ABSTRACT:Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression—such as racism and classism—as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in (...) an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced. (shrink)

Although justice is a central principle in clinical ethics, work that centers social justice is often marginalized in clinical ethics. In addition to institutional barriers that may be preventing clinical ethicists from becoming the activists that Meyers argues we should be, we must also recognize the barriers embedded in the field of clinical ethics itself. As clinical ethicists, we have an opportunity to support anti‐racism work in particular by altering our own organizational structures to be more inclusive and reflective of (...) the Black, Indigenous, and other communities of color we serve, enhancing clinical ethics education and training by making critical theories foundational, and decolonizing our clinical ethics consultation tools and practices. (shrink)

The view of human in Confucian philosophy in Pre Qin Dynasty arose not only from the change in socio-economic conditions but also from the deterioration of social morality. Facing that situation, thipkers of this period began to study human to come up with solutions to help the rulers stabilize society. Despite the presence of past studies on the topicand views on people in Confucian philosophy during the Pre Qin period, there (xists gaps for further research. This study attempted to understand (...) through a document review and extensive in-depth research procedure the theoretical underpjnnings of the perspectives on the origin of man, on human nathře, on hụman rples and positions and on educating people in order to develop perfect people and maintain civil order in society. The methodology used was documehtation research and content analysis of the data collected. The document reséafch method was particularly helpful in investigating categorizing and analyzing physical sources, most commonly written documents in the social, public or dígital world. The study found out that the Confucianism represents a legitimate doctrine of the Pre Qin philosophy to build social stability social harmony and peace. The Confucianists of Pre Qin also advocated the need for a personal cultivation, cultivation of the body, family, country, and the whole world, and use it as the basis of the methodology for governing the country. Howeyer, for this purpose, the study recommends that people need to be educated to know the way to be human. (shrink)

Racism is a pervasive issue in patient care and a key social determinant of health. Clinical ethicists, like others involved in patient care, have a duty to recognize and respond to racism on both individual and systems-wide levels to improve patient care. Doing so can be challenging and, like other skills in ethics consultation, may benefit from specialized training, standardized tools and approaches, and practice. Learning from existing frameworks and tools, as well as building new ones, can help guide clinical (...) ethicists to systematically approach racism as it affects clinical cases. Here, we propose an expansion of the commonly used four-box method to clinical ethics consultation, where racism is considered as a potential factor in each of the four boxes. We apply this method to two clinical cases to highlight ethically salient information that might be missed using the standard formulation of the four boxes but captured with the expanded version. We argue that this expansion of an existing clinical ethics consultation tool is ethically justified insofar as it (a) creates a more just approach, (b) supports individual consultants and services, and (c) facilitates communication in contexts where racism impinges on effecting good patient care. (shrink)

"Dieses Buch entstand in der Zusammenarbeit des Projekts 'Humanismus in der Epoche der Globalisierung: ein interkultureller Dialog 'uber Menschheit, Kultur und Werte' (Kulturwissenschaftliches Institut Essen) und des Sonderforschungsbereichs 626 der Freien Universit'at Berlin ''Asthetische Erfahrung im Zeichen der Entgrenzung der K'unste'"--T.p. verso, Bd. 1.

Many of the items that humans consume are produced in ways that involve serious harms to persons. Familiar examples include the harms involved in the extraction and trade of conflict minerals (e.g. coltan, diamonds), the acquisition and import of non- fair trade produce (e.g. coffee, chocolate, bananas, rice), and the manufacture of goods in sweatshops (e.g. clothing, sporting equipment). In addition, consumption of certain goods (significantly fossil fuels and the products of the agricultural industry) involves harm to the environment, to (...) future persons, and to current persons in low-lying and developing countries, by way of their impacts on climate change. When it comes to such large-scale harms, it's easy for the individual to feel helpless. Even if she sincerely wishes things were otherwise, she may wonder what she could possibly do to make them so. In this paper I briefly explore several promising avenues for generating duties in individuals to consume ethically, and develop one in particular: that an individual ought to signal her commitments to others, as a first step in collectivizing to act against unjust global labour practices. (shrink)

