In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

The allocation of critical care resources and triaging patients garnered a great deal of attention during the COVID-19 pandemic, but there is a paucity of guidance regarding the ethical aspects of resource allocation and patient prioritization in ‘normal’ circumstances for Canadian healthcare systems. One context where allocation and prioritization decisions are required are surgical waitlists, which have been globally exacerbated due to the COVID-19 pandemic. In this paper, we detail the process used to develop an ethics framework to support prioritization (...) for elective surgery at The Hospital for Sick Children, Toronto, a tertiary pediatric hospital. Our goal was to provide guidance for the more value-laden aspects of prioritization, particularly when clinical urgency alone is insufficient to dictate priority. With this goal in mind, we worked to capture familial, relational, and equity considerations. As part of our institution’s concerted efforts to ethically and effectively address our surgical backlog, an ethics working group was formed comprising clinicians from surgery, anesthesiology, intensive care, a hospital bioethicist, a parent advisor, and an academic bioethics researcher. A reflective equilibrium process was used to develop an ethics framework. To this end, the same methodology was used to create a support for patient prioritization that identifies clinically and morally relevant factors for prioritization among medically similar surgical cases, with a substantive goal being to identify and redress health inequities in surgical prioritization, inasmuch as this is possible. While further steps are needed to validate several aspects of the framework, our research suggests that an ethics framework grounded in the practical realities of hospital operations provides consistency, transparency, and needed support for decisions that are often left to individual clinicians, as well as an opportunity to reflect upon the presence of health inequities in all domains of healthcare delivery. (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental illness as the (...) sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-me dical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.67695 04. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

Assumptions about obesity—e.g., its connection to ill health, its causes, etc.—are still prevalent today, and they make up what I call the medical model of fatness. In this paper, I argue that the medical model was established on the basis of insufficient evidence and has nevertheless continued to be relied upon to justify methodological choices that further entrench the assumptions of the medical model. These choices are illegitimate in so far as they conflict with both the epistemic and social aims (...) of obesity research. I conclude the paper with a partial solution to these epistemic and social shortcomings. (shrink)

Growing evidence suggests the presence of a female leadership advantage (FLA), such that women leaders tend to be associated with more effective outcomes in uncertain conditions. However, mechanisms linking women's leadership to effective outcomes are less well understood. We integrate FLA insights with ethics of care philosophical framework to conceptualize how women leaders achieve effective outcomes in the context of the urban revitalization crisis in the United States. We propose and empirically test the mediating role of ethics of care leadership (...) in the relationship between women mayors and economic health of their cities. We used data from the Urban Institute that includes 272 United States cities and measures of variables in our conceptual model at five points in time spanning 36 years (_n_ = 1185 city-year observations). We capture ethics of care leadership focused on racial inclusion with an index measure of a city’s racial spatial segregation, homeownership gap, poverty gap, and education gap, and we capture economic health with an index measure of a city’s employment growth, unemployment rate, housing vacancy rate, and median family income. We found that female-led cities were associated with better economic health, and this association was mediated by female-led cities’ association with greater racial inclusion. Ethics of care leadership appears to be one pathway through which a FLA manifests itself in the context of the urban revitalization crisis. This underscores the importance of city leadership that balances social and economic prerogatives. Implications are discussed. (shrink)

Recent findings regarding the cellular biology and immunology of BST‐2 (also known as tetherin) indicate that its function could be exploited as a universal replication inhibitor of enveloped respiratory viruses (e.g., influenza, respiratory syncytial virus, etc.). BST‐2 inhibits viral replication by preventing virus budding from the plasma membrane and by inducing an antiviral state in cells adjacent to infection via unique inflammatory signaling mechanisms. This review presents the first comprehensive summary of what is currently known about BST‐2 anti‐viral function against (...) respiratory viruses, how these viruses construct countermeasures to antagonize BST‐2, and how BST‐2 function might be targeted to develop therapies to treat respiratory virus infections. The authors address the current gaps in knowledge, including the need for mechanistic understanding of BST‐2 antagonism by respiratory viruses, that should be bridged to achieve that goal. (shrink)

