This article considers the attempt by a prominent fifteenth-century follower of Thomas Aquinas, Dominic of Flanders, to address John Duns Scotus’ most famous argument for the univocity of being. According to Scotus, the intellect must have a concept of being that is univocal to substantial and accidental being, and to finite and infinite being, on the grounds that an intellect cannot be both certain and doubtful through the same concept, but an intellect can be certain that something is (...) a being while doubting whether it is a substance or accident, finite or infinite. The article shows how Flandrensis’ reply in defence of analogy of being hinges on a more fundamental disagreement with Scotus over the division of the logically one. It also shows how Flandrensis’ answer to this question commits him to a position on the unity of the concept of being that lies between the positions of Scotus and of Flandrensis’ earlier Thomistic sources. (shrink)

This article presents two case-studies that shed light on the silent yet significant role an editor might play in the reception of Renaissance texts and the place of Thomas Aquinas therein. Both studies take up texts from fifteenth-century Italy. The first addresses the scholastic philosopher, Dominic of Flanders, suggesting that Dominic’s originality as a thinker may have been ‘corrected’ by an anonymous editor in order to maintain closer accord with Aquinas’s position; inquiry into the manuscript tradition uncovers (...) instances of silent intervention. The second addresses a Latin dialogue by the physician and humanist, Antonio de Ferraris (Galateo), drawing attention to a significant suppression of the interlocutor Thomas Aquinas, this time by a twentieth century editor. (shrink)

Foodscapes, the ways and places in which human beings interact with food, are dominated by the global agri-food system. In many ways, it has never been easier to access such varieties or quantities of food. Be it in restaurants, supermarkets or local markets, food is often only a quick purchase away from the plate. In spite of that, there are persons who choose to follow alternative paths, moving away from reliance on the conventional system by engaging in practices of food (...) self-reliance. In this paper, using the analytical lenses of behavioural, social innovation and social practice theories, we explore why and how people strive for self-reliance and self-governing their foodscapes. We apply these lenses to data gathered from site visits and in-depth interviews with those engaged in self-reliant practices in Flanders. The practices we encountered range from permaculture to transition towns and illustrate the diverse alternative foodscapes found in Flanders. Our research reveals that while practices—and the people who engage in them—may at first appear distinct, they have commonalities as well, including similar values, needs, goals and more. These diverse elements combine to create, reshape and sustain practices within foodscapes. By further understanding the motivational, biogeophysical and social underpinnings that enable them we reveal a diverse, yet connected, continuum of practices. (shrink)

Flanders will complete the migration from analog to digital terrestrial television by the end of 2008. Despite the cable dominated television landscape, the Flemish government is aiming at a smooth transition from analog to digital terrestrial television. Therefore, a multi-methodical study has been set up by order of the Flemish government to understand the specific features and needs of analog antenna viewers and their expectations for the analog switch-off. The study shows that there are three distinctive types of analog (...) antenna viewers. The results demonstrate that the antenna viewers are rather badly informed about the upcoming analog switch-off, which may lead to a negative attitude and may impede a smooth transition. Finally, antenna viewers seem to be rather conservative viewers: they wish to keep on watching the same television programs from the same channels. Moreover, digital terrestrial television is their preferred alternative. (shrink)

The Cistercian order, which had its origins in the late eleventh century, transformed the spiritual landscape of western Europe. The order's insistence on a return to the austerity and simplicity that had originally informed Benedictine life reenergized monasticism, spawning hundreds of new abbeys within decades. By the beginning of the thirteenth century, the Cistercians dominated monastic life, surpassing their black-robed predecessors in terms of popularity and replacing them among patrons as favored recipients of donations. Yet, while a sizable body of (...) historiography exists concerning the ability of men's houses to translate this appeal into spiritual and material success, questions remain regarding the order's female members. In particular, some scholars have constructed a narrative of financial difficulties and eventual decline for Cistercian nunneries, one that began in the thirteenth century and accelerated throughout the late Middle Ages. According to this narrative, such difficulties, by-products of the secondary status of religious women, manifested themselves in small monastic complexes and limited patrimonies. In her work on English Cistercians, Sally Thompson argues that religious women were dependent upon men because of their inferior position in medieval society and generally lacked a true religious vocation, characteristics that led to smaller, impoverished houses. Cistercian nunneries are portrayed in monastic histories as constantly struggling and are often “lumped together as being poor, scandalous, passive institutions which were eschewed by medieval patrons.” The majority of their houses are characterized by modern historians as enjoying a perilous existence at best, permanently poised on the brink of extinction and beset by a host of financial and spiritual difficulties. (shrink)

