In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

BackgroundECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO (...) clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations.MethodsAn online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic.ResultsWhen initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%).ConclusionsWe found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. (shrink)

La maladie de l'ame... la belle expression platonicienne n'a de cesse d'etre d'actualite. Non seulement elle est prompte a revenir d'epoque en epoque, mais elle semble particulierement friande de la notre. Que cette maladie designe une vague tristesse, un taedium vitae, ou, plus grave, une depression, elle implique tout a la fois la souffrance morale et la souffrance physique. L'ame et le corps sont divises mais se retrouvent dans la douleur si bien que la maladie de l'ame vient de ce (...) que nous avons un corps. De ce constat paradoxal Jackie Pigeaud tire une histoire, celle du triomphe du dualisme, du fardeau de l'ame et du corps contraints a etre separes et ensemble a perpetuite. Cette histoire trouve son origine dans le monde grec, et plus exactement dans sa philosophie. La division entre maladies de l'ame et autres maladies, c'est-a-dire maladies du corps, appartient a la philosophie. La medecine aurait ete bien soulagee de cette partition. Est-ce a dire qu'elle n'entendait pas etre philosophique? Sans doute: Hippocrate en offre un bon exemple. L'accord, tacite, est le suivant: l'ame appartient au philosophe et le corps au medecin. Ciceron s'occupe des passions et Galien suspend son jugement des qu'il approche la psyche. Chacun y trouve son compte mais les consequences sont importantes: la partition du champ des maladies, la place du malade dans la societe, les traitements a apporter, notamment a la folie, dependent de ce dualisme initial. Si le legs de la medecine greco-romaine est riche, il est aussi fort lourd et trouve des developpements tout au long de l'histoire de la medecine, jusqu'a la constitution au XVIIIe siecle de la psychiatrie. D'une ecriture et d'une pensee personnelles et profondes, ce livre est un essai sur l'histoire de la pensee medicale, depuis l'Antiquite jusqu'a nos jours. La Maladie de l'ame a ete un succes des sa parution, et ce succes n'a pas ete dementi depuis. L'ouvrage n'etait malheureusement plus disponible: les livres ont leur destin commentait l'auteur. Avec cette edition revue et augmentee, accompagnee d'une preface nouvelle, le livre connait enfin le sort qu'il merite.Jackie Pigeaud est professeur emerite de litterature latine a l'Universite de Nantes et membre de l'Institut universitaire de France. On lui doit egalement, aux Belles Lettres, Folie et cures de la folie chez les medecins de l'Antiquite greco-romaine. La manie. (shrink)

Engaging with the work of Freud, Heidegger, Wittgenstein, and Derrida, this book reconceptualises the language divide between humans and animals within the context of animal ethics.

This book reconceives disability as a set of social relations and practices, as experienced embodiment, and as an emancipatory movement, as well as a biomedical phenomenon. The author brings new attention to complex ethical questions surrounding disability, looking at not only the biomedical understanding of impairment, but also its cultural representations and social organization.

The work of a bioethicist carries distinctive responsibilities. Alongside those of any worker, there are responsibilities associated with giving guidance to practitioners, policy makers and the public. In addition, bioethicists are professionally exposed to and required to identify situations of moral trouble, and as a result may find themselves choosing to work as advocates or activists, with responsibilities that are distinct from those generally acknowledged within academia. The requirement for bioethics to make normative judgements entails taking a stance, which means (...) there cannot be a sharp line between ‘academic’ or ‘objective’ bioethics, and advocacy/activism, but a continuum of bioethicists’ engagement and an associated continuum of responsibilities. (shrink)

Pandemics such as COVID-19 place everyone at risk, but certain kinds of risk are differentially severe for groups already made vulnerable by pre-existing forms of social injustice and discrimination. For people with disability, persisting and ubiquitous disablism is played out in a variety of ways in clinical and public health contexts. This paper examines the impact of disablism on pandemic triage guidance for allocation of critical care. It identifies three underlying disablist assumptions about disability and health status, quality of life, (...) and social utility, that unjustly and potentially catastrophically disadvantage people with disability in COVID-19 and other global health emergencies. (shrink)