Background Institutional Review Boards (IRBs) are federally mandated to include both nonscientific and unaffiliated representatives in their membership. Despite this, there is no guidance or policy on the selection of unaffiliated or non-scientist members and reports indicate a lack of clarity regarding members’ roles. In the present study we sought to explore processes of recruitment, training, and the perceived roles for unaffiliated and non-scientist members of IRBs.Methods We distributed a self-administered REDCap survey of members of the Association for the Accreditation (...) of Human Research Protection Programs familiar with IRB member recruitment. The survey included closed and open-ended questions regarding: the operation of the HRPP/IRB(s), how unaffiliated and non-scientist members are recruited, whether they had faced challenges recruiting for these roles, and training and mentorship offered. The survey also collected information regarding the perceived value and roles of unaffiliated and non-scientist members.Results 76 responses were included in the analysis (38% completion rate). The most common approach for recruitment was referral from current IRB members, with almost half of respondents indicating challenges recruiting unaffiliated members. Over 75% indicated no additional training was provided to unaffiliated or non-scientist members compared to affiliated or scientist members. Most common supports provided were travel/parking expenses and honoraria. Commonly perceived roles were to provide an independent voice from the participant perspective, notably regarding consent processes and materials.Conclusions Respondents indicated challenges in defining unaffiliated and non-scientist members and limited practices toward recruitment and support. Future work should more closely examine the challenges in defining these roles and applying the definitions in practice, as well as strategies that may improve recruitment and retention of unaffiliated and non-scientist members. (shrink)

When a liberal-democratic state signs a treaty or wages a war, does its whole polity do those things? In this article, we approach this question via the recent social ontological literature on collective agency. We provide arguments that it does and that it does not. The arguments are presented via three considerations: the polity's control over what the state does; the polity's unity; and the influence of individual polity members. We suggest that the answer to our question differs for different (...) liberal-democratic states and depends on two underlying considerations: the amount of discretion held by the state's officeholders; the extent to which the democratic procedure is deliberative rather than aggregative. (shrink)

Does ?ought? imply ?can? for collectives' obligations? In this paper I want to establish two things. The first, what a collective obligation means for members of the collective. The second, how collective ability can be ascertained. I argue that there are four general kinds of obligation, which devolve from collectives to members in different ways, and I give an account of the distribution of obligation from collectives to members for each of these kinds. One implication of understanding collective obligation and (...) ability in the proposed way is that a group can be blameworthy for failing to realize its obligation even when no member of the group is blameworthy for failing to realize her obligation. (shrink)

In her ‘On the apparent paradox of ideal theory’, Laura Valentini combines three supposedly plausible premises to derive the paradoxical result that ideal theory is both unable to, and indispensable for, guiding action. Her strategy is to undermine one of the three premises by arguing that there are good and bad kinds of ideal theory, and only the bad kinds are vulnerable to the strongest version of their opponents’ attack. By undermining one of the three premises she releases ideal theorists (...) from the paradox, which is as follows. (1) Any sound theory of justice is action-guiding. (2) Any sound theory of justice is ideal. (3) Any ideal theory fails to be action-guiding. Here I shall respond to Valentini in two ways. First, I shall show that both (1) and (2) are false. The falsity of either is sufficient to release ideal theorists from the paradox. Second, I shall show that Valentini’s response to (3) can be extended, because her bad kinds of ideal theory do not necessarily fail to guide action. The cumulative effect of my arguments further strengthens Valentini’s support of ideal theory. I will deal with premises (1) and (2) in Sections I and II, and (3) in Section III. (shrink)