PurposeThe purpose of this paper is to explore some of the influences that computer‐mediated communication has and could have on the maintenance of interpersonal relationships. In doing this, ethical dilemmas and implications that arise from the technical affordances offered to CMC participants are discussed. Relational maintenance is integral to people's everyday lives. Yet, the ethical issues involve in using CMC to support this have not been explicitly explored.Design/methodology/approachThe concept of relational maintenance will be explored independently and as it relates to (...) CMC and ethics. This paper will examine current literature and briefly discuss a pilot study relevant to these areas. The pilot study consisted of a survey distributed to undergraduate students in non‐platonic long distance and short distance relationships.FindingsThe exploration of prior literature and the findings of a pilot study support the notion that, with the increase of CMC use to maintain relationships follows the potential increase of unethical behavior in this medium. A number of ethical questions have risen that can be used to inform and direct future research.Originality/valueThis paper is original as it explores the concept of ethics from a relational maintenance perspective through electronic communication. It adds value by integrating these three areas and enhancing the understanding of this integration, while providing information of both theoretical and practical relevance. (shrink)

Extravagantly rich and exotic come to mind when thinking of the bygone world of Indian royalty, yet almost all of the 565 princely states abruptly and peacefully came to an end in 1947. In fact, the dazzling princely dress had come to represent subordination to the Queen of Britain. Because Indian rulers were unable to perform the princely duties of defending their state under colonial rule, Indian royalty directed their excess resources to the consumption of luxury goods. These goods, most (...) notably represented in their dress, came to symbolize the ruling class’s increasing incompetence in the governing of their states. (shrink)

Poor air quality is a pressing global challenge contributing to adverse health impacts around the world. In the past decade, there has been a rapid proliferation of air quality information delivered via sensors, apps, websites or other media channels in near real-time and at increasingly localized geographic scales. This paper explores the growing emphasis on self-monitoring and digital platforms to supply informational interventions for reducing pollution exposures and improving health outcomes at the individual level. It presents a technological case study (...) that characterizes emerging air quality information communication mechanisms, or ‘AQ channels’, while drawing upon examples throughout the literature. The questions are posed: which air quality channels are ‘freely’ available to individuals in London, UK, and when and where are they accessed? Digital trace data and metadata associated with 54 air quality channels are synthesized narratively and graphically. Results reveal air quality channels derive air pollution estimates using common data sources, display disparate messaging, adopt variable geographic scales for reporting ‘readings’ and maintain psychosocial barriers to access and adoption of exposure-reducing behaviours. The results also point to a clear association between the publication of a high-profile news article about air pollution and increased air quality channel access. These findings illuminate a need for greater transparency around how air quality channels generate personalized air pollution exposure estimates and tailor messaging. The paper concludes by calling for air quality channel developers to exercise co-creative methods that can support sustainable, democratic data and knowledge production around air quality, while critically approaching disproportionate patterns of both pollution and information exposure. (shrink)

This paper critically interrogates the anti-fat beliefs that are employed in environmental bioethics, particularly in response to climate change. Fat bodies have been associated with climate change because they are presumed to consume more resources and produce more greenhouse gas emissions. In this paper, we argue that such interpretations employ mistaken assumptions to justify placing disproportionate blame on already oppressed individuals, reinforcing weight stigma, which increases the vulnerability of fat people to a range of harms and disproportionately affects communities of (...) color. For these reasons, conceiving fat bodies as harmful to the environment is both misguided and unjust. (shrink)

The social and legal implications of forensic DNA are paramount. For this reason, forensic DNA enjoys ample attention from legal, bioethics, and science and technology studies scholars. This article contributes to the scholarship by focusing on the neglected issue of sameness. We investigate a forensic courtroom case which started in the early ’90s and focus on three modes of making similarities: creating equality before the law, making identity, and establishing standards. We argue that equality before the law is not merely (...) a principle but a practice. In the context of DNA research, equality refers to using standardized technology and procedures to identify the criminal suspect. Our case shows the work at stake in introducing a new technology into the courtroom and serves as a lens, magnifying how contingencies and uncertainties are managed and ordered in everyday court practices to arrive at an equal treatment of the suspect. (shrink)

We define balance games, which describe the formation of friendships and enmity in social networks. We show that if the agents give high priority to future profits over short term gains, all Pareto optimal strategies will eventually result in a balanced network. If, on the other hand, agents prioritize short term gains over the long term, every Nash equilibrium eventually results in a network that is stable but that might not be balanced.

Hans van Ditmarsch, Wiebe van der Hoek and Barteld Kooi (2011). Reasoning about local properties in modal logic. In K. Tumer and P. Yolum and L. Sonenberg and P. Stone (editors). Proceedings of the 10th International Conference on Autonomous Agents and Multiagent Systems (AAMAS 2011), pp. 711-718.

