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)

Daniel Sulmasy has recently argued that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences. The only constraints Sulmasy believes we should place on physicians’ discretionary space are those defined by a form of tolerance he derives from Locke whereby people can publicly act in accordance with their personal religious and moral beliefs as long as their actions are not destructive to society. Sulmasy also claims that those who would reject physicians’ (...) right to conscientious objection eliminate discretionary space thus undermining good medicine and unnecessarily limiting religious freedom. I argue that, although Sulmasy is correct that some discretionary space is necessary for good medicine, he is wrong in thinking that proscribing conscientious objection entails eliminating discretionary space. I illustrate this using Julian Savulescu and Udo Schuklenk’s system for restricting conscientious objections as a counter-example. I then argue that a narrow discretionary space constrained by professional ideals will promote good medicine better than Sulmasy’s wider discretionary space constrained by his conception of tolerance. Sulmasy’s version of discretionary space would have us tolerate actions that are at odds with aspects of good medicine, including aspects that Sulmasy himself explicitly values, such as fiduciary duty. Therefore, if we want the degree of religious freedom in the public sphere that Sulmasy favours then we must decide whether it is worth the cost to the healthcare system. (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)

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)

On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances (...) of clinical care which are non-doxastic and non-deceptive. Inasmuch as this is true, better understanding of non-doxastic attitudes, such as hope and pretence, could improve our understanding of deception in clinical practice. (shrink)

Infertility is recognized as a major problem of modern society. Assisted Reproductive Technology is the one of many available treatment options to cure infertility. However, the efficiency of the ART treatment is still inadequate. Therefore, the procedure’s quality is constantly improving and there is a need to determine statistical predictors as well as contributing factors to the successful treatment. There is a concern over the application of adequate statistical analysis to clinical data: should classic statistical methods be used or would (...) it be more appropriate to apply advanced data mining technologies? By comparing two statistical models, Multivariable Logistic Regression analysis and Artificial Neural Network it has been demonstrated that Multivariable Logistic Regression analysis is more suitable for theoretical interest but the Artificial Neural Network method is more useful in clinical prediction. (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)

The aim of this article was to prepare a basis for further quantitative research concerning the nutritional knowledge of medical professionals (doctors) and dieticians in view of the accuracy of dietary recommendations given to patients. For this purpose, a review of literature data in this area was performed and logical fallacies were proposed as the ‘tool’ that doctors rely on in cases when they lack the proper knowledge required to be able give an informed and beneficial recommendation. In the course (...) of the study, it was found that nutritional education is neglected in medical curricula, while dieticians are underused as professionals in clinical settings. Furthermore, numerous characteristics of the medical profession and the doctor–patient relationship are conducive to committing several types of logical fallacies, prompted mainly by the need for providing advice without delay and the infallibility traditionally expected from doctors. Hence, the gaps in nutritional knowledge and the fallacious character of recommendations, in addition to the re-valuation of the role of the nutritionist, need to be further investigated in order to improve the quality of patient advice in the area of dietary requirements as well as to propose the necessary changes in curricula. (shrink)

Addiction involves a chronic deficit in self-governance that treatment aims to restore. We draw on our interviews with addicted people to argue that addiction is, in part, a problem of self-narrative change. Over time, agents come to strongly identify with the aspects of their self-narratives that are consistently verified by others. When addiction self-narratives become established, they shape the addicted person’s experience, plans, and expectations so that pathways to recovery appear implausible and feel alien. Therefore, the agent may prefer to (...) enact her disvalued self-narrative because at least it represents who she takes herself to be. To recover, the agent needs to conduct narrative work, adjusting her existing self-narrative so that it better supports recovery-directed narrative projections. Reducing cravings, managing withdrawals, increasing self-control, and developing goals are all important for recovery but those approaches will often be in vain if the influence of self-narrative is ignored. If our analysis is correct, addiction treatment will typically be more effective if it incorporates support for self-narrative change. (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.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case—what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (...) (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable. (shrink)

At Swim, Two Boys, a 2001 novel by Jamie O’Neill, tells a story of gay teen romance in the wake of the Easter Rising. This paper considers the ways in which the characters engage in patterns of masculine behaviour in a context that excludes queer men, and the rhetorical effect of transgressive strategies to form a coherent identity. These patterns include involvement with the masculine and heteronormative nationalist movement, as well as a regime of physical exercise, and a religious upbringing (...) in 20th-century Ireland. The strategies of broadening the practices of masculinity include their renegotiation and redefinition, as well as attempts to construct the Irish and the gay canons of history and literature. These strategies, as exemplified by character development, become a rhetorical basis for the novel’s main argument for inclusiveness. This analysis deals with the central metaphors of space and continuity in the novel in the light of a struggle between identities. It also observes the tradition of parallels drawn between the emasculated position of the gay man and the Irish man at the beginning of the 20th century, and O’Neill’s rhetorical deployment of the shared telos in construction of a coherent gay Irish revolutionary identity. (shrink)

Infertility is a global problem affecting 48 to 186 million couples of reproductive age. In Poland, it concerns approx. 1.5 million couples, which amounts to 20% of the population capable of reproducing. One of the factors influencing the incidence of fertility disorders may be lifestyle, understood as a multi-disciplinary accumulation of everyday behaviours and habits. In the study, a group of 201 young adults, students of medical and related faculties, were surveyed in order to check the actual level of knowledge (...) about the impact of lifestyle on reproductive health. The Kohonen network, which is an example of a self-learning neural network, was used to find non-obvious connections between the data. The trained Kohonen neural network formed 4 clusters with different characteristics. Based on analyses of the structure of each cluster, it was found that 2nd year students of Medicine are internally divided into 3 fractions. The first fraction declared a high level of knowledge, but did not have real knowledge. The second fraction was aware of their ignorance, as confirmed by the knowledge test. The last fraction was characterized by a high level of self-confidence regarding their knowledge about reproductive health and obtained a high result in the knowledge test. It was confirmed that people studying at the Medical faculty know more than students of the same year at faculties other than Medicine. Interesting results were obtained for a group of 3rd year students of first-cycle studies in Dietetics. They did not obtain a significantly better result in the knowledge test concerning the influence of diet and lifestyle on reproductive health. It would seem that one could expect at least a few highly knowledgeable students in a group of 3rd year students, but this was not confirmed by the study. In view of the obtained results, it was concluded that the Kohonen neural network is applicable to the analysis of data on the actual state of knowledge about the impact of lifestyle on reproductive health. (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)

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.

