The author introduces two key issues of the Ebola epidemic very clearly. However, the author could elaborate further on the objections to using experimental drugs. The author does a very good job of enumerating the reasons for using these drugs. In terms of reasons against using the drugs, the author only writes that there are regulations in place that are usually followed. Several supporting facts are given to suggest different regulations should be put in place for a crisis like Ebola. (...) Ebola is a deadly disease with no cure. At present, all we have are these experimental drugs. Ordinarily, such drugs would not be given without extensive testing. However, in this case, there is no time for that to be done. People who contract Ebola have no other alternatives, so an unapproved experimental treatment is better than nothing at all. It is important to weigh the risks and benefits. Some may argue that the risks of using an experimental drug may be too great and that we should wait to administer any experimental drug until it has been proven safe. We do not know what the long-term side effects may be. While that argument may be appropriate for other situations, in the case of Ebola epidemic, I do not think it applies. As I have said, and as the author has said, there is no cure or other treatment available for Ebola. People who contract it will likely die of the disease and these experimental treatments are their only option. In this case, the benefits outweigh the risks. As the author mentions, access to these drugs is very problematic. However, they do not elaborate enough on both sides of the issue. There are reasons supporting and reasons against giving health care workers experimental treatments first and I think including them would have added to the depth of the argument presented here. (shrink)

On October 29, 2013, Texas House Bill 2 went into effect, greatly changing women’s access to an abortion in the state. This bill requires that physicians performing clinic-based abortions obtain admitting privileges at a hospital within 30 miles of the clinic. A few months later, on January 1, 2014, the Texas Health and Safety Code was amended to include the requirement that all abortion clinics must meet the standards of an ambulatory surgical centre. These requirements will result in heavy burdens (...) for women seeking an abortion. Many clinics cannot afford the upgrade and are being forced to close down. On August 29, 2014, a Federal District Court for the Western District of Texas ruling to overturned the two proposed requirements. The court deemed them unconstitutional violations of a woman’s right to obtain an abortion recognizing that their purpose was to create obstacles for women. The ruling was appealed and the Federal Appeals Court allowed for the new regulations, forcing all but eight clinics in Texas to close their doors. Before the enactment of HB2, there were approximately 40 abortion clinics serving Texas’ population of about 26 million. The new regulations would force all except eight clinics to close down. The remaining clinics are located in four cities forcing many women to travel hundreds of miles to access them. For some, it is more feasible to leave Texas to go to an abortion clinic outside the state. Even if every woman seeking an abortion was able to travel to one of the remaining clinics, the clinics could not meet the demand. Both of these requirements, the ambulatory surgical requirement and the admitting privileges requirement, constitute an undue burden for women. But what about the physicians? These requirements also place an undue burden on physicians who want to perform abortions. For affected physicians, it is difficult or impossible to obtain admitting privileges at a nearby hospital. Many hospitals are denying these privileges to physicians because the hospitals have no interest in participating in performing abortions and gain nothing by allowing it. If the majority of abortion clinics are forced to close down, physicians who want to perform abortions would have to relocate to one of the four cities mentioned previously, or even leave the state. Women seeking an abortion have to travel to the clinic once or twice. Physicians would have to relocate permanently. Much of the focus of these rulings has been on women’s rights and what constitutes an undue burden for women. In addition to this, physician’s rights should also be considered. There have been several cases of doctors facing harassment and even death threats for performing abortions. Fear of such treatment has led to many doctors to decline to perform abortions. Doctors do not have an obligation to perform abortions but it is within their rights as physicians to do so. However, given this harsh treatment by anti-abortion groups, not a lot of doctors are willing. The new regulations will leave open clinics in four cities in Texas making it more difficult for those few doctors who want to perform abortions to do so. The new regulations impose undue burdens on women and doctors alike. On Tuesday, October 14, the Supreme Court struck down the new requirements allowing thirteen clinics in Texas to reopen. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Proclaimed the “greenest television programme in the world,” the award-winning soap opera Coronation Street is seen as an industry success story. This paper explores how the integration of carbon literacy training led to a widespread transformational change of practice within Coronation Street. Using the theoretical lens of Communities of Practice, this study examines the nature of social learning and the enablers and barriers to change within the organization. Specifically, how boundary spanning practices, objects and people led to the transformation on (...) both a personal and group level. Based on a qualitative analysis of 22 interviews with Heads of Departments and other staff, the paper argues that CLT is a boundary practice which has evolved into a boundary spanning CoP. The importance of infrastructures supporting boundary objects and practices is highlighted as reinforcers of the CLT, both as a boundary object and a community, with the “ultimate” boundary spanning object being the show. A significant enabler in social learning and change in practice is the creation of discursive and creative space, both within CoP and across the boundaries. Findings also highlight the role of “self” in the process of social learning and organizational change. Distinct patterns emerged in the relationship between self-identity, social learning and change across a range of boundary objects, practices and communities both in the CLT and CoP. This suggests that in a diverse social learning setting such as CLT there are different transformational catalysts within the CoP and these identities can influence how knowledge is translated into practice. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other (...) key informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

