The discourse of best interests misdirects attention from the real problem of grasping the implications of particular relationships in particular cases.

Elizabeth Schechter explores the implications of the experience of people who have had the pathway between the two hemispheres of their brain severed, and argues that there are in fact two minds, subjects of experience, and intentional agents inside each split-brain human being: right and left. But each split-brain subject is still one of us.

This is the text of The Lindley Lecture for 2014, given by Elizabeth Anderson, an American philosopher.

This paper argues that abortion access is an important subject for bioethics scholarship and reflects on the relationship between legal frameworks and access to care. The author uses the example of the United Kingdom to examine the benefits and limitations of abortion-permissive legal frameworks in terms of access. These are legal frameworks that enable the provision of abortion but subject to restrictions. An abortion-permissive regime—first in Great Britain and then in Northern Ireland—has gone some way to improving access to care (...) over time. However, aspects of the regime (that lead to its description as permissive rather than supportive of abortion) have the potential to endanger abortion access in the future and so legal reform is necessary. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Microaggressions in Medicine:Narratives, Trauma, and SilenceElizabeth Lanphier (bio)Lauren Freeman and Heather Stewart (2024) have written a richly researched and argued, while also highly engaging and accessible, book with Microaggressions in Medicine. They argue for why microaggressions are best understood on a harm-based account and situate this view within timely examples from a range of healthcare experiences. In their view, focusing on the harms produced by microaggressions shifts the locus (...) of concern from the agent committing a microaggression to the agent receiving it, and it enables an attribution of a microaggression regardless of an agent's intent or even awareness.Freeman and Stewart leave the reader with an expanded understanding of what microaggressions are and how they function. They also offer concrete and actionable suggestions for how healthcare environments and healthcare providers can work to prevent patients from receiving microaggressions in clinical care. Thinking alongside this book, I raise three points intended to further a conversation. The first is about narrative medicine as an additional resource. The second is the possibility for trauma-informed care to address background structural conditions that were beyond the book's scope. The third is to briefly inquire about whether this harm-based account could characterize certain cases of individual and institutional silence as a microaggression.1. Narrative medicineFreeman and Stewart situate their book within the philosophical literature on epistemic injustice, social justice, and feminist theory. So, it is not necessarily surprising that they only mention "narrative medicine," a term coined by Rita Charon (2001) about twenty-five years ago, in passing. They do cite core narrative medicine literature, including Sayantani DasGupta's (2008) account of "narrative humility," Arthur Frank's (1995) book The Wounded Storyteller, and a paper on listening to patient stories (Goldie 2011) in their recommendations and resources for mitigating microaggressions. When they do reference narrative [End Page 163] medicine, it is to suggest that "attending to the identities of patients ought to be more widely recognized as constitutive of good care" (Freeman and Stewart 2024, 182). But beyond illustrating the caring capacities of compassionate and skilled clinicians, narrative medicine offers a potential roadmap for how to get there.What I have elsewhere called a "technical definition of narrative medicine" (Lanphier 2021, 2024) is the narrative medicine methodology of close reading and reflective writing intended to produce three aims: attention (to texts or story), representation (trying to see the perspective of a story), and affiliation (partnering with a story's teller in a solidaristic way). This technical understanding of narrative medicine provides a method for developing skills of "ethical listening" and "medical humility" that Freeman and Stewart recommend. It also affords a structured form of training and practice that institutions can support to better enable healthcare workers to implement individual and environmental correctives to address microaggressions.Although narrative medicine is a resource poised to counter and respond to the very kinds of failures of listening, epistemic injustices, and quick assumptions with which Freeman and Stewart are concerned, narrative practices are not necessarily a fix for epistemic failures or bias. They also run their own risks, including narrative presumptions (Lanphier and Anani 2019), or narrative neglect (Saulnier 2020). Moreover, while the potential exists to scale narrative medicine through structured learning opportunities and broader institutional support, it primarily remains a tool for individual edification and enactment, not systems change.2. Trauma-informed careFreeman and Stewart (2024) describe how "microaggressions occur at the individual level and can be perpetrated by individuals, environments, or institutions" but that "ultimately, they are manifestations or symptoms of structural-level problems. Regardless of the level on which they occur, microaggressions always happen against the backdrop of social and structural oppression" (12). As other commentators point out, the authors recommend correctives primarily at individual and environmental levels (i.e., changing individual behaviors, making small modifications to clinical environments). Freeman and Stewart understand the limits of this scope, saying, "[W]e are well aware that such individual-level fixes can only ever take us so far and that they alone will never dismantle the oppressive structures themselves" (13). It is reasonable to identify achievable individual actions for the "unjust meantime" (Jaggar 2019) concurrent with social and structural... (shrink)

