This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question ‘when health professionals and parents disagree about the appropriate course of medical treatment for a child, under what circumstances is the health professional ethically justified in overriding the parents’ wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. (...) Each of these frameworks centred on a different key moral concept including harm, constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. (shrink)

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

Presently, there is a movement in the UK research governance framework towards what is referred to as proportional ethical review. Proportional ethical review is the notion that the level of ethical review and scrutiny given to a research project ought to reflect the level of ethical risk represented by that project. Relatively innocuous research should receive relatively minimal review and relatively risky research should receive intense scrutiny. Although conceptually attractive, the notion of proportional review depends on the possibility of effectively (...) identifying the risks and ethical issues posed by an application with some process other than a full review by a properly constituted research ethics committee. In this paper, it is argued that this cannot be achieved and that the only appropriate means of identifying risks and ethical issues is consideration by a full committee. This implies that the suggested changes to the National Health Service research ethics system presently being consulted on should be strenuously resisted. (shrink)

Business and society researchers, as well as practitioners, have been critiqued for ignoring those with less voice and power often referred to as “fringe stakeholders.” Existing methods used in B&S research often fail to address issues of meaningful participation, voice and power, especially in developing countries. In this article, we stress the utility of visual participatory research methods in B&S research to fill this gap. Through a case study on engaging Ghanaian cocoa farmers on gender inequality issues, we explore how (...) VPR methods may be used by researchers to achieve more inclusive, and thus more credible, stakeholder research that can improve decision making within businesses. Furthermore, we argue that ingrained social and environmental problems tackled by B&S research and the unique context in which they occur may open up new opportunities to develop participatory visual methods for social change. (shrink)

A natural view is that linguistic understanding is a source of justification or evidence: that beliefs about the meaning of a text or speech act are prima facie justified when based on states of understanding. Neglect of this view is largely due to the widely held assumption that understanding a text or speech act consists in knowledge or belief. It is argued that this assumption rests, in part, on confusing occurrent states of understanding and dispositions to understand. It is then (...) argued that occurrent states of understanding are not states of belief of knowledge since a subject may fail to believe that a text or speech act means what she understands it to mean if she doubts the reliability or truth- fulness of that understanding. States of understanding, it is maintained, belong in the same epistemic category as states of perception and memory. (shrink)

Though largely neglected by philosophers, the concept of ineffability is integral to the Christian mystical tradition, and has been part of almost every philosophical discussion of religious experience since the early twentieth century. After a brief introduction, this article surveys the most important discussions of divine ineffability, observing that the literature presents two mutually reinforcing obstacles to a coherent account of the concept, creating the impression that philosophical reflection on the subject had reached an impasse. The article goes on to (...) survey some more recent work, which draws on the conceptual resources of existential phenomenology, pragmatism, and the later Wittgenstein. It shows that this work has made possible a new philosophical account of divine ineffability that surmounts the obstacles, overcomes the impasse and makes divine ineffability, once again, a live option in philosophy of religion. The article concludes with some brief remarks on how this alternative approach reflects recent trends in the discipline as a whole and has the potential to make a valuable contribution to live research questions in epistemology of religion. (shrink)

It is assumed that bipolarity in happiness and sadness requires mutual exclusion. However, we present psychometric research to show how coendorsements of happiness and sadness do not necessarily constitute evidence against bipolarity. Because individuals have a tendency to endorse emotion terms close to their current state, individuals whose current state is close to the middle of a bipolar continuum would report both happiness and sadness, despite their current state being best represented by a single point. As such, endorsements of happiness (...) and sadness are theoretically expected when individuals’ current state is in the middle of the continuum. Bipolarity however would be violated if endorsements of extreme levels of happiness and sadness can be demonstrated, which has yet to be shown. (shrink)

Do the results of scientific study of the physical world give us any inkling about the value of doing metaphysics? Or is the construction of a philosophy of everything upon the insights of science building on sinking sand? With Matt Hunter, Natasha Kyburg, and Farzad Mahootian.

In the first two sections of this reply article, I provide a brief introduction to the topic of ineffability and a summary of Ineffability and Religious Experience. This is followed, in section 3, by some reflections in reply to the response articles by Professors Metz and Cooper. Section 4 presents some concluding remarks on the future of philosophy of religion in the light of the most recent philosophical work on ineffability.