This article reviews recent work in socio-historical technology studies. Four problems, frequently mentioned in critical debates, are discussed—relativism, reflexivity, theory, and practice. The main body of the article is devoted to a discussion of the latter two problems. Requirements for a theory on socio-technical change are proposed, and one concrete example of a conceptual framework that meets these requirements is discussed. The second point of the article is to argue that present technology studies are now able to break away from (...) a too academic, internalistic perspective and return to the politically relevant "Science, Technology & Society" issues that informed much of this work more than a decade ago. (shrink)

In her 1927 diary, Simone de Beauvoir documents her intent to mix literary style with philosophical content. However, in Anglophone research environments, her works are formally classified as either literature or philosophy. This article questions the legitimacy of this classification by arguing that The Ethics of Ambiguity’s stylistic use of first-person plural narration, metaphor, conversational style, and parable help us understand ambiguity and freedom as necessarily embodied by invoking experiences of both phenomena.

This chapter contains sections titled: Constructivist Studies of Science and Technology The Origin and Development of the Social Construction of Technology The Social Construction of Technology as a Heuristics for Research Some Philosophical Questions Technology and Ideas Conceptual Issues Logic and Epistemological Issues Ethical Issues Issues of Political Philosophy Religious Issues References and Further Reading.

This paper attempts to reassess the educational affordances of digital screens, at a time when their educational impact has become incontournable, but is also increasingly growing suspicion. To bypass the redundancies of overly critical theoretical approaches, the paper foregrounds the subjectifying potentialities of the screen’s elusive technological ‘plasticity’. After the introduction, in which some pedagogical misgivings about the digital screen are addressed, we turn to Marie-José Mondzain’s historico-philosophical genealogy of iconoclasm. Trying to make sense of the aesthetic-political ambivalence that shrouded (...) the icon’s screenic agency within a Christian ‘economy of salvation’, and which climaxed in a politics of strictly economic equivalency, we concur with Peter Szendy that this ambivalence still haunts the icon’s contemporary heirs. By pedagogically re-reading Szendy’s alternative account of ‘iconomy’ we are subsequently led to make a case for exceeding neoliberal screening politics through an affirmation of the digital screen’s radical plasticity. Along with Yves Citton, we suggest, in our conclusion, that this post-critical affirmation calls for an ‘iconomical’ practice of care-ful experiments with the screen’s dynamic technologies. Instead of combating or adapting to its aesthetically dazzling algorithms, educational practices are required that allow these algorithmic quantities to qualitatively differentiate the uses that educands make of them. (shrink)

In this address to the president's plenary at the 2001 annual meeting of the Society for Social Studies of Science in Cambridge, Massachusetts, the author reflected on then recent international events and their possible implications for the research and teaching agendas of the social studies of science, technology, and medicine. He proposed the political engagement of science, technology, and society institutions and individual STS researchers while maintaining a strong commitment to the scholarly studies of science and technology. Drawing on the (...) work of René Gabriëls, the author elaborated a role for STS scholars as the new generation of “public intellectuals.”. (shrink)

Things are thick with politics. This essay illustrates the point by focusing on a variety of technologies that help to manage water: anicuts and tanks in India, dikes and a storm surge barrier in the Netherlands, and levees in New Orleans. Technologies are not only shaped by political forces; they also exert political force themselves: on social stratification in Indian villages or on government stability in the Netherlands. We should recognize, then, that the functioning of technologies and the functioning of (...) societies are intricately linked. The essay traces this interlinking by using the concept of “technological culture.” It argues that the different styles of coastal engineering in the United States and in the Netherlands can be explained by differences in their technological cultures, particularly the different styles of risk handling. This conclusion is then applied to the Indian case and to issues of development, democracy, and innovation. (shrink)

We study several modal languages in which some (sets of) generalized quantifiers can be represented; the main language we consider is suitable for defining any first order definable quantifier, but we also consider a sublanguage thereof, as well as a language for dealing with the modal counterparts of some higher order quantifiers. These languages are studied both from a modal logic perspective and from a quantifier perspective. Thus the issues addressed include normal forms, expressive power, completeness both of modal systems (...) and of systems in the quantifier tradition, complexity as well as syntactic characterizations of special semantic constraints. Throughout the paper several techniques current in the theory of generalized quantifiers are used to obtain results in modal logic, and conversely. (shrink)

Narrative passages told from a character's perspective convey the character's thoughts and perceptions. We present a discourse process that recognizes characters'.