Over the past one hundred years, Catholic sexual ethics has become more hospitable to sexual bonding as a good that is distinct from procreation. However, our increasing knowledge of women’s sexual pain disorders highlights ongoing problems with official Catholic sexual ethics. This essay argues that the Catholic Church still reproduces gendered social scripts that unwittingly encourage heterosexual women to ignore their sexual pain and continue to engage desperately in intercourse, out of an exacerbated concern to satisfy male partners. These are (...) tactics that only prolong and deepen women’s sexual suffering. Further, insights about the various options for women’s healing from sexual pain concretely suggest more liberative sexual scripts: the importance of women’s non‐obligatory, embodied desire and the need to reject intercourse as the compulsory norm for all sexual activity. Ultimately, women’s experiences of having sexual pain and healing from it lead to revisions in Catholic sexual ethics at a fundamental level. (shrink)

The human rights that are enshrined in most western democracies are based on enlightenment ideals of freedom, equality, and justice. Although these core principles are inspirational, their application has not necessarily been equitable or complete enough to provide for the stability, safety, health, and security of all citizens. A more modern understanding of human rights encompasses that which is needed to establish human flourishing, including guaranteed access to water, particularly the clean water provided by adequate sanitation. Without confidence in broad (...) safety and health, and established norms for individual protections, it is difficult for a society to be stable and flourish. Although this argument begins with political philosophy, it ends with a case study in Alabama, one of the poorest states in the United States. This study evaluates the dysfunction caused to local communities and greater society when governmental organizations fail to provide sanitation and guarantee public health for their communities. (shrink)

This paper responds to a proposal for an intersectional approach to the clinical encounter between patient and medical provider. We agree that an intersectional framework offers new insights and information in the clinical encounter. Intersectionality involves awareness of the physician-patient dynamic, and understanding the various privileges and disadvantages of all parties involved, at a micro and macroscopic level. Yet, this analysis alone is insufficient to aid in the clinical encounter and risks harm. We worry about a clinician making assumptions about (...) her patient’s race, gender, economic status, and how these influence the patient’s own views of her life and health. We argue that a narrative supplement is a necessary element of intersectional clinical encounters. Prioritizing patient narrative curtails assumptions, builds trust, and improves care. (shrink)

In reconsidering the question of sexual difference, Weed offers a fresh perspective on what is at stake for critical reading in the neoliberal university.

I begin by examining the answer to a traditional puzzle concerning supererogatory acts: if they are good to do, why are they not required? The answer often given is that they are optional acts because they cost the agent too much. This view has parallels with the traditional view of religious sacrifice, which involves offering up something or someone valuable as a gift or victim and experiencing a ‘cost’ as part of the ritual. There are problems with the idea that (...) costs justify the optional nature of supererogatory acts, however, and I suggest that these problems mirror the tensions that are found in Christian theology when a traditional view of sacrifice is adopted. (shrink)

Are Detroit ruin tours a form of morally permissible cultural tourism, or do these tours amount to a form of exploitation? To answer this question I compare Detroit ruin tours with ‘slum tours’ – guided tours of slums in the world's major cities. I argue that exploitation of the sort we find in slum tourism also exists, to a lesser extent, in Detroit ruin tours. To show this I detail two different accounts of exploitation and argue that Ruth Sample's account (...) best captures what is most morally problematic with slum tours and ruin tours. I then identify the similarities and differences between slum tours and ruin tours, and provide suggestions for how ruin tours could be retooled to avoid some of the worries of exploitation. Finally, I suggest that with the proper framing Detroiters could embrace photographic tours as a new form of cultural tourism. (shrink)

Volume 20, Issue 8, August 2020, Page 76-78.