Since the first decade of the 14th Century, Thomas Aquinas’s disciples have struggled to explain and defend his doctrine of analogy. Analogy after Aquinas: Logical Problems, Thomistic Answers relates a history of prominent Medieval and Renaissance Thomists’ efforts to solve three distinct but interrelated problems arising from their reading both of Aquinas’s own texts on analogy, and from John Duns Scotus’s arguments against analogy and in favor of univocity in Metaphysics and Natural Theology. The first of these three problems concerns (...) Aquinas’s at least apparently disparate statements on whether a name is said by analogy through a single concept or through diverse concepts. The second problem concerns the model of analogy suited for predicating names analogously across the categories of being or about God and creatures. Is “being” said analogously about God and creatures, or substance and accidents, on the model of how “healthy” is said of medicine and an animal, or on the model of how “principle” is said of a point and a line? The third problem comes from outside challenges to Aquinas’s thought, in particular Scotus’ claims that univocal names alone can mediate valid demonstrations, and any demonstration that failed to use its mediating terms univocally would fail by the fallacy of equivocation. Analogy after Aquinas makes a unique contribution to the study of philosophical theology in the tradition of Thomas Aquinas by showing the historical and philosophical connection between these three problems, as well as the variety of solutions proposed by leading representatives of this tradition. Thomists considered in the book include: Hervaeus Natalis (1250-1323), Thomas Sutton (1250-1315), John Capreolus (1380-1444), Dominic of Flanders (1425-1479), Paul Soncinas (d. 1494), Thomas dio vio Cajetan (1469-1534), Francis Silvestri of Ferrara (1474-1528), and Chrysostom Javelli (1470-1538). (shrink)

This dissertation focuses on the philosophical psychology of a little-studied author, Dominic of Flanders, as elaborated upon in a work that has received no attention in the scholarly literature thus far—viz., his Expositio super libros de anima. No modern editions of Dominic’s works exist. Born in the County of Flanders during the first half of the fifteenth century, Dominic was first educated at the University of Paris, but then made his intellectual home in Italy, where (...) he entered the Dominican Order, teaching at the studia of his order, as well as at the University of Florence. This study attempts to place Dominic within the broader context of Aristotelianism to which he belongs, recognizing his place within the school of Thomism that was thriving in Italy at the time, especially in Bologna. We have provided an account of his life and works, exhaustively examining available bibliographical literature, and have situated the composition of his Expositio during his period of Bologna following his entrance into the Order. In particular, we have studied the third book of his Expositio, which takes up the philosophical topics related to cognition and intellectual understanding. We have given attention to the themes of the cognition or knowledge of particulars, as well as the theory of abstraction, which is required for universal understanding. Beyond the fact that the theory of the internal senses is taken up at the outset of Dominic’s third book, it is our contention that a treatment of the internal senses is necessary for a proper understanding of particular knowledge. Dominic is firmly rooted in the Aristotelian tradition, and so for him there is no intellectual cognition without phantasms. Further, the role of the agent intellect is both to abstract from phantasms, as well as to turn back towards phantasms. In this study, we have shown the Flemish master’s reliance upon the thought and writings of Thomas Aquinas; we also have uncovered a silent source of Dominic’s Expositio—viz., the De anima commentary of John Versoris. Versoris’ commentary has been equally unstudied in the relevant scholarly literature. This Versoris had been Dominic’s teacher at Paris. The results of this research also include an edition of Latin text of the third book of Dominic’s Expositio super libros de anima. This edition is based on the four surviving manuscripts of the work, as well as three selected early modern editions ; this edition is presented in the dissertation as an appendix. (shrink)

The desire of knowledge constitutes, as it is well known, the opening ‘theme’ of Aristotle’s Metaphysics. This article focuses on the figure of Dominic of Flanders, one of the commentators of Aristotle’s Metaphysics who much developed this topic. Dominicus deals with it in the second question of the first book of his commentary. What makes the interest of Dominic’s account is its originality, in so far as, according to him, the beginning of Aristotle’s Metaphysics aims to stress (...) the very primacy of Metaphsyics, and not only, the primacy of science in general. In this sense, the desire of knowledge constitutes for Dominic the most efficacious argument for the primacy of Metaphsyics. However, this is possible only if the desiderium sciendi is related to two other principles: the first is that desirability entails perfection, and the second is that the desirability of an object depends on its intelligibility. (shrink)

