In the heady days of 2011–2012, when Barack Obama was in his first term and the Patient Protection and Affordable Care Act heralded a golden future, medical anthropologists and activists had reason to be excited. Their country was about to take—so they believed—the greatest single step in the right direction since LBJ’s “Great Society” welfare spending program. It was in this climate that Inhorn and Wentzell’s collection of essays was published, and the optimism of the times shines through many of (...) the essays.The harsh reality is that at the end of 2012 Obama was re-elected, and after a painful deadlock the health insurance legislation known as “Obamacare” was pushed through. What followed has not turned out quite the way anyone expected and has driven an initial and unprecedented tidal wave of disapproval of the Obama presidency. Reading Medical Anthropology at the Intersections is therefore a sobering lesson in how a week can be a very long time in politics and a year a positive etern. (shrink)

There is ongoing contestation around greenhouse gas emissions from ruminant livestock and how society should respond. Media discourses play a key role in agenda setting for the general public and policymakers, and may contribute to polarisation. This paper examines how UK news media portrayed ruminant livestock’s impact on climate change between 2016 and 2021. The analysis addresses a gap in the literature by comparing discourses in national and farming sector newspapers using a qualitative approach. Four national and two farming sector (...) news outlets were searched for articles published between 2016 and 2021. A corpus of 996 relevant articles was assembled, from which 154 were selected for in-depth examination using Critical Discourse Analysis. Four ‘Critical Discourse Moments’ (CDMs), each signifying a discursive shift in the debate, were identified over the 6-year studied period: 1) Low salience, diverging discourses, 2) We must eat far less meat, 3) Fighting the anti-meat agenda, and 4) Policy (in)action at COP26. There was a large increase in the number of published articles from January 2019 onward, partly associated with publication of the EAT/Lancet Commission report. CDM 2 (We must eat far less meat) occurred mainly in the national media, while CDM 3 (Fighting the anti-meat agenda) occurred mainly in the farming media. Our findings reveal both opinion polarisation and intergroup polarisation between national and farming sector media, and low engagement with food system power imbalances. Addressing polarisation will be important to enhance capacity for collective decision-making regarding methane emissions from ruminant livestock. (shrink)

Philippa Foot has for many years been one of the most distinctive and influential thinkers in moral philosophy. Long dissatisfied with the moral theories of her contemporaries, she has gradually evolved a theory of her own that is radically opposed not only to emotivism and prescriptivism but also to the whole subjectivist, anti-naturalist movement deriving from David Hume. Dissatisfied with both Kantian and utilitarian ethics, she claims to have isolated a special form of evaluation that predicates goodness and defect (...) only to living things considered as such; she finds this form of evaluation in moral judgements. Her vivid discussion covers topics such as practical rationality, erring conscience, and the relation between virtue and happiness, ending with a critique of Nietzsche's immoralism. This long-awaited book exposes a highly original approach to moral philosophy and represents a fundamental break from the assumptions of recent debates. Foot challenges many prominent philosophical arguments and attitudes; but hers is a work full of life and feeling, written for anyone intrigued by the deepest questions about goodness and human. (shrink)

Moral Dilemmas is the second volume of collected essays by the eminent moral philosopher Philippa Foot, gathering the best of her work from the late 1970s to the 1990s. It fills the gap between her famous 1978 collection Virtues and Vices and her acclaimed monograph Natural Goodness, published in 2001. In this new collection Professor Foot develops further her critique of the dominant ethical theories of the last fifty years, and discusses such topics as the nature of moral judgement, (...) practical rationality, and the conflict of virtue with desire and self-interest. Moral Dilemmas, alongside her other two books, completes the summation of her distinctive and lasting contribution to twentieth-century moral philosophy. (shrink)

In this book Philippa Hoskin offers an account of the pastoral theory and practice of Robert Grosseteste, bishop of Lincoln 1235-1253, within his diocese. Grosseteste has been considered as an eminent medieval philosopher and theologian, and as a bishop focused on pastoral care, but there has been no attempt to consider how his scholarship influenced his pastoral practice. Making use of Grosseteste's own writings - philosophical and theological as well as pastoral and administrative - Hoskin demonstrates how Grosseteste's famous (...) interventions in his diocese grew from his own theory of personal obligation in pastoral care as well as how his personal involvement in his diocese could threaten well-developed clerical and lay networks. (shrink)

With regard to current debates on the ethical implementation of AI, especially two demands are linked: the call for explainability and for ultimate human responsibility. In the medical field, both are condensed into the role of one person: It is the physician to whom AI output should be explainable and who should thus bear ultimate responsibility for diagnostic or treatment decisions that are based on such AI output. In this article, we argue that a black box AI indeed creates a (...) rationally irresolvable epistemic situation for the physician involved. Specifically, strange errors that are occasionally made by AI sometimes detach its output from human reasoning. Within this article it is further argued that such an epistemic situation is problematic in the context of ultimate human responsibility. Since said strange errors limit the promises of explainability and the concept of explainability frequently appears irrelevant or insignificant when applied to a diverse set of medical applications, we deem it worthwhile to reconsider the call for ultimate human responsibility. (shrink)

