Background: The parent of a child with profound cognitive disability will have complex decisions to consider throughout the life of their child. An especially complex decision is whether to place a tracheotomy to support the child’s airway. The decision may involve the parent wanting a tracheotomy and the clinician advising against this intervention or the clinician recommending a tracheotomy while the parent is opposed to the intervention. This conflict over what is best for the child may lead to a bioethics (...) consult. Objective: The study explores the conflicts that may arise around tracheotomy placements. Research design: This study is a retrospective cohort study of pediatric patients for whom a tracheotomy decision required a bioethics consult. Participants and research context: Pediatric patients aged birth to 18 years old with a bioethics consult for a tracheotomy decision conflict between April 2010 and December 2016. A standardized data collection tool was used to review notes entered by the palliative care team, social workers, primary clinical team interim summaries, and the bioethics consult service. Ethical considerations: The study was reviewed and approved by the medical center’s institutional review board. Results: There were 248 clinical bioethics consults during the identified study period. There were 31 consults involving 21 children where the word tracheotomy was mentioned in the consult, and 13 of the 21 consults were for children with profound cognitive disability. Discussion and conclusion: Clinicians need to be aware of their own biases when discussing a child’s prognosis and treatment options while also understanding the parents’ values and what the parent might consider to be burdensome in the care of their child and the acceptable burden for the child to experience. (shrink)

In Why Some Things Should Not Be for Sale, philosopher Debra Satz takes a penetrating look at those commodity exchanges that strike most of us as problematic. What considerations, she asks, ought to guide the debates about such markets? What is it about a market involving prostitution or the sale of kidneys that makes it morally objectionable? How is a market in weapons or pollution different than a market in soybeans or automobiles? Are laws and social policies banning the (...) more noxious markets necessarily the best responses to them? Satz contends that categories previously used by philosophers and economists are of limited utility in addressing such questions because they have assumed markets to be homogenous. Accordingly, she offers a broader and more nuanced view of markets--one that goes beyond the usual discussions of efficiency and distributional equality--to show how markets shape our culture, foster or thwart human development, and create and support structures of power. (shrink)

Agora, Academy, and the Conduct of Philosophy offers extremely careful and detailed criticisms of some of the most important assumptions scholars have brought to bear in beginning the process of (Platonic) interpretation. It goes on to offer a new way to group the dialogues, based on important facts in the lives and philosophical practices of Socrates - the main speaker in most of Plato's dialogues - and of Plato himself. Both sides of Debra Nails's arguments deserve close attention: the (...) negative side, which exposes a great deal of diversity in a field that often claims to have achieved a consensus; and the positive side, which insists that we must attend to what we know of these philosophers' lives and practices, if we are to make a serious attempt to understand why Plato wrote the way he did, and why his writings seem to depict different philosophies and even different approaches to philosophizing. From the Preface by Nicholas D. Smith. (shrink)

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...) a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families. (shrink)

The essays in this volume take off from themes in the work of eminent philosopher and political scientist Joshua Cohen. They center around three central ideas: democracy, confronting injustice, and formulating political principles and values in an interdependent world.

Hubert and Patricia Dreyfus, commenting on the common theme of Harold Pinter's The Dumbwaiter, The Room, and The Collection, write, "Something savage intrudes into an island of order, suddenly revealing this island's vulnerability demanding a response."1 Written in the late 1950s and early 1960s, these plays may or may not have been intended as commentaries on Hitler's exposé of the West's vulnerability to savagery. Read as such a commentary, however, the allied military victory, the Nuremburg trials, and the United Nations (...) Declaration of Human Rights may be seen as responses that attempt to reestablish the island's order. The military victory relied on science, technology, guns, tanks... (shrink)

This revised workbook is designed for patients' use as they work, either with a qualified mental health professional or on their own, to manage social anxiety. Based on the principles of cognitive-behavioral therapy, the treatment program described is evidence-based and proven effective. Complete with user-friendly forms and worksheets, as well as relatable case examples and chapter review questions, this workbook contains all the tools necessary to help patients manage their anxiety and improve their quality of life.

This book brings together some of the best minds in neurology and philosophy to discuss the concept of personal identity and the moral dimensions of treating ...