The article offers a critical biography, description and characteristic of method, fonts and doctrine of Master Paul of Soncino († 5 August 1495), friar of the Dominican Order, in particular his Acutissimae Quaestiones Metaphysicales. The life and work of this philosopher falls within the ambit of Italian Thomism of the 15th century. Between his masters we commemorate Peter Maldura of Bergamo and Dominic of Flanders. His exposition of Aristotle’s Metaphysic proceeds from a peculiar synthesis of Arabic Commentator Averroes (...) and Thomas Aquinas. Soncinas’ work and position was frequently discussed up to the 15th century. (shrink)

This paper takes up the topic of the interior senses and sensible cognition as elaborated by Dominic of Flanders, a fifteenth-century Dominican thinker, in his short commentary, Expositio super libros De anima. At a time when Averroistic Aristotelianism was flourishing, and as nominalism spread across the Continent, Dominic’s account of the soul and the interior senses demonstrates a commitment to Thomas Aquinas and, more broadly, scholastic realism. Dominic adopts the fourfold model of the internal senses advanced (...) by Thomas. He carries forth Thomas’s insistence that the sensus communis is both the root (radix) and end (terminus) of sensitivity as such and the individual senses; he follows Thomas in privileging the cogitativa, and posits a more perfect form of memoria in man. Our study concludes by looking briefly at his Quaestiones in XII libros Metaphysica, where we find an innovative account of experimentum, which reveals the thought of a capable philosopher. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

Given the profound influence of social media and emerging evidence of its effects on human behavior and health, bioethicists have an important role to play in the development of professional standards of conduct for health professionals using social media and in the design of online systems themselves. In short, social media is a bioethics issue that has serious implications for medical practice, research, and public health. Here, we inventory several ethical issues across four areas at the intersection of social media (...) and health: the impact of social networking sites on the doctor‐patient relationship, the development of e‐health platforms to deliver care, the use of online data and algorithms to inform health research, and the broader public health consequences of widespread social media use. In doing so, we review discussions of these topics and emphasize the need for bioethics to focus more deeply on the ways online technology platforms are designed and implemented. We argue that bioethicists should turn their attention to the ways in which consumer engagement, bias, and profit maximization shape online content and, consequently, human behavior and health. We also offer a set of recommendations and suggest future directions for addressing ethical challenges in these domains. (shrink)

Rawls's “public reason” has not been without its critics. One criticism is that public reason is “conservative.” Public reason must rely on those beliefs that are “widely shared” among citizens. But if public reason relies on widely shared beliefs, how can it change without departing from those beliefs, thus violating public reason? In part one of my essay, I introduce the conservatism objection and describe two unsatisfactory responses to it. Part two argues that there are aspects of public reason which (...) diminish the force of the conservatism objection: first, that public reason is historical, and second, that it is mutable. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

In intensive care, disputes sometimes arise when patients or surrogates strongly desire treatment, yet health professionals regard it as potentially inappropriate. While professional guidelines confirm that physicians are not always obliged to provide requested treatment, determining when treatment would be inappropriate is extremely challenging. One potential reason for refusing to provide a desired and potentially beneficial treatment is because (within the setting of limited resources) this would harm other patients. Elsewhere in public health systems, cost effectiveness analysis is sometimes used (...) to decide between different priorities for funding. In this paper, we explore whether cost-effectiveness could be used to determine the appropriateness of providing intensive care. We explore a set of treatment thresholds: the probability threshold (a minimum probability of survival for providing treatment), the cost threshold (a maximum cost of treatment), the duration threshold (the maximum duration of intensive care), and the quality threshold (a minimum quality of life). One common objection to cost-effectiveness analysis is that it might lead to rationing of life-saving treatment. The analysis in this paper might be used to inform debate about the implications of applying cost-effectiveness thresholds to clinical decisions around potentially inappropriate treatment. (shrink)