In this book, leading Christian political thinkers and practitioners critique the Rawlsian concepts of “justice as fairness” and “public reason” from the perspective of Christian political theory and practice. It provides a new level of analysis from Christian perspectives, including implications for such hot topics as the culture war.

To approach philosophy as a way of working on the self means to begin not with the experience it clarifies and the subject it discovers, but with the acts of self‐transformation it requires and the subjectivity it seeks to fashion. Commenting on the variety of spiritual exercises to be found in the ancient schools, Pierre Hadot remarks that: Some, like Plutarch’s ethismoi, designed to curb curiosity, anger or gossip, were only practices intended to ensure good moral habits. Others, particularly the (...) meditations of the Platonic tradition, demanded a high degree of mental concentration. Some, like the contemplation of nature as practiced in all philosophical schools, turned the soul toward the cosmos, while still others—rare and exceptional—led to a transfiguration of the personality, as in the experiences of Plotinus. We also saw that the emotional tone and notional content of these exercises varied widely from one philosophical school to another: from the mobilization of energy and consent to destiny of the Stoics, to the relaxation and detachment of the Epicureans, to the mental concentration and renunciation of the sensible world among the Platonists.1 While successfully applied to ancient philosophy,2 this approach has not been widely exploited in the history of philosophy more broadly. There is, however, at least one study of medieval metaphysics in these terms,3 and there are some important discussions of early modern Stoicism and Epicureanism.4 And a recent study of Hume shows the fruitfulness of the approach for Enlightenment philosophy.5 It is all the more surprising then that there seems to have been no serious attempt to approach Kant’s moral philosophy in this way. (shrink)

This paper looks at the issue of consent from children and whether the test of Gillick competency, applied in medical and healthcare practice, ought to extend to participation in research. It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. The question of who would and could determine Gillick competency in research raises further concerns relating to the training of the researcher to make (...) such a decision as well as to the obvious issue of the researcher’s personal interest in the project and possibility of benefiting from the outcome. These could affect the judgment of Gillick competency if the researcher is charged with making this decision. The above notwithstanding, there are two exceptional research situations in which Gillick competency might be legitimately applied: when the research is likely to generate significant advantages for the participants while exposing them to relatively minor risks, and when it is likely to generate great societal benefit, pose minimal risks for the participants and yet raise parental objection. In both cases, to ensure that autonomy is genuinely respected and to protect against personal interest, Gillick competency should be assessed by an individual who has no interest or involvement in the research. (shrink)

In this paper, I plan to show that the use of a specific population concept—Millstein’s Causal Interactionist Population Concept (CIPC)—has interesting and counter-intuitive ramifications for discussions of the reality of biological race in human beings. These peculiar ramifications apply to human beings writ large and to individuals. While this in and of itself may not be problematic, I plan to show that the ramifications that follow from applying Millstein’s CIPC to human beings complicates specific biological racial realist accounts—naïve or otherwise. (...) I conclude with the notion that even if biological races do exist—by fulfilling all of the criteria needed for Millstein’s population concept (which, given particular worries raised by Gannett (Synthese 177:363–385, 2010), and Winther and Kaplan (Theoria 60:54–80, 2013) may not)—the lower-bound limit for the scope of biological racial realism is at the level of populations, and as such they cannot say anything about whether or not individual organisms themselves have races. (shrink)

In this brief paper I intend to make some distinctions between the activities that research ethics committees are required to undertake as part of their role in protecting research participants. These functions are, identifying ethical issues and risks within research projects, providing advice on how to resolve these issues and risks without compromising the validity of the research and finally, when this cannot be achieved, deciding whether the research should still be allowed to go ahead. Distinguishing these distinct functions allows (...) us to determine what an appropriate membership of a Research Ethics Committee is. I will sketch out the implications of these functions for the appropriate membership of NHS and university based ethics committees in the UK. (shrink)