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 35.3 (2002) 185-207 [Access article in PDF] Agonism and Aretê Debra Hawhee Oh, those Greeks! They knew how to live. What is required for that is to stop courageously at the surface, the fold, the skin, to adore appearance, to believe in forms, tones, words, in the whole Olympus of appearance. Those Greeks were superficial—out of profundity. —Friedrich Nietzsche The profound superficiality about which Nietzsche (...) marvels describes ancient Greek culture as a culture of contact, a culture replete with spectacular gatherings, groping eyes, bending flesh, constantly redoubling so that the superficial became embedded, enfolded into bodies, tones, words. One condition of such enfolding was the agôn, the contest, the encounter that produces struggle and change. As scholars such as Walter Ong, John Poulakos, and Jeffrey Walker have pointed out, agonism provided an important context for the emergence of rhetoric in antiquity. 1 As I will suggest, athletics made available an agonistic model for early rhetors to follow as they developed their art. But the force or quality of this brand of agonism is nonetheless at times surprising, and this unusual character of the agôn was central to the particular development of rhetoric as an art of response.It must be noted from the outset that the agôn is more than the one-on-one sparring that is emphasized in most treatments of the topic. That is, agonism is not merely a synonym for competition, which usually has victory as its goal. For outcome-driven competition, the Greeks used the term athlios, from the verb athleuein, meaning to contend for a prize. The agôn, by contrast, is not necessarily as focused on the outcome as it is on athlios, the more explicit struggle for a prize. Rather, the root meaning of agôn is "gathering" or "assembly." The Olympic Games, for example, depended on the gathering of athletes, judges, and spectators alike. Put simply, whereas athlios emphasizes the prize and hence the victor, agôn emphasizes the [End Page 185] event of the gathering itself—the encounter rather than the division between the opposing sides. To be sure, the "gathering" force of agôn to some extent entails—and is enabled by—the victory. One aim of this exploration, though, is less to consider agonism's teleological, or victory-driven side, and more to foreground the agonistic encounter itself. I will suggest that this encounter constitutes the more pervasive agonal dynamic, a dynamic that also figures prominently in the development of rhetoric as an agonistic force.John Poulakos's important book on the sophists points out the agonistic connection between rhetoric and athletics (32-39), arguing that the sophists effectively "turned rhetoric into a competitive enterprise" (35) and that athletics provided a "rich vocabulary" for the rhetorical art. Poulakos's account, however, focuses on the athlios side of agonism, the "victory at all cost" mentality. Yet the "gathering" force of the agôn inheres as well, most notably in the very structure of rhetorical situations and their dependence on an assembly, but also in the training and production of a rhetorical subject. The realm of training, interestingly, shows most clearly the close relation between athlios and agôn, as a drive for the prize depends on the gathering force of agonistic logic from the very beginning. Agôn is also connected to the verb agein, which is generally translated "to lead," but in some instances is linked to training and can be translated "to bring up, train, educate" (e.g., Plato's Laws 782d). So the word agôn suggests movement through struggle, a productive training practice wherein subjective production takes place through the encounter itself. As Nietzsche suggests, the Greeks produced themselves through active struggle; their pedagogy depended on agonism (1974, 58; see also Poulakos, 33).Taking seriously rhetoric's emergence in the context of the agôn requires a reconfiguration of rhetoric as an agonistic encounter. That is, for the sophists at least, agonism produces rhetoric as a gathering of forces—cultural, bodily, and discursive, thus problematizing the easy portrayal of rhetoric as telos-driven persuasion or as a... (shrink)

The People of Plato is the first study since 1823 devoted exclusively to the identification of, and relationships among, the individuals represented in the complete Platonic corpus. It provides details of their lives, and it enables one to consider the persons of Plato's works, and those of other Socratics, within a nexus of important political, social, and familial relationships. Debra Nails makes a broad spectrum of scholarship accessible to the non-specialist. She distinguishes what can be stated confidently from what (...) remains controversial and--with full references to ancient and contemporary sources--advances our knowledge of the men and women of the Socratic milieu. Bringing the results of modern epigraphical and papyrological research to bear on long-standing questions, The People of Plato is a fascinating resource and valuable research tool for the field of ancient Greek philosophy and for literary, political, and historical studies more generally. In discrete sections, Nails discusses systems of Athenian affiliation, significant historical episodes that link lives and careers of the late fifth century, and their implications for the dramatic dates of the dialogues. The volume includes a rich array of maps, stemmata, and diagrams, plus a glossary, chronology, plan of the agora in 399 B.C.E., bibliography, and indices. (shrink)