When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical. Our enormous scientific and medical progress already outstrips our capability to provide treatment. Life can be prolonged at enormous cost, sometimes far beyond the point that the individual appears to be gaining a net benefit from that life. Science (...) can tell us how to achieve something, but it cannot tell us whether we should achieve that end—whether it is good. For that, we need ethics. Ethics grows in importance as our technology creates new possibilities. Where there are no options, there are no ethical questions. However, once there are options, there arise pressing questions about whether to pursue them. We require values and principles to decide how to use medicine and science. During the last 7 years, issues like the creation of brain organoids, human non-human chimeras, mitochondrial transfer, gene editing of embryos and in vitro gametogenesis have grown in prominence. These raise deep questions about moral status and how it should be determined, the limits of modification of humans, and what is good in life. As editors of the JME, we are proud of our small contribution to thinking about these challenges. We are grateful to the hard work of our associate editors and administrative staff, but there is still much more to do. During our term as editors, we have published papers from diverse perspectives, on a wide range of topics. We have seen vigorous debate within the pages of the journal and have often sought to deliberately encourage that debate …. (shrink)

Petrus Nigri (Schwarz) se narodil západočeské Kadani (něm. Kaaden) kolem roku 1435 a spolu se svými třemi bratry vstoupil v Německu do dominikánského řádu. Během svého studia prošel velkou část Evropy (Německo, Itálii, Španělsko, Čechy a Maďarsko) a nakonec se stal rektorem generálního studia v Budíně (1481). Obecně je znám spíše jako význačný středověký hebraista. Do dějin filosofie se zapsal zvláště jako autor Clipeus thomsitarum (před r. 1474), což je filosofický komentář na Porfýriův Úvod (Isagoge) a na aristotelovské Kategorie, formou (...) otázek. Třebaže Nigriho práce není originální, představuje v zaalpských zemích významnou recepci pojetí pomyslného jsoucna (Clipeus, část I, ot. 3-4) tak, jak ho koncipoval Hervaeus Natalis († 1323) ve svém traktátu De secundis intentionisbus. -/- Petrus Nigri (Peter Schwarz, born in Kadaň/Kaaden before 1435, died in Buda 1483), is author of Clipeus thomistarum (printed 1481), a philosophical commentary on Porphyry's Introduction (Isagoge), and on Aristotle's Categories in the form of questions. While Nigri's discussion of the concept of being of reason (Clipeus thomistarum, part I, qq. 3-4) is not original, his work is important for contributing to this concept’s reception, and with it the teaching of Hervaeus Natalis (died 1323) in his treatise De secundis intentionibus, in the transalpine countries. Being of reason (ens rationis) is conceived as not a categorial being, nor is it an intellectual operation, nor is it caused, but is only identifiable by the human intellect. Nigri's being of reason has no subjective existence, but only an objective character, which differs both from categorial being and from mere nothingness. (shrink)

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...) Analgesia, Resuscitation, and Intensive Care issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent “first come, first served” principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy. (shrink)

Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and (...) expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results. Results Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses. Respondents’ agreement to provide treatment decreased as the risk or cost of the requested substitute increased. More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed. Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results. Conclusion Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests. (shrink)

In euthanasia and/or assisted suicide of persons with dementia, the controversy has mostly focused on decisionally incapable persons with very advanced dementia for whom the procedure must be based on a written advance euthanasia directive. This focus on advance euthanasia directive-based EAS has been accompanied by scant attention to the issue of decision-making capacity assessment of persons with dementia who are being evaluated for concurrent request EAS. We build on a previous analysis of concurrent request EAS cases from the Netherlands, (...) which showed that many such cases involve persons with significant cognitive impairment. We use illustrative cases to describe the difficulty of determining decisional capacity in persons whose stage of dementia falls between severely impaired and mildly impaired. We show that the Dutch practice of capacity assessment in such dementia cases is difficult to reconcile with the widely accepted functional model of capacity—a model explicitly endorsed by the Dutch euthanasia review committees. We discuss why such deviations from the standard functional model might be occurring, as well as their ethical implications for dementia EAS policy and practice. (shrink)

Background Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. Objective We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. Research design A questionnaire survey was (...) carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. Ethical considerations This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. Findings Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students’ attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. Conclusion As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress. (shrink)

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...) immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports. (shrink)

