the actions they prescribe. Numerical algorithms and computer programs are judged effective just insofar as they are thought to be translatable into Turing machine programs. Nontechnical procedures (e.g., recipes, methods) are summarily dismissed as ineffective on the (...) grounds that their instructions lack the requisite precision. But despite the pivotal role played by the notion of a precisely specified instruction in classifying procedures as effective and ineffective, little attention has been paid to the manner in which instructions "precisely specify" the actions they prescribe. It is the purpose of this paper to remedy this defect. The results are startling. The reputed exemplary precision of Turing machine instructions turns out to be a myth. Indeed, the most precise specifications of action are provided not by the procedures of theoretical computer science and mathematics (algorithms) but rather by the nontechnical procedures of everyday life. I close with a discussion of some of the rumifications of these conclusions for understanding and designing concrete computers and their programming languages. (shrink)

This chapter contains sections titled: Abstract Two Intuitions Underlying a Consensus on Relativism The Real Dividing Issue: Is the World One or Many? Disagreement and Relative Truth References.

: This response to the preceding article by Gastmans, Dierckx de Casterle, and Schotsmans challenges the notion of "good care" as the ultimate goal of nursing practice, explores further the possible goals of nursing and how they may be identified, and presents six elements of professional caring along with their related virtues and moral obligations.

In this essay, I consider the question of whether women have an obligation to confront men who sexually harass them. A reluctance to be guilty of blaming the victims of harassment, coupled with other normative considerations that tell in favor of the unfairness of this sort of obligation, might make us think that women never have an obligation to confront their harassers. But 1 argue that women do have this obligation, and it is not overridden by many of the considerations (...) that can override other obligations to confront wrongdoers. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 65-66, June 2011.

This book is designed for the sophomore/junior level Introduction to Advanced Mathematics course. Written in a modified R.L. Moore fashion, it offers a unique approach in which readers construct their own understanding. However, while readers are called upon to write their own proofs, they are also encouraged to work in groups. There are few finished proofs contained in the text, but the author offers “proof sketches” and helpful technique tips to help readers as they develop their proof writing skills. This (...) book is most successful in a small, seminar style class. Logic, Sets, Induction, Relations, Functions, Elementary Number Theory, Cardinality, The Real Numbers For all readers interested in abstract mathematics. (shrink)

The assumption that all life on Earth today shares the same basic molecular architecture and biochemistry is part of the paradigm of modern biology. This paper argues that there is little theoretical or empirical support for this widely held assumption. Scientists know that life could have been at least modestly different at the molecular level and it is clear that alternative molecular building blocks for life were available on the early Earth. If the emergence of life is, like other natural (...) phenomena, highly probable given the right chemical and physical conditions then it seems likely that the early Earth hosted multiple origins of life, some of which produced chemical variations on life as we know it. While these points are often conceded, it is nevertheless maintained that any primitive alternatives to familiar life would have been eliminated long ago, either amalgamated into a single form of life through lateral gene transfer (LGT) or alternatively out-competed by our putatively more evolutionarily robust form of life. Besides, the argument continues, if such life forms still existed, we surely would have encountered telling signs of them by now. These arguments do not hold up well under close scrutiny. They reflect a host of assumptions that are grounded in our experience with large multicellular organisms and, most importantly, do not apply to microbial forms of life, which cannot be easily studied without the aid of sophisticated technologies. Significantly, the most powerful molecular biology techniques available—polymerase chain reaction (PCR) amplification of rRNA genes augmented by metagenomic analysis—could not detect such microbes if they existed. Given the profound philosophical and scientific importance that such a discovery would represent, a dedicated search for ‘shadow microbes’ (heretofore unrecognized ‘alien’ forms of terran microbial life) seems in order. The best place to start such a search is with puzzling (anomalous) phenomena, such as desert varnish, that resist classification as ‘biological’ or ‘nonbiological’. Ó 2007 Elsevier Ltd.. (shrink)

Being hit or being given away are subabusive, common behaviors that harm companion animals. Violent childhood socialization increases the risk of adult abuse of animal companions, but relatively little is known about the origins of societally tolerated maltreatment of pets by adults. University students completed surveys about general attitudes toward animals, family socializaton, and current relationships with pets. These students generally had positive childhood socialization about pets and reported high levels of current attachment. Adults whose parents had given children's companion (...) animals away had a heightened likelihood of giving their own pets away. Mothers' kindness to their children's pets was associated with adults' attachment to animal companions, but attachment was not related to the likelihood of hitting current pets. People who score high on a measure of pet abuse potential hit their pets. The pattern of findings related to gender implies that males are at somewhat greater risk for having negative socialization experiences involving pets, for greater pet abuse potential as adults, and for weaker attachments. However, females were equally likely to hit their pets or give them away. The childhood predictors of attitudes about animals, pet abuse potential, hitting pets, giving away pets, and attachment found in this nonclinical, noncriminal sample contribute to our understanding of developmental influences upon relationships with companion animals. (shrink)