In this paper a dialogue game for critical discussion is developed. The dialogue game is a formalisation of the ideal discussion model that is central to the pragma-dialectical theory of argumentation. The formalisation is intended as a preparatory step to facilitate the development of computational tools to support the pragma-dialectical study of argumentation. An important dimension of the pragma-dialectical discussion model is the role played by speech acts. The central issue addressed in this paper is how the speech act perspective (...) can be accommodated in the formalisation as a dialogue game. The starting point is an existing ‘basic’ dialogue game for critical discussion, in which speech acts are not addressed. The speech act perspective is introduced into the dialogue game by changing the rules that govern the moves that can be made and the commitments that these result in, while the rules for the beginning, for the end, and for the structure of the dialogue game remain unchanged. The revision of the move rules is based on the distribution of speech acts in the pragma-dialectical discussion model. The revision of the commitment rules is based on the felicity conditions that are associated with those speech acts. (shrink)

Argument schemes are abstractions substantiating the inferential connection between premise(s) and conclusion in argumentative communication. Identifying such conventional patterns of reasoning is essential to the interpretation and evaluation of argumentation. Whether studying argumentation from a theory-driven or data-driven perspective, insight into the actual use of argumentation in communicative practice is essential. Large and reliably annotated corpora of argumentative discourse to quantitatively provide such insight are few and far between. This is all the more true for argument scheme corpora, which tend (...) to suffer from a combination of limited size, poor validation, and the use of ad hoc restricted typologies. In the current paper, we describe the annotation of schemes on the basis of two distinct classifications: Walton’s taxonomy of argument schemes, and Wagemans’ Periodic Table of Arguments. We describe the annotation procedure for each, and the quantitative characteristics of the resulting annotated text corpora. In doing so, we extend the annotation of the preexisting US2016 corpus of televised election debates, resulting in, to the best of our knowledge, the two largest consistently annotated corpora of schemes in argumentative dialogue publicly available. Based on evaluation in terms of inter-annotator agreement, we propose further improvements to the guidelines for annotating schemes: the argument scheme key, and the Argument Type Identification Procedure. (shrink)

Susan has been profoundly deaf since childhood. She is a hearing aid wearer, and likes to use the induction loops built into some public spaces, such as theaters and cinemas, to help cut down the background noise that can make hearing speech very difficult. But this depends on the building having an induction loop fitted and properly maintained. Like many other induction loop users, Susan frequently finds that the advertised loop system is either working poorly or not working at all. (...) Almost as often, she then has the experience of making a complaint about it only to have the problem denied. If she persists, she is often then met... (shrink)

Mitochondrial replacement techniques are intended to avoid the transmission of mitochondrial diseases from mother to child. MRT represent a potentially powerful new biomedical technology with ethical, policy, economic and social implications. Among other ethical questions raised are concerns about the possible effects on the identity of children born from MRT, their families, and the providers or donors of mitochondria. It has been suggested that MRT can influence identity directly, through altering the genetic makeup and physical characteristics of the child, or (...) indirectly through changing the child's experience of disease, and by generating novel intrafamilial relationships that shape the sense of self. In this article I consider the plausibility and ethical implications of these proposed identity effects, but I focus instead on a third way in which identity may be affected, through the mediating influence of the wider social world on MRT effects on identity. By taking a narrative approach, and examining the nature and availability of identity narratives, I conclude that while neither direct genetic nor indirect experiential effects can be excluded, social responses to MRT are more likely to have a significant and potentially damaging influence on the generation of MRT children's narratives of identity. This conclusion carries some implications for the collective moral responsibility we hold to ensure that MRT, if implemented, are practised in ethically justifiable ways. (shrink)

Très tôt le mystère de la forme du vivant et de l'harmonie qui s'y marque a intrigué l'Occident. Très vite s'est imposée la comparaison du vivant avec l'art, comme s'est posé le problème de l'irruption du monstrueux dans la nature, quand l'art est l'univers du parfait. Pour répondre à ces questions, médecins, poètes, philosophes et artistes, mêlant littérature et anatomie, esthétique et géométrie, botanique et morale, inventèrent un nouveau mode de pensée : la rêverie culturelle. Platon, Pline l'Ancien, Cicéron, Virgile, (...) Longus, Galien, Polyclète rêvèrent hors des catégories arrêtées de l'entendement, au-delà des concepts figés de leurs disciplines ; ils saisirent la fluidité des choses naissantes, la labilité du monde en formation. Entre ce que Valéry appelait " le vide et l'événement pur ", dans cette indécision du temps et de l'espace où surgit la forme, déjà discernable et dicible, pas encore fixée, ils pensèrent la création en songeant à la graine et à la plante, au levain et à la pâte, à la présure et au fromage, à la semence et à la greffe. A ces textes jugés peu dignes de son corpus par la tradition philosophique, à cette rêverie culturelle, des Modernes goûtèrent, toujours préoccupés par les mêmes questions du vivant, de l'art de Piles et sa hiérarchie des arts et des genres, Lessing et sa définition des rapports entre la peinture et la poésie, mais surtout Pinel, en quête des symptômes de la folie dans la belle physionomie, Winckelmann, érigeant le Laocoon en expression de l'idéal grec de liberté et de beauté, ou bien encore Freud, inquiété par l'étrange colère du Moïse de Michel-Ange. Ainsi se dévoile un entre-deux de la culture occidentale, zone où, des Grecs à nos jours, la pensée progresse de s'affranchir de la Raison pour découvrir les raisons du vivant et de sa beauté. (shrink)