Individuals have various kinds of obligations: keep promises, don’t cause harm, return benefits received from injustices, be partial to loved ones, help the needy and so on. How does this work for group agents? There are two questions here. The first is whether groups can bear the same kinds of obligations as individuals. The second is whether groups’ pro tanto obligations plug into what they all-things-considered ought to do to the same degree that individuals’ pro tanto obligations plug into what (...) they all-things-considered ought to do. We argue for parity on both counts. (shrink)

‘Intersectionality’ is one of the rare pieces of academic jargon to make it out of the university and into the mainstream. The message is clear and well-known: your feminism had better be intersectional. But what exactly does this mean? This paper is partly an exercise in conceptual clarification, distinguishing at least six distinct types of claim found across the literature on intersectionality, and digging further into the most philosophically complex of these claims—namely the metaphysical and explanatory. It’s also partly a (...) reply to Sara Bernstein, who argued recently that the best interpretation of the metaphysical claim is explanatory priority. We’ll argue that duly clarified, it’s far from obvious that feminism had better be intersectional. At the very least, it had better not be only intersectional. (shrink)

The objective of this paper is to explain why certain authors - both popular and academic - are making a mistake when they attribute obligations to uncoordinated groups of persons, and to argue that it is particularly unhelpful to make this mistake given the prevalence of individuals faced with the difficult question of what morality requires of them in a situation in which there's a good they can bring about together with others, but not alone. I'll defend two alternatives to (...) attributing obligations to uncoordinated groups. The first solution has us build better people, who will coordinate their actions willingly and spontaneously when the occasion arises. The second solution has us build better groups, so that when the occasion arises, there is a framework in place for coordinating members into action. (shrink)

Climate change appears to be a classic aggregation problem, in which billions of individuals perform actions none of which seem to be morally wrong taken in isolation, and yet which combine to drive the global concentration of greenhouse gases (GHGs) ever higher toward environmental (and humanitarian) catastrophe. When an individual can choose between actions that will emit differing amounts of GHGs―such as to choose a vegan rather than carnivorous meal, to ride a bike to work rather than drive a car, (...) or to take a reusable bag to the supermarket rather than send another plastic bag to landfill―does she have any reason to choose the lower-emitting actions? In this chapter I'll reject the claim that individuals don't make a difference when it comes to climate change. I first discuss making a difference with every action, as a way of getting clearer about how individuals' actions impact causally on the harms resulting from climate change, making a distinction so far overlooked in the climate ethics discussion between 'macro' thresholds like ice-cap melt, and 'micro' thresholds like severe weather events. I set aside making a difference with every action as implausible, and then move on to discuss both low probability of major difference, and high probability of minor difference. I argue that both of these are plausible characterizations of individuals' causal contributions to climate change. I conclude by noting some policy implications of having (probabilistic) individual difference-making back in play. (shrink)

The primary purpose of Institutional Review Boards (IRBs) is to protect the rights and welfare of human research participants. Evaluation and measurement of how IRBs satisfy this purpose and other important goals are open questions that demand empirical research. Research on IRBs, and the Human Research Protection Programs (HRPPs) of which they are often a part, is necessary to inform evidence-based practices, policies, and approaches to quality improvement in human research protections. However, to date, HRPP and IRB engagement in empirical (...) research about their own activities and performance has been limited. To promote engagement of HRPPs and IRBs in self-reflective research on HRPP and IRB quality and effectiveness, barriers to their participation need to be addressed. These include: extensive workloads, limited information technology systems, and few universally accepted or consistently measured metrics for HRPP/irb quality and effectiveness. Additionally, institutional leaders may have concerns about confidentiality. Professional norms around the value of participating in this type of research are lacking. Lastly, obtaining external funding for research on IRBs and HRPPs is challenging. As a group of HRPP professionals and researchers actively involved in a research consortium focused on IRB quality and effectiveness, we identify potential levers for supporting and encouraging HRPP and IRB engagement in research on quality and effectiveness. We maintain that this research should be informed by the core principles of patient- and community-engaged research, in which members and key stakeholders of the community to be studied are included as key informants and members of the research team. This ensures that relevant questions are asked and that data are interpreted to produce meaningful recommendations. As such, we offer several ways to increase the participation of HRPP professionals in research as participants, as data sharers, and as investigators. (shrink)