Agricultural diversification in the Midwestern Corn Belt has the potential to improve socioeconomic and environmental outcomes by buffering farmers from environmental and economic shocks and improving soil, water, and air quality. However, complex barriers related to agricultural markets, individual behavior, social norms, and government policy constrain diversification in this region. This study examines farmer perspectives regarding the challenges and opportunities for both corn and soybean production and agricultural diversification strategies. We analyze data from 20 focus groups with 100 participants conducted (...) in Indiana, Illinois, and Iowa through a combined inductive and deductive approach, drawing upon interpretive grounded theory. Our results suggest that when identifying challenges and opportunities, participants center economics and market considerations, particularly income, productivity, and market access. These themes are emphasized both as benefits of the current corn-soybean system, as well as challenges for diversification. Additionally, logistical, resource and behavioral hurdles– including the comparative difficulty and time required to diversify, and constraints in accessing land, labor, and technical support– are emphasized by participants as key barriers to diversification. Agricultural policies shape these challenges, enhancing the comparative advantage and decreasing the risk of producing corn and soybeans as compared to diversified products. Meanwhile, alternative marketing arrangements, farmer networks, family relationships, and improved soil health are highlighted as important opportunities for diversification. We contextualize our findings within the theories of reasoned action and diffusion of innovation, and explore their implications for farmer engagement, markets, and agricultural policy, and the development of additional resources for business and technical support. (shrink)

In this paper, we develop an argument to show why we expect that multinational companies will ensure that they communicate credibly about their environmental responsibility, across all their subsidiaries. Credible environmental communication helps to increase the firm’s legitimacy and reduce its liability of foreignness on an issue that is globally relevant. We develop a measure to test if there is a standardized level of environmental communication credibility on the country-specific web sites of MNC subsidiaries around the world and find, in (...) fact, that there is considerable variation across countries, among subsidiaries of different firms and among subsidiaries of the same multinational. We discuss the reasons for this and the implications for firm legitimacy. (shrink)

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, (...) rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action. (shrink)

Rather than a history of seventeenth-century natural law, then, this chapter offers an outline of several different contextual uses of the language of natural law, as it was used in formulating the intellectual architecture for rival constructions of political and religious authority.

This corpus analysis of linguistic and semantic features in French parliamentary debates concerning online hate speech regulation, highlights tensions between state powers and private rights. Two key themes are identified: first, the _problem of definition_: how such online content is defined in the debates, and second, the _problem of regulation_: how the debates negotiate the supra-jurisdictional and individual jurisdiction issues involved, in regulating both the global online content and the responsibilities of the owners of the platforms who manage the content. (...) For this analysis, the authors created a corpus of French National Assembly Examination Committee discussions and public sessions between July 2019 to January 2020 discussing the _Loi Avia _(Avia Law). The corpus was analysed using quali-quantitative methods. Overall, the study combines a top-down (global) and a bottom-up (local) analysis of the data, applying corpus semantic approaches (Lecolle et al. in Langages 210(2):35–54, 2018; Rastier in The Routledge handbook of semantics, Routledge, pp 507–522, 2015) to contextualize the analysis of the meta-discourse (Hyland in Meta-discourse: exploring interaction in writing, 1st ed. Bloomsbury Academic, Bloomsbury Collections, 2018. https://doi.org/10.5040/9781350063617 ). The analysis highlights the linguistic features revealing the power dynamics inherent within the discourse and counter-discourse of the dominant and opposition political parties respectively. (shrink)

Many well-meaning “white” people adopt an antiracist agenda because we believe it provides the antidote to pernicious racialized inequity in the United States. Ironically, this schema maintains racism, strengthens whiteness as the measure of humanity, and inoculates us against imagining any alternative to racism’s logic. I argue that we can break the fetters of racism by framing whiteness as a principality and power. Perceived as a demonic force rather than an “identity,” we can perceive the goals of whiteness as well (...) as the spirituality that fuels it—and cast it out. We are then freed to “reinvent the future,” emancipated from racialized politics and its violence. (shrink)

The Nova Scotia Participatory Food Costing Project uses participatory action research to collect data on the cost and affordability of food and involves those who are directly affected by food insecurity. More than a decade of this work has also yielded qualitative evaluation data that illustrates the project participants' experience with the project and with food security more generally. The data are characterized by ample evidence of participants' perceived powerlessness related to government and social structures. At the same time, that (...) data indicate that playing a role in participatory processes seems to have served as an empowering experience for the participants. We highlight some of the findings here and situate them within critical literature on citizens' discourse. (shrink)

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed-for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected.