St. Stephen's Society, Hang Fook Camp, Kowloon, Hong Kong was formally registered in 1981, but its origins go back to 1966. It is a member of the Hong Kong Council of Social Services and the central Registry of Drug Abuse. The Society works in cooperation with the courts, doctors and social workers to provide a spiritual, physical, emotional, educational and social rehabilitation programme. St. Stephen's houses about 300 people on any given day. It meets in Hang Fook Camp which is (...) leased to them by the Hong Kong Government where a regular meeting is held for Christian Fellowship, the Hang Fook Christian Fellowship. (shrink)

This research provides a look at men doing gender in the highly feminized context of temporary clerical employment. Male clerical temporaries, as with other men who cross over into “women's work,” face institutionalized challenges to their sense of masculinity. In particular, male clerical temporary workers face gender assessment—highlighting their failure to live up to the ideals of hegemonic masculinity. The resulting gender strategies these men adopt reveal how male clerical temporary workers “do masculinity”—often in a collaborative performance shaped by the (...) gendered expectations of their agencies, their clients, and even themselves—to reassert the feminine identification of the job while at the same time rejecting its application to them. Paradoxically, rather than disrupting the gender order, the gender strategies used by these male clerical temporaries help to reproduce and naturalize the gendered organization of work and reinvigorate hegemonic masculinity and its domination over women and subaltern men. (shrink)

The last half of the twentieth century saw an explosion in our understanding of genetics and molecular biology; the questions now are in what form that genetic understanding will be put to use; and how and by whom it will be controlled. It's about science and spirituality, and how the two are connected.

This article explores what might constitute the good-enough reader of Maggie Nelson's The Argonauts. Prompted by Nelson's use of D.W. Winnicott's theory of the good-enough mother whose insufficiencies generate the infant's capacity to tolerate ordinary frustration and move beyond both idealizations and denigrations, I argue that the good-enough reader here would be the one who resists the temptation to idealize both the book and its author. This argument is presented as an attempt to open up some spaces for the discussion (...) of ambivalent responses to this book, beyond the rather deferential fandom that has characterized the psychic life of its reception. (shrink)

In this paper, I offer justifications and strategies for teaching taboo, unpopular, or rarely contested views in undergraduate ethics courses. Teaching taboo topics, while challenging, forcefully demonstrates the commitment that few topics in ethics have obvious answers, and that the study of ethics is more than just debating right and wrong. Drawing from my experience teaching on the topic of bestiality, I articulate the importance of motivating topics that may appear remote and irrelevant to students. Inspired by Kathy Rudy’s queer (...) theory approach to the question of bestiality, I propose that we broaden and reframe taboo issues when teaching undergraduates. Instead of introducing these issues with the typical “Is it right or wrong to do X,” I recommend that we examine the essential political, metaphysical, and epistemological presumptions that inform and shape our moral judgments. (shrink)

ABSTRACT The part played by time in ethics is often taken for granted, yet time is essential to moral decision making. This paper looks at time in ethical decisions about having a genetic test. We use a patient‐centred approach, combining empirical research methods with normative ethical analysis to investigate the patients' experience of time in (i) prenatal testing of a foetus for a genetic condition, (ii) predictive or diagnostic testing for breast and colon cancer, or (iii) testing for Huntington's disease (...) (HD). We found that participants often manipulated their experience of time, either using a stepwise process of microdecisions to extend it or, under the time pressure of pregnancy, changing their temporal ‘depth of field’. We discuss the implications of these strategies for normative concepts of moral agency, and for clinical ethics. (shrink)