Kopeikin (forthcoming a, forthcoming b) and Rachels’ (1975) bare-difference cases elicit the intuition that killing is no different than letting die. Hill’s (2018) bare-difference cases elicit the intuition that killing is worse than letting die. At least one of the intuitions must be mistaken. This calls for an error theory. Hill has an error theory for the intuition elicited by the Kopeikin/Rachels’ cases. Kopeikin and Rachels have an error theory for the intuition elicited by Hill’s cases. A (...) natural thought is that we are at an impasse. There is no plausible basis for preferring one error theory to the other. I argue that this natural thought is mistaken. Not all error theories are equal. Preliminary considerations favor Hill’s error theory and disfavor the Kopeikin/Rachels error theory. But preliminary considerations are not decisive. The way forward in the bare-difference debate is not to evaluate intuitions. The intuitions are in. What is left to do now is evaluate the comparative status of the Hill and the Kopeikin/Rachels error theories. (shrink)

Este livro inclui as palestras apresentadas no XIII Congresso Internacional de Estética, ocorrido em Belo Horizonte em outubro de 2017, cujo título, “Os fins da arte”, explora o duplo sentido do termo “fim” que, polissêmico, indica término, conclusão e epílogo, assim como o propósito, a meta, o objetivo, a motivação, e ainda o limite e a decadência. O uso plural desse termo amplifica, ainda, suas possibilidades de interpretação. Os textos deste livro mostram de modo evidente o quanto a questão do (...) “fim” contribui de maneira estratégica para pensar a arte durante o último século e o início deste. O livro conta com textos dos filósofos e filósofas da arte Márcia Ferreira Gonçalves, Gunter Gebauer, Rosa Gabriella Gonçalves, Giorgia Cecchinato, Alessandro Bertinetto, Cliff Hill Kormann, Rodrigo Duarte, Rita Velloso e do filósofo francês David Lapoujade, um dos principais nomes da filosofia na atualidade. (shrink)

ABSTRACT Hill [AJP, 2018] argues that Rachels’s famous bare-difference argument for the moral irrelevance between killing and letting die fails. In this paper, I argue that certain features in Hill’s cases might lead our intuitions astray. I propose new cases and suggest that they support the conclusion that, in itself, intentional killing is morally equivalent to intentional letting-die.

A joke is amusing if and only if it’s fitting to be amused by it; an act is regrettable if and only if it’s fitting to regret it. Many philosophers accept these biconditionals and hold that analogous ones obtain between a wide range of additional evaluative properties and the fittingness of corresponding responses. Call these the _fit–value biconditionals_. The biconditionals give us a systematic way of recognizing the role of fit in our ethical practices; they also serve as the bedrock (...) of various metaethical projects, such as fitting-attitude analysis of value and the ‘fittingness first’ approach. Yet despite the importance of the biconditionals, there is very little discussion of their proper interpretation. This paper argues that any plausible interpretation of the fit_–_value biconditionals must disarm several kinds of apparent counterexample. For instance, that an achievement is pride-worthy doesn’t imply it is fitting for me to take pride in it because the achievement might not be mine or that of anyone close to me; that a joke is amusing doesn’t imply it is fitting for me to be amused by it for six straight months; and that a person is loveable doesn’t imply it is fitting for me to love him romantically because that person might be my sibling. We consider possible responses to such counterexamples and develop what we consider the most promising interpretation of the biconditionals. The upshot is that certain widespread assumptions about fit and its relation to value and reasons should be reconsidered. (shrink)

It is tempting to hold that guilt‐tripping is morally wrong, either because it is objectionably manipulative, or because it involves gratuitously aiming to make another person suffer, or both. In this article, I develop a picture of guilt according to which guilt is a type of pain that incorporates a commitment to its own justification on the basis of the subject's wrongdoing. This picture supports the hypothesis that feeling guilty is an especially efficient means for a wrongdoer to come to (...) more deeply understand why her behavior was wrong; it is precisely because guilt is painful and involves a self‐reflexive justificatory element that it is able to play this role. Such a picture, moreover, preserves the possibility that deliberately making others feel guilty needn't involve aiming gratuitously to harm them and needn't be objectionably manipulative. It follows that we should be surprisingly sanguine about the practice of inducing guilt in wrongdoers as a means of facilitating their moral edification. (shrink)