There is a concern that as a result of COVID-19 there will be a shortage of ventilators for patients requiring respiratory support. This concern has resulted in significant debate about whether it is appropriate to withdraw ventilation from one patient in order to provide it to another patient who may benefit more. The current advice available to doctors appears to be inconsistent, with some suggesting withdrawal of treatment is more serious than withholding, while others suggest that this distinction should not (...) be made. We argue that there is no ethically relevant difference between withdrawing and withholding treatment and that suggesting otherwise may have problematic consequences. If doctors are discouraged from withdrawing treatment, concern about a future shortage may make them reluctant to provide ventilation to patients who are unlikely to have a successful outcome. This may result in underutilisation of available resources. A national policy is urgently required to provide doctors with guidance about how patients should be prioritised to ensure the maximum benefit is derived from limited resources. (shrink)

When parents face the distressing news during pregnancy that their baby is affected by a serious medical condition that will likely lead to the baby’s death before or soon after birth, they experience a range of complex emotions. Perhaps paradoxically, one common response is that of hope. Navigating such hope in antenatal interactions with parents can be difficult for healthcare professionals. That can stem from a desire to accurately communicate prognostic information and a fear of conveying ‘false hope’ to families. (...) In this paper, we examine the role that hope plays when parents and healthcare professionals are grappling with a confirmed antenatal diagnosis of a life-limiting condition. We assess what it means to hope in this context and consider the different types of hopes held by both parents and healthcare professionals as well as why hopeful thinking might be helpful and not harmful. We propose ‘hope pluralism’ as a concept that might allow healthcare professionals to accommodate a multitude of parental and professional hopes, even where these conflict. Finally, we offer some practical suggestions for how professionals should evaluate and respond to hope in situations that might (from the outside) appear hopeless. (shrink)

In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

Death penalty debates appear to be intractable because what is obvious to one side is just as obviously not the case to the other. One side finds it unconscionable that a murderer can still be walk...

We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...) of the public. Thus, we argue that when vaccine mandates are justified on the basis of these criteria, they are not unfairly discriminatory and the level of coercion they involve is ethically acceptable—and indeed comparable to that already accepted in healthcare employment contracts. Such mandates might be justified even when general population mandates are not. Our conclusion is that, given current evidence, those ethical criteria justify mandates for influenza vaccination, but not COVID-19 vaccination, for healthcare workers. We extend our arguments to other vaccines. (shrink)

Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and regulations (...) due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public. (shrink)

Social prescriptions are one term commonly used to describe non-pharmaceutical approaches to healthcare and are gaining popularity in the community, with evidence highlighting psychological benefits of reduced anxiety, depression and improved mood and physiological benefits of reduced risk of cardiovascular disease and reduced hypertension. The relationship between human health benefits and planetary health benefits is also noted. There are, however, numerous barriers, such as duration and frequencies to participate in activities, access, suitability, volition and a range of unpredictable variables impeding (...) a comprehensive approach to their use on a wider scale. From a multidisciplinary perspective, this commentary incorporates a salutogenic and nature-based approach to health, we also provide a range of recommendations that can be undertaken at the patient level to assist in shifting the acknowledged systemic barriers currently occurring. These include using simple language to explain the purpose of health empowerment scripts, ensuing personal commitment to a minimum timeframe, enabling ease of access, co-designing a script program, providing ongoing motivational support and incorporating mindfulness to counter unexpected disruptions. (shrink)

The non-identity problem arises when our actions in the present could change which people will exist in the future, for better or worse. Is it morally better to improve the lives of specific future people, as compared to changing which people exist for the better? Affecting the timing of fetuses being conceived is one case where present actions change the identity of future people. This is relevant to questions of public health policy, as exemplified in some responses to the Zika (...) epidemic. There is philosophical disagreement about the relevance of non-identity: some hold that non-identity is not relevant, while others think that the only morally relevant actions are those that affect specific people. Given this disagreement, we investigated the intuitions about the moral relevance of non-identity within an educated sample of the public, because there was previously little empirical data on the public’s views on the non-identity problem. We performed an online survey with a sample of the educated general public. The survey assessed participants’ preferences between person-affecting and impersonal interventions for Zika, and their views on other non-identity thought experiments, once the non-identity problem had been explained. It aimed to directly measure the importance of non-identity in participants’ moral decision-making. We collected 763 valid responses from the survey. Half of the participants (50%) had a graduate degree, 47% had studied philosophy at a university level, and 20% had read about the non-identity problem before. Most participants favoured person-affecting interventions for Zika over impersonal ones, but the majority claimed that non-identity did not influence their decision (66% of those preferring person-affecting interventions, 95% of those preferring impersonal ones). In one non-identity thought experiment participants were divided, but in another they primarily answered that impersonally reducing the quality of life of future people would be wrong, harmful and blameworthy, even though no specific individuals would be worse off. Non-identity appeared to play a minor role in participants’ moral decision-making. Moreover, participants seem to either misunderstand the non-identity problem, or hold non-counterfactual views of harm that do not define harm as making someone worse off than they would have been otherwise. (shrink)