In a controlled laboratory experiment, we found evidence for our predictions that participants who received fair distributive treatment were more likely to lie to give a supervisor a good performance evaluation than those treated unfairly, and those who received unfair distributive treatment were more likely to steal money from a supervisor than those treated fairly. We further proposed that the presence of an ethical code of conduct would moderate these relationships such that when the code was present these relationships would (...) be weaker than when the code was absent, but we failed to find support for these moderating effects. Our findings suggest that the relationship between distributive justice and unethical behavior is likely more complex than previously considered. Both researchers and managers may benefit from a broader understanding of the factors that motivate and inhibit unethical behaviors intended to benefit and harm supervisors and/or organizations. (shrink)

Kim (1998) has argued that a genuine robust physicalism does not leave any room for real, causally efficacious mental properties. Despite all of his concerns about the reality and causal efficacy of mental phenomena Kim does not eliminate all higher-level macro causation. Kim’s problem with the mental is that most current cognitive theories imply that the mind is not higher-level but higher-order. In this paper I argue that connectionism makes meaning higher-level and therefore by Kim’s own standards puts meaning on (...) the same footing as other real causally efficacious higher-level properties. The upshot is that we can side-step the current debate about mental causation by moving the mind to the shared uncontroversially real and physical common-ground. (shrink)

I argue for a conception of moral community as “ethical home,” in which home is a hybrid public and private concept, cohered through members’ complicit participation in the formation and endorsement of the community’s values and practices. In this essay I present and defend three premises that comprise my argument for this conception of moral community as an ethical home. First, I make a case for why “home” is an apt conception of moral community, defining the features of home relevant (...) to my claim, and clarifying which connotations of home I am abandoning by modifying home to be an “ethical” home. Second, I illustrate how when the concept of moral community is conceptualized as an ethical home, it is formed and defined by a community’s practices of moral self-definition, that occur within the ethical home-making process. Third, I claim that the process of ethical home-making, through moral self-definition around cohering values and practices, renders members of an ethical home as both rights holders within the ethical home, and as having shared responsibility for their fellow ethical home members. (shrink)

Background: Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers’ perceptions and attitudes, as well as facility policies. Objective: This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient autonomy (...) in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population. Research Design: The focus is on residents with early to moderate dementia in states of daily dependency on professional caregivers. The article critically examines existing empirical research on sexuality among persons with dementia, caregivers’ attitudes, and institutional roadblocks to enabling residents’ sexuality. A relational lens and insights from disability studies are used in the philosophical analysis. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and normative framework only. Findings: The analysis highlights the delicate balance that capacity assessments for sexual activity have to strike; while caregivers should protect those who cannot give adequate consent, the denial of sexuality among residents can cause deep, long-ranging harms. Sexual agency features into an ongoing sense of self for many individuals with dementia, and the imposition of inappropriate standards and expectations for sexual autonomy can lead to unwarranted obstacles to sexual activity. Discussion: Recommendations include developing clear and inclusive institutional policies and practices of care, providing education for caregivers on how to discuss and document residents’ sexual preferences over time, and taking advantage of ethics consultation services. Conclusion: This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities. (shrink)