We propose an epistemic logic in which knowledge is fully introspective and implies truth, although truth need not imply epistemic possibility. The logic is presented in sequential format and is interpreted in a natural class of partial models, called balloon models. We examine the notions of honesty and circumscription in this logic: What is the state of an agent that only knows and which honest enable such circumscription? Redefining stable sets enables us to provide suitable syntactic and semantic criteria for (...) honesty. The rough syntactic definition of honesty is the existence of a minimal stable expansion, so the problem resides in the ordering relation underlying minimality. We discuss three different proposals for this ordering, together with their semantic counterparts, and show their effects on the induced notions of honesty. (shrink)

Abstract:In this paper we reconceptualize general music education as a "classical music education," departing from speculative reflection on the notion of conducting. We constitute this notion as an interpretative axis connecting, on the one hand, a different perspective on what classical music might mean in the context of general education, and, on the other hand, a more dynamic, techno-ecological concept of both music and education. This paper develops these connections by thinking along with a concrete specimen of classical music in (...) the strict sense, Mahler's First Symphony, in order to show exactly how thinking about such works may actually take on an aspect that is classical in a more properly general educational sense. Beyond a dichotomy between aesthetical and praxial appraisals of the classical musical work, with their exclusive emphases on intelligible form and socio-critical praxis respectively, our idea of classical music education implies a dynamic (re)conducting of the works. Through practices of (re)conducting, music education can treat works, not as static monuments of eternal beauty or instances of socio-historical criticality, but as catalysts of self-differentiating, transhuman musical experiences—of playing, listening, composing, and thinking—in which human, instrumental, and other techno-ecological agencies mutually transform each other. (shrink)

This article applies a constructivist perspective to the analysis of a town-planning innovation. The so-called Cerdà Plan for the extension of Barcelona was launched in the 1860s and gave this city one of its most characteristic present features. For different reasons it can be considered an extraordinary case in town-planing history, though almost unknown to international scholars. The authors analyze the intense controversy that developed around the extension plan and the three technological frames involved. Finally, the relationship between power and (...) technology is discussed. The sociohistorical account is used to illustrate a specific concept of power, to be used in a politics of technology. (shrink)

The Kantian ethical position, especially as represented in Alan Donagan, rejects the possibility of unavoidable blameworthiness. Donagan also holds that morality is learned by participation. But consider: there must be some first instance of an agent’s being held blameworthy. To hold the agent blameworthy in that instance supposes that the agent could have known what morality required so as to be able to avoid blameworthiness. But before experiencing blameworthiness the agent can have no real understanding of the significance of morality’s (...) requiring anything, if morality is learned by participation. Hence the agent could not have known to avoid violating morality’s requirement. The agent could not have knowingly avoided being blameworthy in the first instance of blameworthiness, as he or she would not understand the significance of doing so. This is unavoidable blameworthiness. (shrink)

The early essays in this volume proceed on the assumption that a compatability system can be fashioned that will not only bring religious knowledge claims into harmony with scientific claims, but will also show there to be a fundamental similarity of method in religious and scientific thinking. They are not, however, unambiguously successful. Consequently Wiebe sets out in the succeeding essays to seek an understanding of the religion/science relationship that does not assume they must be compatible. The examination, in (...) the final analysis, reveals a fundamental contradiction in the compatability system building programme which suggests that religious belief is beyond legitimation. (shrink)

In this paper I try to 'rethink' consistency as an educational quality for the 3rd millennium, following Italo Calvino's choice to take it up in his lecture series Memos for the Next Millennium, and despite the fact that the (final) lecture devoted to this quality remained unwritten. After reflecting on how consistency already plays a certain role in Calvino's other lectures, I expand on the specific educational implications of this role's unresolved ambivalence, in order to argue that this ambivalence, properly (...) understood, might be fully constitutive of the educational significance of consistency. To achieve such an understanding I turn to Gilles Deleuze and his concept of style as a 'practice' of consistency. Not only does a stylistic understanding of consistency offer interesting possibilities for a more constructive approach to the said ambivalence—between consistency as static stability and dynamic keeping-together- but as such it also speaks to a number of issues that are directly and fundamentally educational in nature. (shrink)

ABSTRACTIn this paper we explore the possibility of rethinking the concept of emotional intelligence within the context of education. By developing a pedagogical dialogue with Michel Henry’s phenomenology of incarnation, we try to move beyond existing models of emotional intelligence by shifting the emphasis from the intellectual significance of emotion to a more original incarnate affectivity within intelligence, understood as lived sense-making. We claim that this ontological and ontogenetic perspective on emotion puts it at the heart of education. Yet only (...) because it evokes an understanding of education which is expressly non-functionalist: a disruptive, even dreadful event that marks the threshold and tension between what Henry terms Life and World. More than simply learning us to manage our emotions or recognize the value of experiences, emotional intelligence is about the very making of World out of Life, a Life that is at once radically subjective and communal. (shrink)