"Stop slacking off " Your parents may have said this to you when you were deep into a video-gaming marathon. Or maybe your roommate said it to you when you were lounging on the couch scrolling through Instagram. You may have even said it to yourself on days you did nothing. But what is so bad about slacking? Could it be that there's nothing bad about not making yourself useful? Against our hyper-productivity culture, Alison Suen critically interrogates our disapproval (...) of slackers--individuals who do the bare minimum just to get by. She offers a taxonomy of slackers, analyzes common objections to slacking, and argues that each of these objections either fails or carries problematic assumptions. But while this book defends slacking, it does not promote the slacker lifestyle as the key to something better, as some pro-leisure scholars have argued. In fact, Suen argues that slacking is unique precisely because it serves no noble cause. Slacking is neither a deliberate protest to social ills nor is it a path to autonomy. Slackers just slack. By examining the culture of hyper-productivity, Suen argues that it is in fact OK to be a slacker. Key Features Demonstrates the uniqueness of slacking, via a critical examination of six distinct "pro-leisure" philosophical accounts. Articulates a taxonomy of slackers, as well as in-depth examinations of Hollywood slackers and slackers in academia. Examines common objections to slacking, and offers a rebuttal to each of them. Offers an understanding of our productivity culture from an existential perspective. (shrink)

This paper identifies and discusses ethical issues associated with the increasingly common use of multiple reminders in postal survey research. When undertaking postal surveys, it is common to improve response rates by contacting survey recipients multiple times encouraging them to complete the questionnaire. The ethical implications of the use of multiple reminders are rarely discussed in the literature advocating their use. The paper briefly reviews the arguments encouraging use of multiple reminders, and identifies and discusses the potential ethical issues raised (...) by their use in postal surveys. A set of principles is then proposed for using multiple reminders in an ethically responsible way. It is argued that by following these principles, the use of multiple reminders should present no increased potential for harassment or coercion of survey recipients compared to alternative survey techniques. The use of these principles in a recent postal survey is then presented and discussed; a 60% response rate was achieved utilising multiple survey reminders in a way consistent with this set of principles. (shrink)

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the (...) practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

The Donchin and Holmes Emerging Scholar Prize was established in 2016 on the occasion of the twentieth anniversary of the founding of the International Network on Feminist Approaches to Bioethics. The name of the prize honors the two cofounders of FAB, Anne Donchin and Helen Bequaert Holmes. Anne was Professor Emerita of Philosophy at Indiana University at the time of her death in 2014, and she had recruited Becky Holmes, a biologist and independent women’s studies scholar, to help set up (...) the first international network of feminists writing and researching in areas related to bioethics.Both Anne and Becky were strongly committed to what now tends to be called “building capacity”: a rather ugly description... (shrink)

Ideal for students in philosophy, animal studies and gender studies, this volume explores an important question: what grounds our ethical responsibility? It covers a range of topics including maternal bodies, animal rights, capital punishment, depression and trauma, demonstrating the evolution of Kelly Oliver's seminal work in response ethics.

In lieu of an abstract, here is a brief excerpt of the content:Secret Name, or the Secret of a NameAlison SuenIn HumAnimal: Race, Law, Language, Kalpana Seshadri carefully examines the secret of silence, the nonsovereign power of silence. She wants to conceive of silence as neither repressive nor transcendent; that is, on the one hand, she wants to resist the temptation to restore silence to speech, but on the other she also wants to resist the temptation to posit silence in (...) opposition to speech, as something above and beyond language. Rather, she wants to think of silence as "an empty space where the regulatory power of discourse is nullified" (Seshadri 2012, 35).Seshadri powerfully illustrates silence as an "empty space" that invalidates the power of speech through her provocative reading of Charles Chesnutt's story "Dumb Witness." In this story, about a mute slave who holds a secret, silence becomes a most unexpected secret weapon. The slave is mute because her master's nephew has brutally cut off her tongue. The irony of this story is that the nephew realized, only after cutting off her tongue, that the slave is the only person entrusted with the secret of the will—the will that the nephew needs in order to claim his right to his uncle's property, which would include the slave woman. As the story goes, the slave woman refuses to disclose the secret until after the nephew is dead. Her refusal is made possible by the wound of her tongue, by the brutal punishment inflicted by the nephew. As Seshadri points out, the secret of the slave woman's silence exceeds her knowledge of the will. This is the case because the slave woman's silence is not a simple silence, but rather "a capability of silence, which manifests as a withholding" (Seshadri 2012, 107). Indeed, it is through her silence that the law is rendered unenforceable. It is through her silence that the nephew failed to properly own her. [End Page 182]In Seshadri's reading, the silence of the slave woman is not a deprivation of speech, but rather a capability to withhold, a silent treatment designed to punish. I am fascinated by this notion of silence as an active resistance—a subversive power that confounds the law. Nonetheless, what is the political efficacy of this silence? Specifically, what can we do with this nonsovereign power, a power that seems contingent and conditional? After all, even if the slave woman was able to use her silence to outsmart her (would-be) master, at the end of the day she is still missing her tongue, and her nonsovereign "power" over the nephew may simply be a consolation prize.I am equally fascinated by the idea that silence is a "capability." Recasting silence as a kind of "capability" is noteworthy in light of contemporary debates on animal ethics, which often revolve around the kind of capacities that animals have. As is well known, Peter Singer, following Bentham, makes the capacity to suffer the ticket to the moral community, while for Tom Regan, one needs the capacity to experience life in order to become a moral patient. In other words, recasting silence as a capability actually conforms to, rather than challenges, a typical strategy in animal rights discourses.What is at stake in this story is also the power of the secret. In her chapter on literature and the secret, Seshadri articulates different ways the secret manifests itself in literature. She writes, "literature is allied to the secret because it emerges from what is suspended (for example, meaning, truth, the word, a determinate context) and therefore can only be read and interpreted as a sign" (Seshadri 2012, 46–47). Literature always harbors secrecies because its interpretation is never exhaustive. In this sense, language itself is also secretive because meaning is necessarily excessive of the sign. In a paradoxical way, every time we speak, we are necessarily withholding.I will say more about secrets and silence as a mode of resistance in the context of animal advocacy at the end of my commentary. For now, I want to turn to Seshadri's excellent discussion on "naming" and hospitality. Specifically, I want to connect it to questions of secrecy and resistance... (shrink)

