While positive information in the context of clinical care can lead to placebo effects, negatively framed information can have negative or nocebo effects. Extant literature documents how doctor–patient encounters are fertile ground for suboptimal interactions leading to negative experiences for ethnoracial minority patients. In their _JME_ paper, Blease presents a critical perspective on the potential for patients’ access to their doctors’ clinical notes, ‘open notes’, to engender nocebo effects. 1 In this commentary, we affirm the central claim that nocebo effects (...) could emerge ‘via negative wording or framing of health information expressed by clinicians in documentation’. The advent of electronic health records (EHR) allowed patients the unprecedented opportunity to access personal clinical documentation, giving them a window into decision making around their health. This shift is undoubtedly complex, and thus warrants a more fulsome rendering of the unique challenges faced by ethnoracial minority patients. Herein, we highlight three... (shrink)

We propose to expand the conversation around moral enhancement from direct brain-altering methods to include technological means of modifying the environments and media through which agents can achieve moral improvement. Virtual Reality (VR) based enhancement would not bypass a person’s agency, much less their capacity for reasoned reflection. It would allow agents to critically engage with moral insights occasioned by a technologically mediated intervention. Users would gain access to a vivid ‘experience machine’ that allows for embodied presence and immersion in (...) a virtual world that meaningfully replicates relevant aspects of real life. We explore how VR can train empathy and foster moral growth in complex ways that would be inaccessible even for traditional moral education. Virtual Reality Perspective Taking is a unique medium for making empathy more reflective. (shrink)

This paper explores how Deleuze and Guattari's philosophical concepts extend and elaborate discursive and psychoanalytic interpretations of qualitative research findings. Analyzing data from a UK research project exploring young people's engagements with Social Networking Sites (SNSs), Deleuze and Guattari's schizoanalytic method is drawn upon to consider complex desire-flows in the social. In particular the notion of ‘affective assemblages’ is developed to explore the relationships between school and online spaces and subjective interfacing with these spaces. The paper suggests online space is (...) heterosexually striated and SNSs create new intensified gendered and sexualized identities and affective relations between young people. Investigating the case study of a teen girl, Louise, who is socially rejected through the affective assemblage of the SNS, then pathologized at school for violently retaliating against being called a ‘fat slag’ online, the paper suggests a Deleuzoguattarian analysis offers new theoretical tools for thinking about discursive subjectification but also for mapping complex desire-flows and micro movements through and against discursive/symbolic norms. (shrink)

Recent feminist theorizing has pointed to a `resurgent patriarchy' within neo-liberal postfeminist times, which re-orders and restabilizes the heterosexual matrix through a politics of `postfeminist masquerade' demanded of girls and women (McRobbie). This paper seeks to complicate this thesis, exploring the regulation and rupture of Butler's `heterosexual matrix' as a complex performative politics through which girls' conflictual relationships with themselves, and other girls and boys are staged and through which dominant versions of tweenage and teenage femininity are reinscribed but also (...) reworked, in race and class specific ways. Drawing on Deleuze and Guattari's powerful conceptual repertoire for disrupting Oedipal logics in Anti-Oedipus, we offer a `molecular mapping', illustrating cracks and ruptures in what is a porous heterosexual matrix, exploring a rhythm of `deterritorializations' and `reterritorializations' of the normative in our respective ethnographic and narrative interviews with girls. We also trace more sustained ruptures of heteronormative femininity drawing upon Deleuze and Guattari's notion of `lines of flight' and Braidotti's concept of `alternative figuration'. We argue ruptures and alternative figurations are not constitutive of total `molar' resistance to norms, but are significant spaces of doing girl differently and crucial to map if we are to perceive the malleability and multiplicity of contemporary girl subjectivities, which exceed heteronormative femininity and phallogocentric desire. (shrink)

In his still-authoritative history of science essay, Kuhn showed that scientific discoveries commence with awareness of anomaly that researchers initially struggle to notice. Kuhn drew on a psychological study to illustrate the problem. Bruner and Postman asked people to name playing cards on brief exposure. Most cards were normal, but some were anomalous, such as a red six of spades and a black four of hearts. On brief exposure all participants fitted the anomalous cards unhesitatingly into their existing cognitive scheme, (...) identifying them as, for example, a six of spades or a four of hearts. With longer exposures subjects began to hesitate: ‘That’s a six of... (shrink)

In this anthology of new and classic articles, fifteen noted feminist philosophers explore contemporary ethical issues that uniquely affect the lives of women. These issues in applied ethics include autonomy, responsibility, sexual harassment, women in the military, new technologies for reproduction, surrogate motherhood, pornography, abortion, nonfeminist women and others. Whether generated by old social standards or intensified by recent technology, these dilemmas all pose persistent, 'nagging,' questions that cry out for answers.