The politics of climate change is marked by the fact that countries are dragging their heels in doing what they ought to do; namely, creating a binding global treaty, and fulfilling the duties assigned to each of them under it. Many different agents are culpable in this failure. But we can imagine a stylised version of the climate change case, in which no agents are culpable: if the bad effects of climate change were triggered only by crossing a particular threshold, (...) and it was reasonably, but mistakenly, believed by each country that insufficiently many other countries were willing to cooperate in order for that threshold to remain uncrossed, no country would be required to make a unilateral contribution. Yet even without culpability, we can diagnose a moral ill: the world has gone other than it should have. If not for the mistaken beliefs, there would have been a global climate treaty, and all the avoidance of future suffering that would come with it. In this article I argue that this moral ill has implications for the non-culpable agents, in that it generates duties to disgorge actual holdings over and above the counterpart holdings in the relevant counterfactual: those holdings the agents would have had, were the world to have gone as it should. (shrink)

Law and racism are intertwined, with legal tools bearing the potential to serve as instruments of oppression or equity. This Special Issue explores this dual nature of health law, with attention to policing in the context of mental health, schools, and substance use disorders; industry and the environment in the context of food advertising, tobacco regulation, worker safety, and environmental racism; health care and research in the context of infant mortality, bias in medical applications of AI, and diverse inclusion in (...) research; and anti-racist teaching and practice in the context of building an interprofessional curriculum and medical-legal partnerships. (shrink)

Susan Sontag once remarked that since the invention of the camera, photography has “kept company with death.” And indeed, images of suffering human beings and devastated landscapes appear regularly in the popular media and even in contemporary art. This volume explores these painful images from the past few decades of photography, weighing in on the intense critical debate that has arisen in recent years around depictions of acute human suffering—especially those that are beautifully rendered. Drawing on works from advertising, photojournalism, (...) art photography, and conceptual art, Beautiful Suffering features reproductions of all the pieces in the Williams College Museum of Art exhibition that shares its name—including portrayals of AIDS sufferers, Abu Ghraib prisoners, refugees, and casualties of war. It also includes five critical essays that engage the works themselves as well as the larger issues the exhibition confronts: Is it inherently problematic to seek aesthetic pleasure in a rendering of pain? And if so, why? These essays, composed by scholars in fields as diverse as art history and political science, are perfect complements to the powerful images of suffering that probe some of the most pressing issues we face today. (shrink)

From infancy, we recognize that labels denote category membership and help us to identify the critical features that objects within a category share. Labels not only reflect how we categorize, but also allow us to communicate and share categories with others. Given the special status of labels as markers of category membership, do novel labels (i.e., non‐words) affect the way in which adults select dimensions for categorization in unsupervised settings? Additionally, is the purpose of this effect primarily coordinative (i.e., do (...) labels promote shared understanding of how we categorize objects)? To address this, we conducted two experiments in which participants individually categorized images of mountains with or without novel labels, and with or without a goal of coordination, within a non‐communicative paradigm. People who sorted items with novel labels had more similar categories than people who sorted without labels only when they were told that their categories should make sense to other people, and not otherwise. We argue that sorters' goals determine whether novel labels promote the development of socially coherent categories. (shrink)