One of the reasons why most of us feel puzzled about the problem of abortion is that we want, and do not want, to allow to the unborn child the rights that belong to adults and children. When we think of a baby about to be born it seems absurd to think that the next few minutes or even hours could make so radical a difference to its status; yet as we go back in the life of the fetus we (...) are more and more reluctant to say that this is a human being and must be treated as such. No doubt this is the deepest source of our dilemma, but it is not the only one. For we are also confused about the general question of what we may and may not do where the interests of human beings conflict. We have strong intuitions about certain cases; saying, for instance, that it is all right to raise the level of education in our country, though statistics allow us to predict that a rise in the suicide rate will follow, while it is not all right to kill the feeble-minded to aid cancer research. It is not easy, however, to see the principles involved, and one way of throwing light on the abortion issue will be by setting up parallels involving adults or children once born. So we will be able to isolate the “equal rights” issue and should be able to make some advance... (shrink)

This paper is part of a larger project. My overall aim is to argue that the evolution of familiar forms of termination of life sustaining treatment, constituting so called passive euthanasia,1 has severaly undercut the logic of every form of reasoning that has traditionally been used to oppose active euthanasia and assistance in suicide. Basically, there are two such forms of traditional opposition, each represented in a range of different versions. There is the inevitable argument concerning social utilities — that (...) permitting euthanasia and assisted suicide will have bad social consequences. But more fundamentally, the idea persists that killing is intrinsically worse than letting‐die in some sense that justifies the current practice of prohibiting the first while allowing the latter. In this paper, I first consider this latter claim. My ultimate strategy, as I have said, is to show that the nature of certain things we have all come to approve regarding termination of treatment makes it next to impossible to convincingly explain, in either of these ways, what is wrong with certain forms of assistance in suicide and euthanasia. In the second part of this paper I take another step in this direction by discussing, in a preliminary way, a special case of the argument from social risks. (shrink)

Is there a link between how a firm manages its internal and external stakeholders? More specifically, are firms that give employees stock ownership and more say in running the enterprise more likely to engage with external stakeholders? This study seeks to answer these questions by elaborating on mechanisms that link employees to external stakeholders, such as the community, suppliers, and the environment. It tests these relationships using a sample of 347 private, mostly small-to-medium size firms, which completed a stakeholder impact (...) assessment organized by the non-profit B Lab. The results support the hypotheses that both employee ownership and employee involvement are positively associated with external stakeholder engagement. Further, we found that certification plays a role, as employee ownership contributes to external stakeholder engagement only in certified B Corporations, and not in firms that merely completed the B Lab Impact assessment. Our findings have import for stakeholder engagement frameworks, as we show that there is interplay between internal employee stakeholders and external stakeholders that may be important to overall firm–stakeholder management. (shrink)

BackgroundResearch using data from medical care promises to advance medical science and improve healthcare. Academia is not the only sector that expects such research to be of great benefit. The research-based health industry is also interested in so-called ‘real-world’ health data to develop new drugs, medical technologies or data-based health applications. While access to medical data is handled very differently in different countries, and some empirical data suggest people are uncomfortable with the idea of companies accessing health information, this paper (...) aims to advance the ethical debate about secondary use of medical data generated in the public healthcare sector by for-profit companies for medical research (ReuseForPro).MethodsWe first clarify some basic concepts and our ethical-normative approach, then discuss and ethically evaluate potential claims and interests of relevant stakeholders: patients as data subjects in the public healthcare system, for-profit companies, the public, and physicians and their healthcare institutions. Finally, we address the tensions between legitimate claims of different stakeholders in order to suggest conditions that might ensure ethically sound ReuseForPro.ResultsWe conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients’ informational rights and their actions need to be compatible with the public’s interest in health benefit from ReuseForPro. (shrink)

Personalisation is the new mantra in social care; this article focuses on how personalisation can be achieved in practice, by presenting an analysis of data from people with learning disabilities and their personal assistants, where traditional care relationships have often been shown to be disempowering. The focus here is on the ways in which both parties use references to shared knowledge, joint experiences or personal-life information. These strategies can be used for various social goals, and instances are given where shared (...) references are used during non task-related talk. Both parties are seen on occasion to attempt to refer to shared information, and dense layers of inference can result, which move the interaction onto an ordinary, more symmetrical and friendly footing. The article concludes that shared knowledge referencing creates a way to shift between the personal and the professional, to blur the boundaries, and to create a new and more personalised relationship. (shrink)

In this comparative analysis of twelve focus groups conducted in Austria, France, and the Netherlands, we investigate how lay people come to terms with two biomedical technologies. Using the term ‘‘technopolitical culture,’’ we aim to show that the ways in which technosciences are interwoven with a specific society frame how citizens build their individual and collective positions toward them. We investigate how the focus group participants conceptualized organ transplantation and genetic testing, their perceptions of individual agency in relation to the (...) two technologies and to more collective forms of acting and governing, and also their understanding of the two technologies’ relationship to broader societal value systems. Against the background of the sustained political effort to build common European values, we suggest that more fine-grained attention toward the culturally embedded differences in coming to terms with biomedical technologies is needed. (shrink)