The arts of rule cover the exercise of power by princes and popular sovereigns, but they range beyond the domain of government itself, extending to civil associations, political parties, and religious institutions. Making full use of political philosophy from a range of backgrounds, this festschrift for Harvey Mansfield recognizes that although the arts of rule are comprehensive, the best government is a limited one.

The contribution of this book to the field of reconciliation is both theoretical and practical, recognizing that good theory guides effective practice and practice is the ground for compelling theory. Using a Girardian hermeneutic as a starting point, a new conceptual Gestalt emerges in these essays, one not fully integrated in a formal way but showing a clear understanding of some of the challenges and possibilities for dealing with the deep divisions, enmity, hatred, and other effects of violence.

Concerns over the organising of food are widespread, stemming from unsustainable production practices that focus on extractive ‘use’ of resources that privilege wealth creation over planetary flourishing, care and well-being. We propose a conceptual framework based on _ecologies of care_ to assist in the re-entanglement of food systems. The concept of ecologies of care brings together theoretical understandings of relationality, ecology and care, along with an Aotearoa New Zealand indigenous Māori perspective. We examine how food production can be underpinned by (...) interdependent webs of relationships (whanaungatanga), stewardship (kaitiakitanga), and care and support (manaakitanga) with healthy land and healthy people at the core of organising. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

For stem cells, life is full of potential: they have a high capacity to proliferate and a wide choice of future identities. When they differentiate, cells leave behind this freedom and become ever more committed to a single fate. Intriguingly, the Polycomb and Trithorax groups of proteins are vital to the very different natures of both stem cells and differentiated cells, but little is known about how they make the transition from one cell type to the other. A recent paper1 (...) throws light on this mystery, showing that the Polycomb proteins dramatically change their behaviour at a crucial moment of differentiation. BioEssays 28: 330–334, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

In this article we take off from critiques of psychological and school bullying typologies as creating problematic binary categories of bully and victim and neglecting sociocultural aspects of gender and sexuality. We review bullying research informed by Judith Butler’s theories of discursive performativity, which help us to understand how subjectification works through performative repetitions of heterosexual gender norms. We then build on these insights drawing on the feminist new materialist approach of Karen Barad’s posthuman performativity, which we argue enlarges our (...) scope of inquiry in profound ways. Barad’s theories suggest we move from psychological models of the inter-personal, and from Butlerian notions of discursive subjectification, to ideas of discursive-material intra-action to consider the more-thanhuman relationalities of bullying. Throughout the article, we demonstrate the approach using examples from qualitative research with teens in the UK and Australia, exploring nonhuman agentic matter such as space, objects and time as shaping the constitution of gender and sexual bullying events. Specifically we examine the discursive-material agential intraactions of skirts and hair through which ‘girl’ and ‘boy’ and ‘slut’ and ‘gay’ materialise in school spacetimematterings. In our conclusion we briefly suggest how the new materialism helps to shift the frame of attention and responses informing gendered intraactions in schools. (shrink)

In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...

New coverage of the recent wars in Afghanistan and Iraq, and the ensuing public education campaigns by the Department of Veterans Affairs and private veterans advocacy groups combine to call the public's attention to the many potential mental health problems associated with traumatic event exposure. Indeed, since 2001, Operation Iraqi Freedom and Operation Enduring Freedom combat and peacekeeping missions have been characterized by high levels of exposure to acts of extreme violence, with often gruesome effects. Less publically discussed is the (...) fact that a surprisingly large number of United States civilians also report exposure to traumatic events, such as severe interpersonal violence, natural disasters, and serious automobile accidents. In fact, approximately 70% of randomly sampled respondents indicated that they have experienced an incident characterized by significant perceived life threat at some point during their lives. (shrink)

