Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs (...) to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...) aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape thecontentof those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card (...) has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards. (shrink)

Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...) approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

In this paper I discuss the kinds of dependence relation that philosophers have argued may obtain between neural events and conscious events; between Ns and Cs. Three major candidate relations are constitution, realization, and identity. There are other candidates for the mind/body relation, but these will serve as the major options. Indeed, these are already more than three options, because philosophers do not agree on the best way to understand constitution; still less to understand realization. I argue that dispute is (...) not merely "metaphysical": each candidate has distinct empirical consequences. (shrink)

For Howard Gardner, Multiple Intelligences Theory (MI) constitutes “a new understanding of human nature,” on a par with those proffered by Socrates and Freud. While the educational community in general has responded enthusiastically to MI, because it enables them to deal with students more holistically, MI embeds a significant dualism that is detrimental to truly holistic education. I will argue that: values are pervasive; intelligence requires the exercise of judgment, which no computational system can emulate; domains in which intelligence functions (...) are contested, as much as in the realm of “values,” judgments about “values” are “intelligent” in seeking to determine what conditions will promote flourishing, and the more appropriate distinction to draw is not between two structural domains of “empirical fact” and “subjective value,” but between structural conditions and directional responses to these conditions. (shrink)

This paper examines neuroethics as a discipline in which ongoing formation and development in both ethics and medicine are shedding new light on the care of patients diagnosed as being in a vegetative state. From the perspective of the Catholic moral tradition, the author proposes that ethics and recent developments in functional neuroimaging form a complementary relationship that gives rise to an ethical imperative: because we can care for patients in a vegetative state, we should do so. This imperative for (...) care finds a particular expression in the ethical debate in light of the 2004 statement of Pope John Paul II that assisted nutrition and hydration for patients in a vegetative state should be considered, in principle, ordinary care. What do neurology and developments in scientific research teach us about patients in a vegetative state? Neuroethics is providing a unique opportunity for both medicine and ethics to discover more completely not only who we are as human beings but also how we should act. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 477–488. (shrink)

From the one-room chapel in a prairie town to the grandiose cathedral on a city street, churches stand at the heart of the Minnesota landscape.

Complex‐trait genetics has advanced dramatically through methods to estimate the heritability tagged by SNPs, both genome‐wide and in genomic regions of interest such as those defined by functional annotations. The models underlying many of these analyses are inadequate, and consequently many SNP‐heritability results published to date are inaccurate. Here, we review the modelling issues, both for analyses based on individual genotype data and association test statistics, highlighting the role of a low‐dimensional model for the heritability of each SNP. We use (...) state‐of‐art models to present updated results about how heritability is distributed with respect to functional annotations in the human genome, and how it varies with allele frequency, which can reflect purifying selection. Our results give finer detail to the picture that has emerged in recent years of complex trait heritability widely dispersed across the genome. Confounding due to population structure remains a problem that summary statistic analyses cannot reliably overcome. Also see the video abstract here: https://youtu.be/WC2u03V65MQ. (shrink)

Montaigne is generally portrayed either as a principal proponent of the mix of scepticism, neo-Stoicism and Tacitism that feeds the early-modern reason-of-state literature or as a thoroughgoing political moralist who rejects this literature's politics of necessity and princely deception in favour of a politics of classical or Christian virtue. I argue that Montaigne inhabits neither of these positions exclusively. Instead, he argues in utramque partem, both for and against reason of state, in order to educate > his readers about the (...) perils of following elites who would use either political necessity or religious moralism as pretexts for violence in pursuit of political gain. (shrink)

In The Time After, which references the process of photography as well as the future fate of our planet, fine arts photographer Doug Fogelson uses an iconoclastic multiple exposure technique in order to depict our collective surroundings, producing imagery that reflects our own alien experience of nature, as well as the distanced perspective of the viewer. This volume collects over 160 of Fogelson's spectacular images and pairs them with speculative and poetic essays by Derrick Jensen, Eiren Caffall, and Bridgette (...) R. McCullough. (shrink)

A charming survey of Minnesota's treasured getaways, with over 120 color photographs of cabins by Doug Ohman and witty prose by well-known writer Bill Holm.