This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particular to the COVID-19 pandemic. We concentrate in this article on vaccines and ventilators because (...) these are both highly scarce resources in the pandemic, and there has been a need to develop policies for allocating them. However, as will become clear, the ethical considerations relating to them may diverge. We first set out two rationales for AAs and what they might entail in a healthcare setting. We then consider some disanalogies between AA and AARA, as well as the different implications of AARA for allocating ventilators as opposed to vaccines. Finally, we consider some of the practical ways in which AARA could be implemented, and conclude by responding to some key objections. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionSpatial, Environmental, and Ecocritical Approaches to Holocaust MemoryEmily-Rose Baker (bio), Michael Holden (bio), Diane Otosaka (bio), Sue Vice (bio), and Dominic Williams (bio)The successful implementation of genocide during the Holocaust depended on the spatial organisation of mass murder. From the concentrated ghettos and camps delimited by walls and barbed wire to the open fields and camouflaged forests where victims were shot en masse, Anne Kelly Knowles et al. (...) argue, specific locations, patterns of migration, deportation and evacuation, and other spatial elements such as scale, were all central to the Nazi regime's creation of a "comprehensive geography of oppression."1 This is hardly surprising given the biopolitical logics and colonial fantasies underpinning Lebensraum ('living space'), the territorial concept guiding the genocidal aims of the Third Reich, which designated zones of life as well as the inverse on the European continent. The Holocaust was also experienced spatially by its victims, who were forced to navigate new (and at times familiar) sites and landscapes as those of genocide, and whose testimonies in the aftermath of the event conjured these very places in detail.In recent years, the spaces of the Holocaust have been variously revisited, reconstructed, and reimagined within Holocaust studies scholarship. As a broader part of the 'spatial turn' in the humanities, Holocaust scholars have increasingly employed spatial perspectives of the event to deepen our understanding of the environments in which the Holocaust took place and the transformation of these spaces over time—particularly in the fields of history and social science.2 While drawing on diverse modes of spatialisation from interdisciplinary perspectives, contributions from these fields have tended to privilege methods we might describe as variously 'forensic,' including mapping, model-making, and investigations of material traces of the past.3 This work has resulted in many significant insights, not only into the [End Page 1] contexts and structures of Nazi genocide and the perpetrator imaginings of space, but also the experiences of victims and survivors.4Another significant body of work has attended to space and culture within Holocaust contexts. From early on in the postwar period, particular locations and buildings became identified with the Holocaust, such as the notorious entrance guard house at Auschwitz-Birkenau, which appears on countless book covers as well as within films and artworks. Engaging with spatial insights and methodologies from the perspective of cultural and memory studies, scholars have attested to the production and mnemonic significance of these and less well-known sites, as well as the symbolic spatial worlds and experiences to which they give rise. These include Paul Jaskot and Gavriel Rosenfeld, who have turned respectively to Holocaust and post-Holocaust architectures as commonly overlooked sites of history and memory. Drawing attention to the construction of Holocaust space, Jaskot shows how reading architecture 'as process' rather than static structures laden with symbolic meaning reveals unique histories of forced labor in which "the goals of the SS intersected with victims' experience."5 Rosenfeld demonstrates the ways in which spaces built in response to Nazi genocide after 1945 have been variously "imbued with Jewish significance" by their users and creators, resulting in the rise to prominence of Jewish-identified architects.6 Along similar lines, Michael Meng's work has explored the ways in which Jews and gentiles interact with ruined synagogues, cemeteries and Jewish districts as important remnants of pre-war Jewish life in the post-war period in German and Polish cities.7Studies such as those noted above have tended to focus on cities and public buildings, as well as state and civic policy. But as the spatial histories and geographies of the Holocaust have helped to show, extermination often took place in rural settings (mostly located in Central and Eastern Europe), such as the killing fields where Jews were shot en masse; the forests where victims hid and were hunted by Germans and local collaborators; or the open spaces of the dissolving Reich through which former concentration camp inmates were forced to march during the final year of the war—sites in which, owing to less contained spatial dynamics, violence played out differently.8These kinds of sites, which are sparsely documented and often simply thought of... (shrink)