Having a self is associated with important advantages for an organism.These advantages have been suggested to include mechanisms supporting elaborate capacities for planning, decision-making, and behavioral control. Acknowledging such functionality offers possibilities for obtaining traction on investigation of neural correlates of selfhood. A method that has potential for investigating some of the brain-based properties of self arising in behavioral contexts varying in requirements for such behavioral guidance and control is functional brain imaging. Data obtained with this method are beginning to (...) converge on a set of brain areas that appear to play a significant role in permitting conscious access to representational content having reference to self as an embodied and independent experiencer and agent. These areas have been identified in a variety of imaging contexts ranging from passive state conditions in which they appear to manifest ongoing activity associated with spontaneous and typically ‘self-related’ cognition, to tasks targeting explicitly experienced properties of self, to demanding task conditions where activity within them is attenuated in apparent redirection of cognitive resources in the service of task guidance and control. In this paper, these data will be reviewed and a hypothesis presented regarding a significant role for these areas in enabling degrees of self-awareness and participating in the management of such behavioral control. (shrink)

This paper points to a lost and ignored strand of argument in the writings of liberalism's earliest defenders. These “classical” liberals recognized that market liberty was not always compatible with individual liberty. In particular, they argued that labor markets required intervention and regulation if workers were not to be wholly subjugated to the power of their employers. Functioning capitalist labor markets (along with functioning credit markets) are not “natural” outgrowths of exchange, but achievements hard won in the battle against feudalism. (...) Further, and crucially, the existence of such markets required closing off other market choices. Footnotesa I would like to thank the other contributors to this volume, and its editors, for their helpful comments on an earlier draft of this essay. (shrink)

Congdon (2017), Giladi (2018), and McConkey (2004) challenge feminist epistemologists and recognition theorists to come together to analyze epistemic injustice. I take up this challenge by highlighting the failure of recognition in cases of testimonial and hermeneutical injustice experienced by victims of sexual harassment and sexual assault. I offer the #MeToo movement as a case study to demonstrate how the process of mutual recognition makes visible and helps overcome the epistemic injustice suffered by victims of sexual harassment and sexual assault. (...) I argue that in declaring “me too,” the epistemic subject emerges in the context of a polyphonic symphony of victims claiming their status as agents who are able to make sense of their own social experiences and able to convey their knowledge to others. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

Research on gender inequality within different-sex marriages shows that women do more unpaid labor than men, and that the perception of inequality influences perceptions of marital quality. Yet research on same-sex couples suggests the importance of considering how gender is relational. Past studies show that same-sex partners share unpaid labor more equally and perceive greater equity than do different-sex partners, and that lesbian, gay, and bisexual people are less gender conforming than heterosexuals. However, studies have not considered how gender conformity (...) might shape inequalities and marital quality within same- and different-sex unions. In this study, we analyze dyadic data from both spouses in same- and different-sex marriages to explore how sex of spouse and gender conformity influence perceptions of shared power within the relationship, which, in turn, influences marital quality. Results show that greater gender conformity is related to stronger perceptions of shared power in different-sex and male same-sex couples but not in female same-sex couples. Perceptions of shared power are positively associated with marital quality in all union types. Our findings suggest that maintaining hegemonic masculinity and power inequalities may be salient to marriages with men. In female same-sex couples, gender and its relation to power inequalities may carry less meaning. (shrink)

This book offers practical advice for legal professionals to optimize cognitive fitness and protect their brain from the damaging effects of chronic stress. Drawing on the latest research in neuroscience and psychology, it provides actionable information to help readers thrive amidst the demands and stressors of the legal profession.

Plato's Republic critiques Athenian democracy as practised during the Peloponnesian War years. The diseased city Socrates attempts to purge mirrors Athens in crucial particulars, and his proposals should be evaluated as counter-weights to existing institutions and practices, not as absolutes to be instantiated. Plato's assessment of the Athenian polity incorporates two strategies -- one rhetorical, the other argumentative -- both of which I address. Failure to consider Athens a catalyst for Socrates' arguments has led to the misconception that Plato was (...) dogmatically committed to a single political doctrine for all and for all time. (shrink)

This article examines the construction of gender within men's accounts of domestic violence. Analyses of in-depth interviews conducted with 33 domestically violent heterosexual men indicate that these batterers used diverse strategies to present themselves as nonviolent, capable, and rational men. Respondents performed gender by contrasting effectual male violence with ineffectual female violence, by claiming that female partners were responsible for the violence in their relationships and by constructing men as victims of a biased criminal justice system. This study suggests that (...) violence against female partners is a means by which batterers reproduce a binary framework of gender. (shrink)