Ever since its publication in 1947, Thomas Mann's Doktor Faustus,1 his last major novel, has triggered many discussions and scholarly analyses. Evidently, the fictitious life story of Adrian Leverkühn, the genius composer who strikes an unsavory bargain with the devil, abounds in literary artifice and ingenuity, drawing to that end from a nigh bottomless reservoir of extremely variegated cultural references.2 Leaving out strictly literary analyses, most critical attention for Mann's version of the Faust myth is centered on its politico-aesthetical motifs—its (...) allegedly strong Nietzschean-Adornian bias.3 This is understandable, not only considering Mann's vocal interest in these philosophical traditions but also... (shrink)

ABSTRACT In this article I venture the hypothesis that music confronts education with the possibility to think violence in ways that are both inherently educational and radically affirmative. Beginning with a reflection on a poem by Elizabeth Barrett Browning, which emphatically evokes the violence within the genesis of music, I then move in a different direction in the second section, which surveys how extant (music-) educational has thematized violence so far. Concluding that this thematization, notwithstanding many nuances, invariably implies a (...) negative validation of violence, I devote the third section to a search for more affirmative concepts of educational violence. Eventually, this culminates in a return to the issue of a possibly intrinsic, positive relation between violence and music education. I first discuss this possibility more generally, connecting the discussed affirmative concepts of violence to the antipodal music-educational ideas of Plato and Nietzsche. Finally, in the last section, returning to Browning’s poem, I specify it by reclaiming the particular violence of music’s instrumental aspects for music education. (shrink)

This paper discusses Christic visions as a significant kind of religious experience requiring explanation. It is based upon research published in ‘Visions of Jesus: Direct Encounters for the New Testament to Today’ , in which I draw on information obtained from 30 living visionaries, using 21 categories to classify their experiences, including 15 phenomenological ones. Proposed explanations can be plausibly classified as falling into three broad categories: supernaturalistic, mentalistic and neurophysiological. I argue that no single explanation in any of these (...) broad classes can adequately account for the detailed phenomena reported by visionaries. I demonstrate the ineffectiveness of mentalistic explanations, including several made popular by well-known psychologists, and argue that they cannot be improved without adverting to neurophysiological concepts. I argue that one of the most advanced neurophysiological explanations developed by recent psychiatric researchers cannot account for a particular kind of experience frequently reported in vision experiences. I also show that well-known supernaturalistic explanations for Christic visions do not provide adequate explanations, and identify some of the features of such visions that continue to tempt percipients toward supernaturalism. (shrink)

The Chinese Love Story from the Tenth to the Fourteenth Century. By Alister D. Inglis. Albany, NY: State University of New York Press, 2023. Pp. xiv + 271. $99 (cloth); $36.95 (paper).

In this article we want to rethink the educational significance of the novel from the perspective of a ‘metanovelistic’ reading of Don Quixote, often acclaimed as the ‘first modern novel’. Our point of departure is two-fold: on the one hand, there is the controversial contemporary phenomenon of de-reading, and all the educational discussions it entails; on the other hand, there is the existing tradition of literary education, which has already extensively reflected upon the (moral, epistemological, ontological) relations between novel reading, (...) education, and subjectification, but which perhaps also has exhausted its means for doing so. To problematize this double starting point in a new way, we propose to revisit the ‘origins’ of the (Western) novel and novel reading, at the dawn of modernity. Exploring the differences between the narratives of subjectification represented by the Cartesian cogito and Cervantes’ Don Quixote—which were near-contemporaries—we strongly argue for an educational–philosophical rehabilitation of the latter. In a first movement, and in dialogue with novelists Milan Kundera and Carlos Fuentes, we do so by focusing on the novel as a particular form or configuration of knowledge—one that is by nature experimental and pluralist. In a second movement, we link this to Jean Baudrillard’s famous distinction between ‘simulation’ and ‘illusion’, claiming that novel reading qua educational subjectification always involves a quixotic practice of adventurous, ‘playful’, and public negotiation between reality and its more or less illusory alternatives. (shrink)

Accession Number: ATLA0001712249; Hosting Book Page Citation: p 503-522.; Language(s): English; General Note: Bibliography: p 519-522.; Issued by ATLA: 20130825; Publication Type: Essay.

At the occasion of the annual banquet of the Society for Social Studies of Science, the President commemorated Robert K. Merton, Dorothy Nelkin, and David Edge, who all died in 2003. The address highlights some of the contributions of these three scholars and past presidents to the development of the social studies of science, and to 4S.