Polycomb response elements (PREs) are regulatory switch elements that can direct the genes that they control to be either active or silenced. Once decided, this on or off state is maintained through subsequent cell divisions. We do not know how the switching works, or how it is copied to newly replicated chromosomes. Experiments that switch a silenced PRE to an active state have provided insights into both questions. A PRE switched experimentally can remember its previously silenced state and return to (...) it after several cell divisions. In the most recent study of this phenomen on,(1) the data show that several distinct variables affect the ability of PREs to “remember” and restore their previous state. The authors' interpretation of these results is discussed here. BioEssays 23:566–570, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...) of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Indeterminate Bodies organizes a number of theoretical and empirical studies around the concept and actuality of indeterminacy, as it relates to body and society. Located within the struggle to apprehend different categories of ‘body’ in the volatile flows of late-capital, indeterminacy is considered through such multiple incarnations as economy, contingency, inheritance, question, force, uncertainty, materiality and affective resistance to determination. While indeterminacy is often positioned as the ‘trouble’ or friction in subject/object knowledge-formation (framed as ontological or empirical challenge), it also (...) engenders affects such that some subjects are both in and out of recognition. Questions of indeterminacy overlap with work on imperceptibility, giving rise to interlocked questions about the modes of representation, categorization, inclusion, exclusion and sensibility in the production of bodies. We address the hesitancies, difficulties and necessities of working with and through indeterminacy in order open up new descriptions, visions and modes of political work. (shrink)

This special issue advances arguments for an examples of socially relevant and socially engaged philosophy of science. -/- The introduction (Fehr & Plaisance) provides an argument for a more socially relevant philosophy of science (SRPOS). Their aims are to characterize this body of work in philosophy of science, to argue for its importance, and to demonstrate that there are significant opportunities for philosophy of science to engage with and support this type of research. The impetus of this project was a (...) keen sense of missed opportunities for philosophy of science to have a broader social impact. Fehr & Plaisance illustrate various ways in which SRPOS can provide social benefits, as well as benefits to scientific practice and philosophy itself. Also, SRPOS is consistent with some historical and contemporary goals of philosophy of science. They call for an expansion of philosophy of science to include more of this type of work. In order to support this expansion, they characterize philosophy of science as an epistemic community and examine the culture and practices of philosophy of science that can help or hinder research in this area. (shrink)

Philosophers of science are increasingly arguing for the importance of doing scientifically- and socially-engaged work, suggesting that we need to reduce barriers to extra-disciplinary engagement and broaden our impact. Yet, we currently lack empirical data to inform these discussions, leaving a number of important questions unanswered. How common is it for philosophers of science to engage other communities, and in what ways are they engaging? What barriers are most prevalent when it comes to broadly disseminating one’s work or collaborating with (...) others? To what extent do philosophers of science actually value an engaged approach? Our project addresses this gap in our collective knowledge by providing empirical data regarding the state of philosophy of science today. We report the results of a survey of 299 philosophers of science about their attitudes towards and experiences with engaging those outside the discipline. Our data suggest that a significant majority of philosophers of science think it is important for non-philosophers to read and make use of their work; most are engaging with communities outside the discipline; and many think philosophy of science, as a discipline, has an obligation to ensure it has a broader impact. Interestingly, however, many of these same philosophers believe engaged work is generally undervalued in the discipline. We think these findings call for cautious optimism on the part of those who value engaged work—while there seems to be more interest in engaging other communities than many assume, significant barriers still remain. (shrink)

The United States considers educating all students to a threshold of adequate outcomes to be a central goal of educational justice. The No Child Left Behind Act introduced evidence-based policy and accountability protocols to ensure that all students receive an education that enables them to meet adequacy standards. Unfortunately, evidence-based policy has been less effective than expected. This article pinpoints under-examined methodological problems and suggests a more effective way to incorporate educational research findings into local evidence-based policy decisions. It identifies (...) some things educators need to know and do to determine whether available interventions can play the right casual role in their setting to produce desired effects. It examines the value and limits of educational research, especially randomized controlled trials, for this task. (shrink)

This article explores the fit between the lived reality in entrepreneurial organizations and the Buddhist concept of the bodhisattva in order to see whether the juxtaposition of these two very different realities can shed light on the impact of spiritual values in the workplace. Semi-structured interviews were conducted with an array of entrepreneurs who have been practising Buddhists for over three years to see whether they were using core elements of this concept in their daily work and, if so, how (...) they experienced the value and impact of these notions. The interviews showed that it was very much a part of the participants’ daily work lives and seems to be a force in creating a happier, more nourishing work environment. All participants brought up the notion unasked and provided stories describing how their relationships at work were influenced by this and other fundamental aspects of their spiritual practice. The data have implications at the levels of both individual action and societal change. Buddhism has shown a strong ability to retain its core concepts while developing new practices as it moved from one culture to another over the centuries. Perhaps Western societies will prove to be as conducive an environment for the further evolution of Buddhist teachings as was eighth-century Tibet. As Tibet's unique form of aliveness was infused into Buddhism without changing the core constructs or values, perhaps what is alive about Western culture (such as entrepreneurialism) will nourish analogous new forms. (shrink)

Challenges current claims that humans ought to be vegetarians because animals have moral standing.