If funding allocation is an indicator of a field’s priorities, then the priorities of the field of bioethics are misaligned because they perpetuate injustice. Social justice mandates priority for the factors that drive systematic disadvantage, which tend not to be the areas supported by funding within academic bioethics. Current funding priorities violate social justice by overemphasizing technologies that aim to enhance the human condition without addressing underlying structural inequalities grounded in racism, and by deemphasizing areas of inquiry most frequently pursued (...) by Scholars of Color. This lack of attention to upstream determinants of health in bioethics research perpetuates a gap in the resources needed to understand the experiences of communities disproportionately experiencing poor health, which is itself a form of epistemic injustice. Both social and epistemic injustices are apparent in the impact of these funding priorities on people of color, both in the public and in the bioethics community. (shrink)

A major goal of this work is to specify some steps of the process by which participants maintain coherency in their conversations.The underlying element of the analysis is a construct called a “context space.” Roughly, a group of utterances that refers to a single issue or episode forms the basis for a context space. Superficially, a conversation is a sequence of utterances; at a deeper level it is a structured entity whose utterances can be parsed into hierarchically related context spaces.As (...) a conversation proceeds, each conversant builds a discourse model that includes the conversation's context space structure, a notion of the present discourse topic, and a list of items being focused upon. Conversational coherency depends upon a lack of conflict between the respective models of the participants. Conflicts are prevented by speakers following high level syntactic and semantic relational rules that enable listeners to identify their discourse models. These rules, given in the study, are highly integrated with the view of conversation presented here—a hierarchy of related context spaces. (shrink)

[The method of doubt in Descartes’ “First Meditation”: Comments on the interpretation of Josef Moural].

Julia Knopes’s (2025) article aims to explain how models of disability apply in the lives and experiences of people with lived mental health conditions who serve as peer support providers. However,...

Mounting evidence suggests that endorsement of psychological continuity and the afterlife increases with age. This developmental change raises questions about the cognitive biases, social representations, and cultural input that may support afterlife beliefs. To what extent is there similarity versus diversity across cultures in how people reason about what happens after death? The objective of this study was to compare beliefs about the continuation of biological and psychological functions after death in Tanna, Vanuatu, and the United States. Children, adolescents, and (...) adults were primed with a story that contained either natural or supernatural cues. Participants were then asked whether or not different biological and psychological processes continue to function after death. We predicted that across cultures individuals would be more likely to endorse the continuation of psychological processes over biological processes and that a theistic prime would increase continuation responses regarding both types of process. Results largely supported predictions; U.S. participants provided more continuation responses for psychological than biological processes following both the theistic and non-theistic primes. Participants in Vanuatu, however, provided more continuation responses for biological than psychological processes following the theistic prime. The data provide evidence for both cultural similarity and variability in afterlife beliefs and demonstrate that individuals use both natural and supernatural explanations to interpret the same events. (shrink)

According to “voluntarists,” voluntary control is a necessary precondition on being blameworthy. According to “non-voluntarists,” it isn’t. I argue here that we ought to take seriously a type of voluntary control that both camps have tended to overlook. In addition to “direct” control over our behavior, and “indirect” control over some of the consequences of our behavior, we also possess “constitutive” control: the capacity to govern some of our attitudes and character traits by making choices about what to do that (...) constitute those attitudes and traits. Taking this sort of control seriously, I argue, ultimately tips the scale towards voluntarism. First, I address a non-voluntarist case in which an agent is putatively made blameworthy by the reasons for which she acts, even though the particular reasons for which she acts aren’t up to her. I argue that this case looks compelling only if we overlook constitutive control, and thereby miss how the agent’s motivating reasons are under her voluntary control even though non-voluntarists think they are not. I then use the notion of constitutive control to diffuse some of the best putative counterexamples to voluntarism: cases in which subjects are blameworthy either for caring inadequately about others or for wishing them ill. (shrink)

Surgical training has traditionally involved a lengthy apprenticeship to a series of master surgeons, who teach medical students and residents the techniques of surgery while allowing them to work on patients in the operating room. This article examines surgical training as a structured environment that prepares students for the embodied lessons taught by a surgeon. It argues that even the most seemingly mechanical of surgical techniques contains social lessons when taught by a surgeon within the rich environment of the operating (...) room. (shrink)