From a radical feminist perspective, gender is a cage. Or to be more precise, it’s two cages. If genders are cages, then surely we want to let people out. Being less constrained in our choices is something we all have reason to want: theorists in recent years have emphasized the importance of the capability to do and be many different things. At the very least, we should want an end to sex-based oppression. But what does this entail, when it comes (...) to gender? In this paper, I’ll compare four ‘transitional pathways’, with a view to considering how each relates to the ultimate end of ending sex-based oppression. Should we open the doors to the cages, so that people can move freely between them, but leave the cages themselves in place?. Should we add more cages?. Should we make the cages bigger, so that people have a lot more room to move around inside them? Or should we dismantle the cages, so there are no more genders at all?. Some of these options are ‘gender revisionist’, others are gender abolitionist. I’ll argue in favour of a gender abolitionist pathway. (shrink)

What should we do when we won't do as we ought? Suppose it ought to be that the procrastinating professor accept the task of reviewing a book, and actually review the book. It seems clear that given he won't review it, he ought not to accept the task. That is a genuine moral obligation in light of less than perfect circumstances. I want to entertain the possibility that a set of such obligations form something like a 'practical morality'; that which (...) we ought to do given that we're unlikely or unwilling to do much of what ideal morality demands. If it is possible to give a coherent account of these kinds of obligations, then it is possible to entertain the idea that these obligations are in fact what morality demands. The conceptual truths about justice (good, right, fairness) that come from ideals are one thing; the actions that morality demands of people given their actual circumstances are quite another. In this paper I will ask about the kinds of facts that can be used to establish a more circumscribed set of obligations than we get from the orthodox view about moral obligation. (shrink)

In this chapter we explain what the no-difference challenge is, focusing in particular on act consequentialism. We talk about how different theories of causation affect the no-difference challenge; how the challenge shows up in real-world cases including voting, global labour injustice, global poverty, and climate change; and we work through a number of the solutions to the challenge that have been offered, arguing that many fail to actually meet it. We defend and extend one solution that does, and present a (...) further solution of our own. (shrink)

Individuals sometimes pass their duties on to collectives, which is one way in which collectives can come to have duties. The collective discharges its duties by acting through its members, which involves distributing duties back out to individuals. Individuals put duties in and get (transformed) duties out. In this paper we consider whether (and if so, to what extent) this general account can make sense of states' duties. Do some of the duties we typically take states to have come from (...) individuals having passed on certain individual duties? There are complications: states can discharge their duties by contracting fulfilment out to non-members; states seem able to dissolve the duties of non-members; and some of states' duties are not derived in this way. We demonstrate that these complicate, but do not undermine, the general account and its application to states. And the application has an interesting upshot: by asking which individuals robustly participate in this process of duty transfer-and-transformation with a given state, we can begin to get a grip on who counts as a member of that state. (shrink)

We argue that if evidence were knowledge, then there wouldn’t be any Gettier cases, and justification would fail to be closed in egregious ways. But there are Gettier cases, and justification does not fail to be close in egregious ways. Therefore, evidence isn’t knowledge.

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study (...) nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

A Teoria dos Cinco Elementos é uma das primeiras teorias na história da filosofia chinesa. O nascimento da doutrina marcou uma virada no processo de percepção do mundo com os cinco elementos básicos de metal, madeira e água, fogo e terra. Esses cinco fatores são percebidos na forma de experiência, o nível de consciência ainda é rudimentar e as características mais gerais da matéria ainda não foram generalizadas. No entanto, com as duas leis dos Cinco Elementos do nascimento mútuo, os (...) cinco elementos opostos se complementam ao explicar a formação, desenvolvimento e transformação do mundo material. São duas leis que se aplicam para explicar as leis da natureza, da sociedade e do corpo humano. A Teoria dos Cinco Elementos mostra que coisas e fenômenos no universo e na sociedade não ficam parados, mas estão sempre em movimento, mudando e girando constantemente. Neste artigo, nos concentraremos em esclarecer o pensamento dialético da teoria dos Cinco Elementos na natureza, na sociedade e no corpo humano. O artigo abrirá uma nova abordagem para a teoria dos Cinco Elementos e a próxima direção de pesquisa é a aplicação da teoria na medicina oriental. (shrink)