What are the consequences of globalization for the structure of political conflicts in Western Europe? How are political conflicts organized and articulated in the twenty-first century? And how does the transformation of territorial boundaries affect the scope and content of political conflicts? This book sets out to answer these questions by analyzing the results of a study of national and European electoral campaigns, protest events and public debates in six West European countries. While the mobilization of the losers in the (...) processes of globalization by new right populist parties is seen to be the driving force of the restructuring of West European politics, the book goes beyond party politics. It attempts to show how the cleavage coalitions that are shaping up under the impact of globalization extend to state actors, interest groups and social movement organizations, and how the new conflicts are framed by the various actors involved. (shrink)

We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric considerations she helpfully raises and fruitfully discusses. We also agree with Williams about the (...) need to provide a clear rationale for mandates, and to obtain different kinds of data in support of possible policies.Unfortunately, we lack the space to engage with every one of the more critical comments raised in this rich set of commentaries; as such, in this response, we shall focus on a discussion of hybrid immunity, which underlies a number of different arguments evident in the commentaries, before concluding with some reflections responding to Lipsitch’s concern about the appropriate standard of proof in this context. (shrink)

Many factors complicate the education of urban students. Among them have been issues related to population density; racial, ethnic, cultural, and linguistic diversity; poverty; racism ; and funding levels. Although urban educators have been addressing these issues for decades, placing them under the umbrella of "urban education" and treating them as a specific area of practice and inquiry is relatively recent. Despite the wide adoption of the term a consensus about its meaning exists at only the broadest of levels. In (...) short, urban education remains an ill-defined concept. This comprehensive volume addresses this definitional challenge and provides a 3-part conceptual model in which the achievement of equity for all -- regardless of race, gender, or ethnicity – is an ideal that is central to urban education. The model also posits that effective urban education requires attention to the three central issues that confronts all education systems _accountability_ of individuals and the institutions in which they work, _leadership_, which occurs in multiple ways and at multiple levels, and _learning_, which is the raison d'être of education. Just as a three-legged stool would fall if any one leg were weak or missing, each of these areas is essential to effective urban education and affects the others. (shrink)

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced (...) and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in (...) the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)

Health, Disease, and Illness brings together a sterling list of classic and contemporary thinkers to examine the history, state, and future of ever-changing "concepts" in medicine.

Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are the (...) limits to this decision-making authority? In particular, can they refuse treatment that might be considered best for the infant? We examine different ethical arguments to underpin parental decision-making authority; we argue that provided that minor parents are capable of fulfilling their parental duties, they should have a right to make medical decisions for their infant. We then examine the ethical limits to minor parents’ decision-making authority for their children. We argue that the restricted authority that teenagers are granted to make medical decisions for themselves looks very similar to the restricted autonomy of all parents. That is, they are permitted to make choices, but not harmful choices. Like all parents, minor parents must not abuse or neglect their children and must also promote their welfare. They have a moral right to make medical decisions for their infants within the same ‘zone of parental discretion’ that applies to adult parents. We conclude that adult and minor parents should have comparable decision-making authority for their infants. (shrink)

Nominal terms extend first-order terms with binding. They lack some properties of first- and higher-order terms: Terms must be reasoned about in a context of ‘freshness assumptions’; it is not always possible to ‘choose a fresh variable symbol’ for a nominal term; it is not always possible to ‘α-convert a bound variable symbol’ or to ‘quotient by α-equivalence’; the notion of unifier is not based just on substitution.Permissive nominal terms closely resemble nominal terms but they recover these properties, and in (...) particular the ‘always fresh’ and ‘always rename’ properties. In the permissive world, freshness contexts are elided, equality is fixed, and the notion of unifier is based on substitution alone rather than on nominal terms’ notion of unification based on substitution plus extra freshness conditions.We prove that expressivity is not lost moving to the permissive case and provide an injection of nominal terms unification problems and their solutions into permissive nominal terms problems and their solutions.We investigate the relation between permissive nominal unification and higher-order pattern unification. We show how to translate permissive nominal unification problems and solutions in a sound, complete, and optimal manner, in suitable senses which we make formal. (shrink)