Rovane explores eight related claims: persons are not merely rational, but possess full reflective rationality; there is a single overarching normative requirement that rationality places on persons, which is to achieve overall rational unity within themselves; beings who possess full reflective rationality can enter into distinctively interpersonal relations, which involve efforts at rational influence from within the space of reasons; a significant number of moral considerations speak in favor of defining the person as a reflective rational agent; this definition of (...) the person has led Locke and others to distinguish personal identity from animal identity; although it is a platitude that a person has special reason to be concerned for its own well being, it is not obvious how best to account for that platitude; groups of human beings and parts of human beings might qualify as individual agents and, hence, as individual persons in their own right; there is a sense in which the normative requirements of rationality are not categorical but merely hypothetical. (shrink)

This paper explores the conduct of performance appraisals of nurses in a New Zealand hospital, and how fairness is perceived in such appraisals. In the health sector, performance appraisals of medical staff play a key role in implementing clinical governance, which, in turn, is critical to containing health care costs and ensuring quality patient care. Effective appraisals depend on employees perceiving their own appraisals to be fair both in terms of procedure and interaction with their respective appraiser. We examine qualitative (...) data from interviews and focus groups, involving 22 nurses in a single department, to determine whether perceived injustices impact on the effective implementation of the appraisal system. Our results suggest that particular issues had been causing some sense of injustice, and most of these were procedural. Potential solutions focus on greater formalisation of the performance appraisal process, and more training for appraisers and appraisees. (shrink)

This chapter contains sections titled: Introduction The Scientific Method of Yore The Structure and Research Practices of Scientific Historiography of Nature Explanation and Confirmation in Scientific Historiography Narrative Explanation Common Cause Explanation References.

Qualitative researchers often face unpredictable ethical issues during fieldwork. These may be regarded as ethical dilemmas that need to be ‘solved’, but Guillemin and Gillam’s concept of ‘ethicall...

In “Robots, Trust and War” Simpson claims that victory in counter-insurgency conflicts requires that military forces and their governing body win the ‘hearts and minds’ of civilians. Consequently, forces made up primarily of autonomous robots would be ineffective in these conflicts for two reasons. Firstly, because civilians cannot rationally trust them because they cannot act from a motive based on good character. If they ever did develop this capacity then the purpose of sending them to war in our stead would (...) be lost because there would be no moral saving. Secondly, because if robot forces did offer a moral saving then this would signal that the deploying government could not be trusted to be committed to the conflict. I disagree with both claims. I argue firstly that there are less demanding grounds that could allow robot forces to be trusted sufficiently to be effective whilst still achieving a moral saving over the deployment of human ones. Secondly, that this moral saving would not necessarily signal that the deploying body lacked commitment because its interpretation would be highly context-dependent. I conclude therefore, contra-Simpson, that robot forces could plausibly be effective in counter-insurgency engagements in the foreseeable future. I suggest therefore that there may be a case for developing a more finely grained understanding of the opportunities for, and challenges of, their use. (shrink)

Despite substantial evidence pointing to a looming Malthusian catastrophe, governmental measures to reduce population have been opposed both by religious conservatives and by many liberals, especially liberal feminists. Liberal critics have claimed that 'utilitarian' population policies violate a 'fundamental right of reproductive liberty'. This essay argues that reproductive liberty should not be considered a fundamental human right, or certainly not an indefeasible right. It should, instead, be strictly regulated by a global agreement designed to reduce population to a sustainable level. (...) Three major points are discussed: 1) the current state of the overpopulation problem; 2) the claim of a fundamental human right of reproductive liberty; 3) an outline of a global agreement to address overpopulation as a 'tragedy of the commons'. (shrink)

Matthew Kramer’s The Ethics of Capital Punishment: A Philosophical Investigation of Evil and its Consequences explores the morality of capital punishment and develops his own “purgative rationale” in support of the practice. I present my objections to Kramer’s purgative rationale and trace our disagreement to differences over the nature of evil, the autonomy of human character formation, and the concept of defilement.