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, (...) we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice. (shrink)

Building upon Thornton's (1991) work on teachers as “curricular-instructional gatekeepers,” the author explores what guided the curricular decision-making for one novice teacher concerning controversial issues that center on race, social class, and lesbian, gay, bisexual, and transgender (LGBT) issues. Qualitative case study revealed context, student demographics, and teacher positionality as influencing this teacher's choices regarding these themes in her curriculum. Findings indicated that this teacher was willing and able to challenge racist views in her classroom when she was a student (...) teacher and her students more closely mirrored her own race and social class. When she was a full-time teacher of students who were of a different racial and class background, she was unable to similarly challenge their homophobic beliefs. Implications for teacher education are discussed. (shrink)

Abstract The strength of a discipline is reflected in the development of a set of concepts relevant to its practice domain. As an evolving professional discipline, nursing requires further development in this respect. Over the past two decades in North America there have emerged three different approaches to concept analysis in nursing scholarship: Wilsonian-derived, evolutionary, and pragmatic utility. The present paper compares and contrasts these three methods of concept in terms of purpose, procedures, philosophical underpinnings, limitations, guidance for researchers, and (...) ability to contribute to nursing knowledge and disciplinary advancement. This work extends prior criticisms of concept analysis methods, especially as formulated by Morse and colleagues, by promoting further critical discussion regarding the direction and effectiveness of nursing efforts to meet the basic needs of disciplinary development. Its central thesis is that nursing concept analysis must advance beyond the Wilsonian-derived methods of Walker and Avant by devoting greater attention to understanding the domain of concepts to be analysed and deriving features from these contexts. (shrink)

Lodged in an impasse between questions of environmental justice and modes of capitalisation in the green economy, indeterminacy is a vulnerable and porous relation. Pollution activates a potentiality in the organism to be otherwise, to generate certain kinds of tumours, mini-deaths or mutations. Toxicity has an intermediary status that launches a mobility of effects that is often fragmented through sense organs, affirming forms of non-identity in biopolitical relations. Organisms are receptive to such bodily reconfigurations precisely because they are open to (...) the material communication of the world. In contrast to the “hidden labour” of indeterminacy in capitalist modes of capture, this article crafts an analytics of indeterminacy as an interjection in the politics of environments. Through dispersants in the Gulf of Mexico and military bees, two economies of indeterminacy are discussed. Drawing on Georges Bataille’s notion of political economy, I argue that what is required is an economy of radical inequivalence; an excessive engagement with the possibilities of indetermining forces to make fleeting marks. (shrink)

It is argued that the question of whether or not one is required to be or become a strict vegetarian depends, not upon a rule or ideal that endorses vegetarianism on moral grounds, but rather upon whether one's own physical, biological nature is adapted to maintaining health and well-being on a vegetarian diet. Even if we accept the view that animals have rights, we still have no duty to make ourselves substantially worse off for the sake of other rights-holders. Moreover, (...) duties to others, such as fetuses and infants, may require one to consume meat or animal products. Seven classes of individuals who are not required to be or become vegetarians are identified and their examption is related to nutritional facts; these classes comprise most of the earth's population. The rule of vegetarianism defines a special or provisional duty rather than any general or universal rule, since its observance it based upon the biological capacities of individual humans whose genetic constitution and environment makes them suitably herbivorous. It is also argued that generalizing the vegetarian ideal as a social goal for all would be wrongful because it fails to consider the individual nutritional needs of humans at various stages of life, according to biological differences between the sexes, and because it would have the eugenic effect of limiting the adaptability of the human species. The appeal to the natural interests of omnivores will not justify any claim that humans may eat amounts of meat or animal products in excess of a reasonable safety margin since animals have rights-claims against us. (shrink)

Concerns about non-participation in lifelong learning may indicate an emerging moral authoritarianism arising from pessimism about the future. Low expectations of potential for social progress, human agency and learners' motivation to take part in formal learning, exacerbate moves towards a 'minimalist pedagogy' regulated by government agencies and encourages the idea that lifelong learning should be compulsory for adults 'at risk'.