The number of cesarean sections performed globally has been consistently rising since the 1980s.1 The number of cesareans performed now greatly exceeds the number that experts predict are necessary.2 In Brazil, the world's "cesarean capital," over half of births are surgical. In the United States, approximately one third of babies are delivered by cesarean, and in the United Kingdom around 26 percent of births are by cesarean.3 Cesarean section can be a life-saving intervention when vaginal birth poses a risk to (...) woman or fetus.4 However, some doctors believe that cesareans performed in the absence of an emergency carry substantial risks for limited or no benefit (Wagner 2000... (shrink)

While many books on ethics contain a chapter discussing prisoners’ rights and the ethical dimensions of research involving incarcerated persons, Vulnerability and Incarceration is the first monograph devoted to the subject. Victor interrogates the concept of vulnerability to examine prisoners’ right to medical research from a novel point of view.

This interdisciplinary study of commitment draws on the disciplines of theology, philosophy, and psychology to demonstrate the importance of trust in midlife adulthood. It gives particular attention to the place of trust in resolving tensions surrounding commitments. Taking a relational perspective, this text addresses the various aspects of commitment as they affect the self, the community, and God. Several midlife people serve as test cases to illustrate the crucial role of trust for those who are called to reassess interpersonal commitments (...) at midlife. Contents: An Ethics of Trust; Marcel on Philosophy of Trust; Theology of Trust; Psychology of Trust; and An Ethics of Trust; Trust and Commitment in Adulthood. (shrink)

This article explores two central notions of ‘dialectics’ and ‘dialogics’ based on the work of Vygotsky and Bakhtin respectively, as well their varying interanimations within Stalin-Marxist Russian societyIt is proposed that these two positions are incommensurably located alongside one another in contemporary education. I argue that Bakhtin offers diametrically oppositional educational provocations to those of Vygotsky.The implications of these interpretations will be explored with consideration of their underlying philosophical incompatibilities and contradictions, as well as the opportunities such a consideration pose (...) for educational practice today. (shrink)

European Journal of Political Theory, Volume 21, Issue 3, Page 585-586, July 2022. Ayelet Shachar's lead essay in The Shifting Border draws out dramatic transformations of bordering practices currently taking place worldwide. These have yielded spatial relocations for bordering, a privatization of enforcement, and legal innovations that tie the border to individual people as they move, among many other changes. Shachar argues in favor of a form of reciprocity, in which states that shape shift their borders are also compelled to (...) recognize rights for people who require humanitarian assistance. In response, Shachar's interlocutors offer an array of reflections and friendly amendments. (shrink)

ABSTRACT To what extent, this article asks, does the drive to reconcile psychoanalysis with neuroscience risk participating in a movement of appropriation, an attempt to reduce the event of psychoanalysis? This article shows how the neuro-psychoanalytic attempt to locate a psychoanalytic understanding of the mind in the brain does not end up correlating psychoanalysis with neuroscience; rather, it points to another, less conciliatory model for their relationship. In psychoanalysis, neurology encounters a Fremdkörper, something unassimilable to its inside, something forever inside-outside (...) any neurological theory of trauma. This Fremdkörper prevents neurology from reducing neurological traumas to mere cerebral laws; it is what makes every neurological trauma traumatic in its own way. (shrink)

This study used two waves of the National Survey of Families and Households to examine the effect of the transition to parenthood on the division of labor among married couples, hypothesizing that parenthood would produce a more differentiated gender division of labor, but that attitudes and preparental division of labor would moderate parenthood. There were no effects of parenthood nor direct or moderating effects of gender attitudes on husbands' employment or housework hours, with the exception that fathering more than one (...) child results in slightly longer employment hours. Motherhood increases wives' housework hours and reduces employment hours. Wives' traditional gender attitudes reduce their employment, but not their housework. Women married to full-time breadwinners have the largest reductions in employment after motherhood. Last, wives' initial economic dependency increases wives' subsequent housework and husbands' employment. Parenthood crystallizes a gendered division of labor, largely by reshaping wives', not husbands', routine. (shrink)

In this work of sweeping erudition, one of our foremost historians of early Christianity considers a variety of theoretical critiques to examine the problems ...

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and (...) responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)