This article explores how visual images of dependency and care reflect and reinforce perceptions of people who are ill, disabled, or otherwise dependent, those who sustain them, and the meaning of the work they do. Scenes of care are a valuable index for understanding cultural assumptions about who is deserving of care, how and where care should be given, and who is obligated to serve as a giver of care. It positions these images in the context of the emphasis, within (...) the disability rights movement, on independence. I argue that the insistence on independence entails a form of what Lauren Berlant calls "cruel optimism"—desire for the very things that undermine happiness and well-being—because they rely on a willful disregard of the inevitable interdependency that is a fact of all human existence, as well as the particular forms of dependency that pertain to many disabled bodies. The end of the article considers works of visual art that challenge dominant modes for representing how care is given and received. If the invisibility of caregiving is one aspect of our willful forgetting that all bodies are dependent, I'll argue that visual images of care are an essential resource for recognizing and reimagining its status in our society. One desired outcome of such reconsideration would be to complicate the meaning of autonomy—as it relates to choosing disability—as well as how the work of caregiving is acknowledged and valued. (shrink)

This paper suggests that a basic distinction between philosophical counselling and psychotherapy is to be found in the conception of ‘the person’that is inherent in each of the fields. Understanding this distinction allows not only for a more profound recognition of what is unique to philosophical counselling but also for a better view of possibilities of interchange between the fields. [1].

Recent turmoil in the Middle East and North Africa has prompted renewed concerns about women’s rights in Muslim societies. It has also raised questions about women’s agency and activism in religious contexts. This article draws on ethnographic research with women activists in Indonesia, the country with the world’s largest Muslim population, to address such concerns. My fieldwork shows that some Muslim women activists in democratizing Indonesia manifest pious critical agency. Pious critical agency is the capacity to engage critically and publicly (...) with religious texts. While some scholars have argued that pious and feminist subjectivity are inherently at odds, the emergence of pious critical agency in Indonesia demonstrates that piety and feminism can intersect in surprising and unexpected ways. Moreover, it shows that women’s agency can draw on both secular and religious resources and that religion can be used to promote critical discourses on gender. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a framework of analysis. Cultural (...) theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

Schütz’ tuning-in relationship designates sharing time as the ground of we-experiences, but the Husserlian account of time that he relies upon for this argument seems to undermine the very possibility of doing so. I argue that Merleau-Ponty’s conception of temporality offers a more plausible account of shared time via the ‘transferability’ of the body schema. Disability theorists and critical phenomenologists, however, would remind us that any account of we-experiences must recognize bodily difference. I argue that bodies of diverse motilities can (...) come to share a body schema without risk of ‘forced time compliance’ if we jettison synchronization and embrace improvisation as a paradigm for schematic sharing: I use the example of collective free improvisation to illustrate flexible, emergent, and bidirectional body schemas that, I claim, circumvent the assimilationist tendencies looming in any account of we-experiences premised upon bodily sameness. (shrink)

The “public charge” rule is a long-standing immigration policy that seeks to determine the likelihood that a prospective immigrant will become dependent on the government for subsistence. When the Trump administration sought to expand the criteria that would count against an applicant for permanent residency to include public benefits historically excluded from the calculation, thousands of commenters wrote to oppose or support the proposed changes. This paper explores the moral and practical reasons commenters provided for their position on the public (...) charge rule and considers the value of the public comment process for immigration, health, and social policy. (shrink)

Drawn from the authors' experiences in the UK, Australia and mainland Europe and with contributions from across the globe, this clear and accessible book includes a wide range of examples. The authors show the reader how to: identify ethical issues which may arise with any research project, gain informed consent, provide information in the right way to participants, and present and disseminate findings in line with ethical guidelines.

Food systems are being affected by multiple shocks related to climate change, the COVID-19 pandemic and geopolitical events. Food prices and food insecurity are rising globally as a result, raising questions about the effective governance of food security during shocks. This paper critically examines the governance of food security in Melbourne, Australia during a major food system shock, the COVID-19 pandemic. It draws on document analysis and 34 stakeholder interviews with 41 participants from government, industry and civil society between May (...) 2020 and March 2021. The paper examines the role of these actors in governance mechanisms for two important aspects of food system governance during the COVID-19 pandemic, continuity of food supply and delivery of emergency food relief. Clark et al.’s ( 2021 ) “governance engagement continuum” is used to show how civil society groups were excluded from these formal governance mechanisms, instead establishing their own spaces of “self-governance”. The resilience aims associated with these governance mechanisms are also analyzed using Zurek et al.’s ( 2022 ) “three R’s” (robustness, recovery and reorientation) framework. Our study highlights the significant role of food industry actors in the continuity of food supply and delivery of emergency food relief, and it shows the vulnerabilities of emergency food relief that depends on industry food “surpluses” as a model for addressing food insecurity during food system shocks. We conclude that greater government leadership is needed in the governance of food security during food system shocks, and in implementation of legislative and policy approaches that are grounded in the human right to food. (shrink)