Plato seems to have been pessimistic about how most people stand with regard to virtue. However, unlike the Stoics, he did not conclude that most people are vicious. Rather, as we know from discussions across several dialogues, he countenanced decent ethical conditions that fall short of genuine virtue, which he limited to the philosopher. Despite Plato's obvious interest in this issue, commentators rarely follow his lead by investigating in detail such conditions in the dialogues. When scholars do investigate what kind (...) of virtue, if any, Plato thinks is open to non-philosophers, they typically look to the Republic. But in the Republic Plato sets out an ideal city; therefore, the virtue available to non-philosophers there is likely different from what he thinks is available to them in the real world. If we want to determine Plato's thoughts about the virtue of actual non-philosophers, we must look elsewhere. In this paper, I set my sights on the Phaedo. (shrink)

In this nationwide study of American and Canadian journalists, I found that their moral and ethical values are solidly connected to the Judeo-Christian tradition, even among those who do not claim to be religiously oriented. This study shows that religious values are imbedded deeply, if not always consciously, in the moral and ethical values of journalists and that journalists of varying religious orientations tend to endorse a core group of moral and ethical principles at the heart of the religious heritage (...) of the United States and Canada. However, journalists have expanded their definition of what religion coverage means in an increasingly diverse and secular society, and few want to connect their professional values only with Christian teaching. (shrink)

© The Author 2017. Published by Oxford University Press on behalf of The Analysis Trust. All rights reserved. For Permissions, please email: [email protected] volume collects nine of Mark Schroeder’s essays on expressivism, two of which are previously unpublished, along with a substantial introduction that helpfully ties them all together.1 The essays work very nicely as a collection. They are mutually illuminating, and together they make a ‘cumulative case’ for a particular conclusion – namely, that expressivist theories are best understood in (...) terms of their ‘surprising and novel views’ about the nature of propositions and propositional attitudes. As Schroeder sees things, the most promising way for expressivists to develop their view is for them to ‘get over’ their hesitation about propositions and to embrace an expressivist-friendly account of what propositions are. This requires going beyond the ‘merely deflationary talk about propositions’ that is typically endorsed... (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)

Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms (...) of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections. (shrink)

Harold Shapiro, the former president of Princeton, ventured to say that theology had been divorced from the liberal. Professor Doug Dix's book is about arranging a remarriage. His analysis suggests the divorce goes deeper than Shapiro may have realized. Love has been divorced from learning because money has replaced truth as the object of affection. Now students learn to earn. Natural Literacy strives to motivate students and faculty to instead learn to love.

A full-color guide to the art of digital portrait photography Portrait photography entails taking posed photographs of individuals or set scenery and is the most common photo style among the most novice photography hobbyist to the most advanced photographer. With this easy-to-understand guide, bestselling author and professional photographer Doug Sahlin walks you through the best techniques for getting professional-quality digital portraits. Packed with hundreds of full-color photos and screen shots, this book discusses best practices for taking formal portraits, wedding (...) photos, event photos, casual photos, and more. You'll examine the difference between using the built-in flash and natural lighting and take a look at the benefits of upgrading to a photo lighting kit and pro backdrop. Portrait photography is the most popular style of photography Features helpful information for everyone from beginner hobbyists to advanced photographers Shares insider tips for selecting equipment and choosing from the various tools for portrait photography Walks you through working with a wide range of subjects, including children, pets, and wildlife Discusses lighting and editing images Takes a look at ways to create a portrait that is suitable for framing Make sure your subjects are ready for their close ups with this fun and friendly guide to digital portrait photography. (shrink)

I argue that Aristotle believes that virtue comes in degrees. After dispatching with initial concerns for the view, I argue that we should accept it because Aristotle conceives of heroic virtue as the highest degree of virtue. I support this interpretation of heroic virtue by considering and rejecting alternative readings, then showing that heroic virtue characterized as the highest degree of virtue is consistent with the doctrine of the mean.