In this essay, I analyze various ways in which pregnant bodies are rendered consumable. Tracing our preoccupation with pregnancy diets, I argue that a pregnant woman is made responsible for producing a consumable body. Indeed, producing and maintaining a consumable, fetus-friendly body is a responsibility that women carry before, during, and even after pregnancy. The sphere of this responsibility is also ever-expanding: it goes from detoxing the body to disinfecting the household, and even to protecting the environment at large. I (...) examine two conditions that help construct the maternal body as consumable: 1) the invisibility of the consumed body, and 2) the appeal to “nature” as a justification for consumption. As I will show, the default position of women as consumable is reinforced both by erasing the maternal body and by appealing to the “naturalness” of breastfeeding. (shrink)

This paper is based on linked qualitative studies of the donation of human embryos to stem cell research carried out in the United Kingdom, Switzerland, and China. All three studies used semi-structured interview protocols to allow an in-depth examination of donors’ and non-donors’ rationales for their donation decisions, with the aim of gaining information on contextual and other factors that play a role in donor decisions and identifying how these relate to factors that are more usually included in evaluations made (...) by theoretical ethics. Our findings have implications for one factor that has previously been suggested as being of ethical concern: the role of gratitude. Our empirical work shows no evidence that interpersonal gratitude is an important factor, but it does support the existence of a solidarity-based desire to “give something back” to medical research. Thus, we use empirical data to expand and refine the conceptual basis of bioethically theorizing the IVF–stem cell interface. (shrink)

This chapter examines the ways in which disabled people are subject to epistemic injustice. It starts by introducing how social epistemology models the creation of shared knowledge and then uses feminist epistemology to highlight the role of social and political power in producing epistemic privilege, exclusion, and oppression. The well-known concepts of testimonial and hermeneutic epistemic injustice are discussed in relation to disability, showing how these forms of injustice are frequently experienced within the lives of disabled people. In particular, disabled (...) experience has features that distinguish it from the experiences of sexism and racism most commonly used as illustrations of epistemic injustice. The chapter ends by arguing that the potential for epistemic injustice poses unprecedented risks for disabled people in the current context, which could be minimized by recognizing that ignorance about disabled lives is not inevitable, but something that can and should be challenged. (shrink)

In this paper I consider one effect that disablism has on social interactions between nondisabled and disabled people: the “hidden labor” carried out by disabled people to manage or manipulate the presentation of their impairment to others, and their own and others’ emotional responses, in order to achieve their goals. Although such management may be understood as actively enhancing the disabled person’s autonomous agency, I argue that the cost of this labor to the disabled person and the fact that it (...) must be hidden from the nondisabled partner in order to be effective, create an ethical problem. Such interactions confer a form of autonomy through a connection that is fundamentally distorted by asymmetries of power, knowledge, risk, and is therefore ethically undesirable. (shrink)

Philosophically grounded, methodologically sound, and theoretically rigorous, this paradigm-challenging collection ponders the most dynamic areas of feminist inquiry into bioethical thought and practice and sketches future directions for this rapidly growing field.

Kim Q. Hall, Feminist disability studies, Bloomington: Indiana University Press, 2011, reviewed by Jackie Leach Scully.