It is well known that Socrates sketches, through his similes of the sun, line, and cave, an account of the form of the good in the middle books of the Republic and that this conception of the good relies heavily on his theory of forms. What is less well-noted is that Socrates presents a distinct account of goodness - a functional account - in Republic I. In numerous influential articles, Gerasimos Santas has presented an interpretation of Plato's two theories of (...) goodness and their relationship to one another. In this discussion, I argue that Santas's account cannot be correct. My critique has implications with regard to the issue of the relationship between form and function in Plato's metaphysics of value. (shrink)

We implemented a user-centered approach to the design of an artificial intelligence (AI) system that provides users with access to information about the workings of the United States federal court system regardless of their technical background. Presently, most of the records associated with the federal judiciary are provided through a federal system that does not support exploration aimed at discovering systematic patterns about court activities. In addition, many users lack the data analytical skills necessary to conduct their own analyses and (...) convert data into information. We conducted interviews, observations, and surveys to uncover the needs of our users and discuss the development of an intuitive platform informed from these needs that makes it possible for legal scholars, lawyers, and journalists to discover answers to more advanced questions about the federal court system. We report on results from usability testing and discuss design implications for AI and law practitioners and researchers. (shrink)

This essay considers how an “intimacy contract,” as a conceptual tool and a political reality, extends existing critiques of the social contract tradition by accounting for the privatized nature of the post-9/11 US empire. Examining critiques by Carole Pateman and Charles Mills, I argue that an intimacy contract uncovers the coercive power relations underlying neoliberal discourses of entrepreneurial freedom. Focusing on migrant labor on US military bases, I provide an overview of the racial, sexual, and settler contracts and the need (...) to extend Mills’s and Pateman’s critiques of embodiment and spatiality. Next, I suggest how the intimacy contract generates a transnational, embodied account of the labors upholding US empire; a lens into the shifting significance of these labors under neoliberal imperialism; and a chronicling of desire and workers’ interests. In conclusion, I suggest how the intimacy contract exposes multiple resistances to US empire and neoliberal capitalism. (shrink)

This paper examines the practice implications of various state policies that provide publicly funded prenatal care to undocumented immigrants for health care workers who see undocumented patients. Data were collected through in-depth interviews with purposively sampled health care workers at safety net clinics in California, Maryland, Nebraska, and New York. Health care workers were asked about the process through which undocumented patients receive prenatal care in their health center and the ethical tensions and frustrations they encounter when providing or facilitating (...) this care under policy restrictions. Respondents discussed several professional practice norms as well as the ethical tensions they encountered when policy or institutional constraints prevented them from living up to professional norms. Using Nancy Berlinger's “workarounds” framework, this paper examines health care workers' responses to the misalignment of their professional norms and the policy restrictions in their state. These findings suggest that the prenatal policies in each state raise ethical and professional challenges for the health care workers who implement them. (shrink)

This book critiques the contemporary recourse to transparency in law and policy. This is, ostensibly, the information age. At the heart of the societal shift toward digitalistion, is the call for transparency and the liberalisation of information and data. Yet, with the recent rise of concerns such as 'fake news', post-truth and misinformation, where the policy responses to all these phenomena has been a petition for even greater transparency, it becomes imperative to critically reflect on what this dominant idea means, (...) whom it serves, what the effects are of its power. In response, this book provides the first sustained critique of the concept of transparency in law and policy. It offers a concise overview of transparency in law and policy around the world, and critiques how this concept works discursively to delimit other forms of governance, other ways of knowing and other realities. It draws on the work of Michel Foucault on discourse, archaeology and genealogy, together with later Foucaultian scholars, including Gayatri Chakravorty Spivak and Judith Butler, as a theoretical framework for challenging and thinking anew the history and understanding of what has become one of the most popular buzzwords of 21st century law and governance. At the intersection of law and governance, this book will be of considerable interest to those working in these fields; but also to those engaged in other interdisciplinary areas, including society and technology, the digital humanities, technology laws and policy, global law and policy, as well as the surveillance society. (shrink)