Punishing groups raises a difficult question, namely, how their punishment can be justified at all. Some have argued that punishing groups is morally problematic because of the effects that the punishment entails for their members. In this paper we argue against this view. We distinguish the question of internal justice—how punishment-effects are distributed—from the question of external justice—whether the punishment is justified. We argue that issues of internal justice do not in general undermine the permissibility of punishment. We also defend (...) the permissibility of what some call “random punishment.” We argue that, for some kinds of collectives, there is no general obligation to internally distribute the punishment-effects equally or in proportion to individual contribution. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 51-58, January/February 2022.

Do consumers’ ordinary actions of purchasing certain goods make them complicit in global labour injustice? To establish that they do, two things much be shown. First, it must be established that they are not more than complicit, for example that they are not the principal perpetrators. Second, it must be established that they meet the conditions for complicity on a plausible account. I argue that Kutz’s account faces an objection that makes Lepora and Goodin’s better suited, and defend the idea (...) that consumers are complicit in at least two of the ways distinguished by the latter. In the final section of the paper, I consider whether consumers’ responsibility for complicity in global labour injustice is likely to be as strong as responsibility from another source, namely benefiting from that injustice. (shrink)

The phenomenological goal of grounding the content of conceptual thought in the background understanding of everyday, skillful coping was approached using evolutionary autonomous agent methodology. The behavior of an EAA evolved to perform a specified motor task was identified with skillful coping. Changes in the dynamics of the EAA controller occurred when the EAA encountered an unexpected obstacle with loss of longer time scale components in its hierarchical temporal organization. These temporal changes are consistent with the phenomenological changes which we (...) experience with breakdown during equipment use with our adoption of a more immediate, determinate stance. Since this latter experience is the basis of conceptual thought, the EAA paradigm goes some way in providing a naturalized explanation for the grounding of the content of conceptual thought in everyday, skillful coping in a manner that is physiologically plausible and phenomenologically accurate. (shrink)

Acute exercise consistently benefits both emotion and cognition, particularly cognitive control. We evaluated acute endurance exercise influences on emotion, domain-general cognitive control, and the cognitive control of emotion, specifically cognitive reappraisal. Thirty-six endurance runners, defined as running at least 30 miles per week with one weekly run of at least 9 miles (21 female, age 18-30 years) participated. In a repeated measures design, participants walked at 57% age-adjusted maximum heart rate (HRmax) (range 51-63%) and ran at 70% HRmax (range 64-76%) (...) for 90 minutes on two separate days. Participants completed measures of emotional state and the Stroop test of domain-general cognitive control before, every 30 minutes during, and 30 minutes after exercise. Participants also completed a cognitive reappraisal task after exercise. Functional near-infrared spectroscopy tracked changes in oxygenated and deoxygenated hemoglobin levels in the prefrontal cortex (PFC). Endurance exercise elevated positive emotion and cognitive reappraisal success. Endurance exercise reduced Stroop response time and test-evoked PFC oxygenation during exercise. Results suggest that even at relatively moderate intensities, endurance athletes benefit emotionally from running both during and after exercise, and task-related prefrontal cortex oxygenation reductions do not appear to hinder prefrontal-dependent cognitive control. (shrink)

Primatological and archaeological evidence along with anthropological accounts of hunter-gatherer societies indicate that lethal between-group violence may have been sufficiently frequent during our ancestral past to have shaped our evolved behavioral repertoire. Two simulations explore the possibility that heroism (risking one's life fighting for the group) evolved as a specialized form of altruism in response to war. We show that war selects strongly for heroism but only weakly for a domain-general altruistic propensity that promotes both heroism and other privately costly, (...) group-benefiting behaviors. A complementary analytical model shows that domain-specific heroism should evolve more readily when groups are small and mortality in defeated groups is high, features that are plausibly characteristic of our collective ancestral past. (shrink)