Ethical issues arise in the world’s first population-level treatment of severe lead poisoning caused by small-scale mining for gold in rural Nigeria. Emergency medical intervention and environmental cleanup have reduced the mortality in children younger than 5 years from lead poisoning from over 40 to 2.5 per cent leaving little evidence of the harms caused by lead poisoning. In the absence of obvious sequelae, family adherence to long-term intensive therapy to remove accumulated lead reservoirs in children wanes and some community (...) miners challenge safer mining interventions to prevent recontamination of the environment with lead. This letter raises questions regarding community versus individual rights in public health interventions and patient autonomy. (shrink)

I BEGIN THIS ESSAY BY EXAMINING HOW OUR "VIAGRA CULTURE"—ATAN-gled web of biotechnology, consumerism, and medicalization—creates an opening for patriarchy in our era. The second section examines how such large sociocultural forces invade women's bedrooms, impacting their intimate relationships. We then consider men who adopt a counternarrative to that of patriarchy and anxiety, whose sexuality is distinguished by tenderness and mutual regard. The essay closes with reflections on how the Viagra culture reminds us of the need to nurture the virtue (...) of generosity, a virtue that marks good sex and characterizes the lovers who practice it. (shrink)

Should we implement biomedical interventions like psychopharmaceuticals or brain stimulation that aim to improve morality in society? Since 2008, moral bioenhancement (MBE), has received considerable attention in bioethics, generating wide scholarly disagreement. However, reviews on the subject are few and either outdated or not structured in method. This paper addresses this gap by providing a scoping review of the last fifteen years of debate on MBE (from 2008 to 2022). To enhance clarity, we map the debate into three key areas: (...) the conceptual foundations of MBE (foundational questions), the practical feasibility of MBE (practical questions), and the normative legitimacy of MBE (normative questions). Beyond identifying specific research gaps within these domains, our analysis reveals a general lack of empirical evidence either supporting or opposing MBE, as well as a shift in the literature from a universal interpretation of MBE to a more pragmatic one, targeting specific groups. (shrink)

It is hard to think of a better subject for the exercise of retrospective analysis with which we are here concerned than Robert Boyle, the leading British scientist of his day, and arguably the most significant before Newton. A prolific and influential author, Boyle was lionized in his time both for his scientific achievement and for his piety and philanthropy. Of late, he has been the subject of attention from a variety of viewpoints which, as we shall see, raises the (...) issue of how he is best understood. In particular, I want to argue that, for all his eminence, there are complications about Boyle's personality that cry out for scrutiny, and it is on the implications of these that I will dwell in the latter stages of my paper.Boyle was born into one of the most privileged aristocratic families in England. His father, Richard Boyle, Earl of Cork, was Lord High Treasurer of Ireland before the Civil War, and Robert, the youngest – and, as he himself claimed, favourite – son, was brought up in an opulent, privileged setting, surrounded by servants and with an entrée at the royal court. His elder brothers were suave and active figures, only too ready to be involved in the fighting of the Civil War – in which one, Viscount Kinalmeaky, was killed, though two others, Lords Dungarvan and Broghill, survived to go on to high state office under both Cromwell and Charles II. This background undoubtedly had a significant influence on Boyle, giving him an aristocratic demeanour to which his contemporaries almost automatically deferred. It also made him familiar with the mindless social milieu of landed society, in which it was all too easy to ‘squander away a whole afternoone in tatling of this Ladys Face & tother Lady's Clothes; of this Lords being Drunke & that Lord's Clap; in telling how this Gentleman's horse outrun that other's Mare’. (shrink)

At the 5th International Conference on Priorities in Health Care in Wellington, New Zealand, 2004, one resonating theme was that for priority setting to be effective, it has to include clinicians in both decision making and the enforcement of those decisions. There was, however, a disturbing undertone to this theme, namely that doctors, in particular, were unjustifiably thwarting good systems of prioritising scarce healthcare resources. This undertone seems unfair precisely because doctors may, and in some cases do, feel obligated by (...) their professional ethics to remain uninvolved either in deciding priorities and in some cases in enforcing them. I will argue that the professional role of a doctor ought not be considered inconsistent with the role of a priority setter or enforcer, as long as one crucial element is in place, a rationally coherent and broadly justifiable regime for prioritising healthcare. Given this I conclude both that prioritisation and doctoring are not incompatible under certain conditions, and that the education of healthcare professionals ought to include material on distributive justice in healthcare. (shrink)