Well-trained, competent therapists are crucial for safe and effective psychedelic-assisted therapy (PAT). The question whether PAT training programs should require aspiring therapists to undergo their own PAT—commonly referred to as “experiential training”—has received much attention within the field. In this article, we analyze the potential benefits of experiential training in PAT by applying the framework developed by Rolf Sandell et al. concerning the functions of any training therapy (the therapeutic, modeling, empathic, persuasive, and theoretical functions). We then explore six key (...) domains in which risks could arise through mandatory experiential training: physical and psychological risks; negative impact on therapeutic skill; justice, equity, diversity, and inclusion; dual relationships; privacy and confidentiality; and undue pressure. Ultimately, we argue that experiential training in PAT should not be mandatory. Because many PAT training programs already incorporate experiential training methods, our exploration of potential harms and benefits may be used to generate comprehensive risk-mitigation strategies. (shrink)

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, (...) and what are the virtues that are likely to promote and sustain them? -/- Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. -/- Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. -/- Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice. (shrink)

Background: Allocation of scarce organs for transplantation is ethically challenging. Artificial intelligence (AI) has been proposed to assist in liver allocation, however the ethics of this remains unexplored and the view of the public unknown. The aim of this paper was to assess public attitudes on whether AI should be used in liver allocation and how it should be implemented. Methods: We first introduce some potential ethical issues concerning AI in liver allocation, before analysing a pilot survey including online responses (...) from 172 UK laypeople, recruited through Prolific Academic. Findings: Most participants found AI in liver allocation acceptable (69.2%) and would not be less likely to donate their organs if AI was used in allocation (72.7%). Respondents thought AI was more likely to be consistent and less biased compared to humans, although were concerned about the “dehumanisation of healthcare” and whether AI could consider important nuances in allocation decisions. Participants valued accuracy, impartiality, and consistency in a decision-maker, more than interpretability and empathy. Respondents were split on whether AI should be trained on previous decisions or programmed with specific objectives. Whether allocation decisions were made by transplant committee or AI, participants valued consideration of urgency, survival likelihood, life years gained, age, future medication compliance, quality of life, future alcohol use and past alcohol use. On the other hand, the majority thought the following factors were not relevant to prioritisation: past crime, future crime, future societal contribution, social disadvantage, and gender. Conclusions: There are good reasons to use AI in liver allocation, and our sample of participants appeared to support its use. If confirmed, this support would give democratic legitimacy to the use of AI in this context and reduce the risk that donation rates could be affected negatively. Our findings on specific ethical concerns also identify potential expectations and reservations laypeople have regarding AI in this area, which can inform how AI in liver allocation could be best implemented. (shrink)

In recent years, a dramatic increase in the study of infrastructure has occurred in the social sciences and humanities, following upon foundational work in the physical sciences, architecture, planning, information science, and engineering. This article, authored by a multidisciplinary group of scholars, probes the generative potential of infrastructure at this historical juncture. Accounting for the conceptual and material capacities of infrastructure, the article argues for the importance of paradox in understanding infrastructure. Thematically the article is organized around three key points (...) that speak to the study of infrastructure: ruin, retrofit, and risk. The first paradox of infrastructure, ruin, suggests that even as infrastructure is generative, it degenerates. A second paradox is found in retrofit, an apparent ontological oxymoron that attempts to bridge temporality from the present to the future and yet ultimately reveals that infrastructural solidity, in material and symbolic terms, is more apparent than actual. Finally, a third paradox of infrastructure, risk, demonstrates that while a key purpose of infrastructure is to mitigate risk, it also involves new risks as it comes to fruition. The article concludes with a series of suggestions and provocations to view the study of infrastructure in more contingent and paradoxical forms. (shrink)

This book theorises technology and its host of social, material, and epistemic transformation techniques, tools, and methods as indeterminate through sixteen methodologically diverse contributions from media philosophy, art and architectural theory, mathematics, computer science, and anthropology scholars.

This paper critically examines traditional rule-based and externalist approaches to the teaching of business ethics. The review materializes in a framework of seven pitfalls associated with the traditional approach, and bridges to overcome these perils are offered. Care is taken to avoid submitting the implausible positions of moral relativism. A perspective of methodological pluralism and normative internalism is developed and presented as a fruitful avenue for effective teaching in business ethics, and possible avenues for empirical exploration are offered.