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that co-authors can undermine autonomy (...) by contributing disvalued content to the agent’s self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship. (shrink)

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’ strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors’ strikes are morally permissible in a narrower range of circumstances than strikes in other sectors.We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to doctors’ (...) interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory. (shrink)

This publication discusses how modernist techniques for depicting characters' thoughts, feelings, and desires have been reinvented by some of the most influential and innovative writers of the postwar period, including Vladimir Nabokov, Samuel Beckett, Toni Morrison, John Banville, J.M. Coetzee, and Eimear McBride.

Various causal factors have been offered to explain the motives behind the Al-Qaeda terrorist attacs on 9/11 and at various other times and places throughout the world. Quite often the reasons or purposes are said to include political, economic, religious and ethnic factors. Often historical factors, such as colonialism and neo-colonialism, as well as nationalism, poverty, class divisions and modernization, are included. But some scholars and political figures, quite inconsistently at times, assert that there is no discernable purpose or purposes (...) in these attacks. It is argued, for example, that the sheer magnitude of the death and carnage in the 9/11 attacks suggests no rational purpose in the minds of the perpetrators. The implication is that the Al-Qaeda attacks are allegedly purely irrational. In contrast, I argue that there are flaws and inconsistencies with this No Purpose Theory, and that oil, moreover, shouldn’t be omitted from any plausible broad explanation of the complex mix of causal factors. Needless to say, to suggest that Al-Qaeda had reasons is not to suggest that the reasons were necessarily good or morally justifiable. Then again, among these reasons it is necessary to sort out the goals from the violent tactics so as to discover why, in particular, many Arabs and Muslims sympathize with some of the goals.This whole issue is important because, among other things, if the No Purpose Theory is assumed to be accurate, it would, at least for the problem at hand, eliminate from serious consideration in one fell swoop literally all of the other possible factors. This would be so in spite of the initial reasonableness of the notion that many of these factors have at least some weight or other. But if, contrary to what the No Purpose Theory says, items such as oil are shown to be actually causally important, and are consequently on the table for more extended and open discussion, then there at least would be a better opportunity for more successfully tackling these problems and ameliorating the risk of future terrorist attacks. At least so I will argue. (shrink)

Résumé: Dans ce dialogue, deux personnages principaux, Philopolis et Éleuthérios, proposent la position communautarienne et la position contractualiste libérale comme fondements de la théorie politique. Le débat se déroule, comme tout bon débat devrait le faire, autour d’une bouteille de Chardonnay.

The author uses an intersectionality framework to examine how lesbian, gay, bisexual, and transgender people evaluate the severity of their violent experiences. Previous research focusing on the severity of anti-LGBT violence has given relatively little attention to race, class, and gender as systems of power. In contrast, results from this study, based on 47 semi-structured, in-depth interviews, reveal that Black and Latino/latina respondents often perceived anti-queer violence as implying that they had negatively represented their racial communities, whereas white respondents typically (...) overlooked the racialized implications of their violent experiences. Furthermore, while lesbians of color emphasized their autonomy and self-sufficiency to challenge this discourse, Black and Latino gay men underscored their emotional and physical strength to undermine perceptions that they were weak for identifying as gay. Results also indicate that LGBT people experience forms of anti-queer violence in different ways depending on their social position, as Black lesbians faced discourse that neither white lesbians nor Black gay men were likely to confront. Thus, these findings suggest that topics primarily associated with homophobia should be examined through an intersectional lens. (shrink)

In the United States today, the use or possession of many drugs is a criminal offense. Can these criminal laws be justified? What are the best reasons to punish or not to punish drug users? These are the fundamental issues debated in this book by two prominent philosophers of law. Douglas Husak argues in favor of drug decriminalization, by clarifying the meaning of crucial terms, such as legalize, decriminalize, and drugs; and by identifying the standards by which alternative drug policies (...) should be assessed. He critically examines the reasons typically offered in favor of our current approach and explains why decriminalization is preferable. Peter de Marneffe argues against drug legalization, demonstrating why drug prohibition, especially the prohibition of heroin, is necessary to protect young people from self-destructive drug use. If the empirical assumptions of this argument are sound, he reasons, drug prohibition is perfectly compatible with our rights to liberty. (shrink)