The essays in this book range over the fields of environmental ethics, business ethics, professional ethics, and bio-medical ethics. In each of the essays a significant question in the field of applied ethics is treated in a way that is methodologically revealing and provides some sense of new directions and preoccupations in the field. Among the questions discussed are: How should we conceive of the relations between theoretical ethics and practical ethics? What is the nature of responsible moral reasoning and (...) deliberation? To what extent is rationality ultimately the same in morality and science? Is applied ethics inherently conventional or conservative in its deliberations and results? Can or should specialists in applied ethics claim moral expertise in relation to problems in a given domain? TO what extent is the personal history of persons working in the field opf applied ethics relevant to assessing their work? While the contributors appear to agree on the answers to some of these questions, there is spirited disagreement concerning others. (shrink)

Every healthcare organisation enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient’s refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.Policy writing for morally (...) controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO’s obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. (shrink)

Even philosophers who believe there is a single “problem of personal identity” conceive of that problem in different ways. They differ not only in their ways of stating the problem, but in the parts of philosophy to which they assign it, and in the resources they feel entitled to call upon in their attempts to deal with it. My topic in this paper is an eighteenth-century uncertainty about the place within philosophy of the problem of personal identity. Is it a (...) problem in metaphysics, or a problem in ethics? Here I try to show that the boundary between ethics and metaphysics was—for a line of philosophers beginning with Locke, continuing with Shaftesbury, and ending with Hume—a shifting and sometimes disputed one. I hope what I have to say will help to clarify a longstanding problem in the interpretation of Hume: his motive for repudiating, in the Appendix to the Treatise, the account of judgments of personal identity and simplicity he had provided in Book I. (shrink)

Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, (...) we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about ‘futile’ treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families. (shrink)

In what Arjun Appadurai has dubbed the ‘colonial imaginary’ issues of femininity, and who possessed it, were of prime importance. An orientalizing sociology sought to distinguish, and indeed to fix, differences between metropolitan and indigenous women as a rhetoric of hierarchy which secured proper and western femininity to white women. One critical route which colonial commentators and authorities took to produce that knowledge was to measure women's proximity to the practice of prostitution, a means which permitted discussion and judgement of (...) racialized sexualities as well as of proper models of feminine behaviour. This article will explore the ways in which the new sociology of the Victorian period, wielded in a colonial context, served to separate women through race-based ideas of sexual behaviour and sexual order. It will deal with British India in the nineteenth and early twentieth centuries. (shrink)

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Philosophers are often asked whether they can provide a defence against hostile theories which are said to be “undermining the foundations of morality,” and they often try to do so. But before anything of this kind is attempted we should surely ask whether morality could be threatened in this way. If what people have in mind is simply that the spread of certain doctrines leads to the growth of indifference about right and wrong there is no philosophical problem involved. So (...) long as we treat the matter as a case of cause and effect it will belong rather to the psychologist than the philosopher, and we have no reason for questioning that correlations of this kind may exist. But this is not the assumption, or not the only one, for people undoubtedly do think that if certain doctrines could be proved then moral judgment would have been shown to be “nonsensical,” “meaningless,” or “invalid,” so that thereafter it would be not merely difficult but positively irrational to formulate and attempt to follow moral principles. It would be simple enough if the attack was supposed to be against some particular moral code, for there are recognized ways of arguing that a thing is not right but wrong. But when it is morality in general which is to be disproved or discredited it is difficult to see what this means or how it could be done. What would have to be shown is not that this or that is not right, but that nothing is—or not in the old sense so that attacking moral judgment is not like attacking a theory but more like attacking theorizing itself, which shows where the difficulty lies. If something is stated it can be denied or disproved, but a moral judgment does not contain statements except about what in particular is right or wrong. Yet many people, though they would probably reject a request for a justification of morality in the form of some argument as to why we should do our duty, feel that morality would be in a positive sense unjustifiable if certain supporting truths were knocked away from the structure. This may indeed be so, but we are unable to show that it is, or to explain the matter by appealing to “presuppositions” of morality, which besides being far too vague would too easily include much that was linked merely psychologically to the recognition of obligation. I propose, therefore, to look at some specific arguments which are supposed by those who resist them to constitute a threat to morality, and to ask whether this supposition is justified. (shrink)

'Foot stands out among contemporary ethical theorists because of her conviction that virtues and vices are more central ethical notions than rights, duties, justice, or consequences - the primary focus of most other contemporary theorists. This volume brings together a dozen essays published between 1957 and 1977, and includes two new ones as well. In the first, Foot argues explicitly for an ethic of virtue, and in the next five discusses abortion, euthanasia, free will/determination, and the ethics of Hume and (...) Nietzsche. The final eight essays chart her growing disenchantment with emotivism and prescriptivism and their account of moral arguments. All the essays embody to some extent her commitment to an ethics of virtue... Foot's style is straightforward and readable, her arguments subtle, ingenious, and some of them important.' Choice. (shrink)