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 rich exhibition of Minnesota’s beloved libraries, with stunning photographs by the popular Doug Ohman and library stories by seven of Minnesota’s best-known writers of books for children and young adults.

This full-color guide explains how to get better photos from an SL1. Written by professional photographer Doug Sahlin, this book explains the camera?s controls and shooting modes.

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)

Cognitive Science, Volume 46, Issue 7, July 2022.

It is common to think of medical and ethical modes of thought as different in kind. In such terms, some clinical situations are made more complicated by an additional ethical component. Against this picture, we propose that medical and ethical modes of thought are not different in kind, but merely different aspects of what it means to be human. We further propose that clinicians are uniquely positioned to synthesise these two aspects without prior knowledge of philosophical ethics.

Many different versions of cultural studies have emerged in the past decades. While during its dramatic period of global expansion in the 1980s and 1990s, cultural studies was often identified with...

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)

Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that (...) healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships. (shrink)

In this paper, we explicate the method of Investigative Ordinary Language Philosophy (IOLP). The term was coined by John Cook to describe the unique philosophical approach of Frank Ebersole. We argue that (i) IOLP is an overlooked yet valuable philosophical method grounded in our everyday experiences and concerns; and (ii) as such, Frank Ebersole is an important but neglected figure in the history of ordinary language philosophy.

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.

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)

We conducted and analyzed qualitative interviews with 12 persons working on the Healthy Public Housing Initiative in Boston, Massachusetts in 2001. Our goal was to generate ideas and themes related to the ethics of the community-based participatory research in which they were engaged. Specifically, we wanted to see if we found themes that differed from conventional research that is based on an individualistic ethics. There were clearly distinct ethical issues raised with respect to projects and individuals who engage in community-based (...) collaborations. The differences that arose from the interviews were seeking equality between the partners, the need for the community partner to defend the community, dealing with unflattering data, meeting community expectations and producing tangible benefits to the community. (shrink)

On the mainstream view, consciences are valuable because they promote moral unity. However, conscience, so defined, will systematically prevent moral growth that threatens unity, even when unity has formed around oppressive moral values. This motivates Carolyn McLeod's alternative ‘Dynamic View’ whereby consciences are valuable to the extent that they are dynamic. Consciences are dynamic when they interact with our best moral judgements to shape or ‘retool’ the moral values underpinning conscience, sometimes at an initial cost to unity. We modify and (...) extend McLeod's account in two ways: (1) We object to her claim that conscience encourages its own retooling. We argue that the opposite is true – conscience creates a motivational barrier to change that moral judgement must overcome to successfully retool conscience. The task of ensuring dynamism, therefore, falls to moral judgement. (2) However, this motivational barrier enables conscience to play a valuable role that McLeod overlooks – compensating for the limitations of moral judgement. On our Balanced View, the value of conscience depends on it being sufficiently open to being shaped by our best moral judgements but inert enough to compensate for distorted moral judgements and to guide action when under cognitive load. (shrink)

Drawing on Charles Peirce’s descriptions of his correspondence course on the “Art of Reasoning,” I argue that Peirce believed that the study of logic stands at the center of a liberal arts education. However, Peirce’s notion of logic included much more than the traditional accounts of deduction and syllogistic reasoning. He believed that the art of reasoning required a study of both abductive and inductive inference as well the practice of observation and imagination. Employing these other features of logic, his (...) course foreshadowed a number of developments in twentieth century educational theory: the belief that non-traditional students should be educated, the claim that the art of reasoning was important to all theoretical practices, and that the art of reasoning was important to the overall growth of a person. The upshot is that Peirce’s course in the art of reasoning should make us reconsider making logic courses, under Peirce’s broad conception of logic, required courses in high school and higher education. (shrink)

Family Drug and Alcohol Courts (FDAC) were introduced to England in 2008 following their development in the USA. Pilots launched across the country adopted a family-based strategy with the aim to improve outcomes for children that live with parents who misuse substances or alcohol. The numbers of children entering the care system has increased with ‘subsequent new borns’ being a particular concern frequently becoming ‘looked after’ by the state at birth. This article will focus upon an initial phase of a (...) study that tracked the establishment of an FDAC pilot. It reveals how the FDAC team collaborated with Judges and a diversity of professionals and parents to create conditions through which ground-breaking practice was forged. The environment created is unique as it is one fully set within the context of each family’s lived experience. Through this approach parents have become full participants in court proceedings as opposed to purely subject to them. As a result, significant numbers of children have remained with or been returned to their families. (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)

With AIDS increasingly recognized as a potentially devastating disease, no concensus has emerged in the media about such AIDS?coverage questions as use of names of AIDS victims, whether cause of death of AIDS victims should be reported and what moral limitations should restrict AIDS coverage. A study of AIDS coverage in two major newspapers and two news magazines in 1987 identify weaknesses in current coverage of the AIDS phenomenon and suggests guidelines for ethical reporting ? servicing the greater good without (...) violating the integrity of victims. (shrink)