In his paper ‘Gesture Projection and Cosuppositions,’ Philippe Schlenker argues that co-verbal gestures convey not at-issue content by default and in particular, that they trigger conditional presuppositions. In this commentary, I take issue with both of these claims. Conditional presuppositions do not supply a systematic means for capturing the semantic contribution of a co-verbal gesture. Some gestures appear to contribute content inside of a negation when their associated speech content is likewise embedded; in other cases, co-verbal gestures arguably contribute unconditional (...) content to the global level. When this happens, we can infer what might look like a conditional presupposition, but this inference follows naturally from general principles already at work in purely verbal discourse and does not justify the claim that gesture content is contributed to a conditional presupposition. Problems exposed in the discussion of conditional presuppositions show that we are not yet in a position to make a general claim about the at-issue status of co-verbal gestures. (shrink)

Should we implement biomedical interventions like psychopharmaceuticals or brain stimulation that aim to improve morality in society? Since 2008, moral bioenhancement (MBE) has received considerable attention in bioethics, generating wide scholarly disagreement. However, reviews on the subject are few and either outdated or not structured in method. This paper addresses this gap by providing a scoping review of the last 15 years of debate on MBE (from 2008 to 2022). To enhance clarity, we map the debate into three key areas: (...) the conceptual foundations of MBE (foundational questions), the practical feasibility of MBE (practical questions), and the normative legitimacy of MBE (normative questions). Beyond identifying specific research gaps within these domains, our analysis reveals a general lack of empirical evidence either supporting or opposing MBE, as well as a shift in the literature from a universal interpretation of MBE to a more pragmatic one, targeting specific groups. (shrink)

Despite his significance in early modern Germany, where he was well-known as a political and moral philosopher, jurist, lay-theologian, social and educational reformer, Christian Thomasius (1655-1728) is little known in the world of Anglophone scholarship. 1 Unlike those of his mentor, Samuel Pufendorf, none of Thomasius's works was translated into English, when, at the end of the seventeenth century, English thinkers were searching for a final settlement to the religious question. None has been translated since. Moreover, while Thomasius has been (...) subject to increasing scholarly attention in Germany since the 1970s, where he has been treated largely as a representative of the "early Enlightenment," there is very little secondary literature on him in English. 2 Things are however beginning to change in this regard, with recent research already giving rise to important new Anglophone books and essays. 3 Knud Haakonssen's article on [End Page 595] Thomasius for the new Routledge Encyclopedia of Philosophy might well be a straw in the wind. (shrink)

This chapter aims to bring to the fore some of the ontological presuppositions that undergird the concepts of race and racism as they are used in public health. Included are discussions of differing accounts for race in public health, the ways in which racism is understood to be a public health issue, and where future research in public health, as it relates to the concepts of race and racism, is headed.

The novel represents a formal attempt to come to terms with innovation and originality and to accept the limitations of tradition; it reflects the larger cultural embracing of the present moment as a legitimate subject not only for passing conversation but for serious discourse. For at least a half century before the novel emerged, the world of print had experimented in assuming, absorbing, and exploiting that new cultural consciousness based on human curiosity—on the one hand “preparing” readers for novels and (...) on the other offering later writers of novels some sense of potential subject matter and potential form, a sense of how the present could be won over to serious literature. The process was a curious and unstructured one; in its early manifestations it hardly seemed destined to lead to a significant new literary form. Even in retrospect, the print novelties of the turn of the century hardly seem part of a teleology of form or thought, but the broad ferment that authenticated the new, together with the apparent permanence that print seemed to bestow on accounts of the temporary and passing, ultimately led to a mind and art that transcended occasions and individuals even though it engaged them first of all—energetically, enthusiastically, evangelically. The first fruits of the modern moment-centered consciousness were not very promising, but the emergence of that consciousness enabled, when other cultural contexts were right, an altogether new aesthetic and a wholly different relation between life and literature. J. Paul Hunter, professor of English at the University of Chicago, is the author of The Reluctant Pilgrim, Occasional Form, and of a forthcoming book on literacy, readership, and the contexts of early English fiction, Before Novels. (shrink)