The concept of ‘accounts’ (Scott and Lyman, 1968) – or linguistic strategies for neutralizing the negative social meanings of norm violation – has a long history in sociology. This work examines British and American women's accounts of cosmetic surgery. In the medical literature, feminist writings and the popular press, aesthetic plastic surgery has been associated with narcissism, psychological instability and self-hatred. Given these negative connotations, cosmetic surgery remains a practice requiring justification even as its popularity increases. Drawing on interview data, (...) I argue that respondents' efforts to account for cosmetic surgery vary according to the ‘repertoires of evaluation’ (Lamont and Thévenot, 2000) made available by their own nation and, particularly, by its healthcare culture. In the market-based US healthcare system, women justify cosmetic surgery by referring to their personal and financial ‘investments’ in physical attractiveness and well-being. Such explanations are less legitimate in Britain, where healthcare is considered a social right rather than a consumer good. In the latter context, women employ narratives that medicalize the pre-surgical body by stressing the physical pain and emotional distress that it caused. (shrink)

Women are routinely subjected to penetrating surveillance during pregnancy. On the surface, this may appear to flow from a cultural commitment to protect babies – a cultural practice of “better safe than sorry” that is particularly vigilant given the vulnerability of fetuses and babies. In reality, pregnancy occasions incursions against human rights and well-being that would be anathema in other contexts. Our cultural practices concerning risk in pregnancy are infused with oppressive norms about women’s responsibility for pregnancy outcomes and the (...) demands of extreme self-sacrifice from women to protect their fetuses. Of particular concern is our culture’s willingness to enforce norms concerning risk during pregnancy using coercive measures including forced cesarean sections and criminal penalties for exposing fetuses to risk. This chapter will consider assaults on self-determination, bodily integrity and privacy inherent in such interventions, as well as the structural violence and “mangled pieties” that buttress such practices in our unjust society. (shrink)

Although consumers and physicians alike have long described the goal of aesthetic surgery as the production of an “improved” but still “natural-looking” body, interviews with women who had cosmetic surgery between 1990 and 2007 suggest that the “artificial” is becoming increasingly prevalent within consumers’ narratives of breast enlargement. This article explores that change in relation to processes of conspicuous consumption, the growing cultural emphasis on continual self-transformation, and the increasing normalization of cosmetic modification. Following Fraser, it treats consumers’ accounts not (...) as the reflection of “reality” or a “true self” but instead as indicators of the kinds of options, expressions, assumptions, and perspectives that are available for use in communication about cosmetic surgery. The analysis also draws on feminist writings about the social construction of “breastedness” in femininity. In so doing, it seeks to conceptualize the cultural significance of breasts that are “too good to be real.”. (shrink)

In his article "How Certain Boundaries and Ethics Diminish Therapeutic Effectiveness", Lazarus asserts that many clinicians are adhering to strict therapeutic boundaries and ethics in a fear-driven effort to avoid unwarranted malpractice claims. Although I agree that maintenance of conventional therapeutic boundaries is apt to minimize malpractice claims in most cases, I believe that is because such boundaries are critical to protect patients' welfare and thereby promote effective treatment. My reasoning, discussed next, revolves around the following premises: 1. For many, (...) if not most, types of patient problems and patient populations, boundaries and the personal meaning of the therapeutic boundaries are an arena in which critical emotional issues are manifested and worked through. 2. Clear, consistent boundaries provide a structure and safety for many patients that is a curative factor in itself. 3. Patients' reactions to alterations in usual therapeutic boundaries are often unpredictable ahead of time (even if requested by the patient) and typically complex, ambivalent, and heavily colored by transferential meaning. 4. Because alterations in therapeutic boundaries typically add a new therapist role or activity that involves potential gratification of personal needs of the therapist, objectivity in evaluating such a change may be compromised by the inherent self-interest. 5. Consistent, clear boundaries need have no impact on therapist warmth and empathy. (shrink)

Challenges Beauvoir's self-portrait and argues that she was a philosopher in her own right.

Although World of Warcraft utilizes ethnic and gender stereotypes in the construction of its playable characters, the structure of the gaming environment provides a modest utopian vision that is structurally just, maximizing both liberty and equality among participants in a way consistent with John Rawls's Theory of Justice. As a result, class, race, and gender are much more a matter of human (humanoid) variety, rather than a tool for hierarchically differentiation. Nevertheless, in players' engagement with the game, class, race, and (...) gender differences take on meaning well beyond the strucuture of the Warcraft universe demonstrating how real world values infect our imagination. (shrink)

The hypothesis that excessive early infant crying evolved to reduce the risk of withdrawal of parental care is disputed on the grounds that excessive infant crying is irritating and imposes fitness losses rather than gains. Alternative explanations for the early crying curve that take into account development on the part of the infant and the emerging infant-caregiver bond are proposed.