The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another (...) version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

This book brings together international academics from a range of Social Science and Humanities disciplines to reflect on how Deleuze's philosophy is opening up and shaping methodologies and practices of empirical research.

van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...) to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people. At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …. (shrink)

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...) the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)

Most patients suffering from progressive dementia have thoughts, emotions, perspectives, and perceptions of a world of experience. Decisions about life‐sustaining treatment should incorporate a principled approach to evaluating what life is like for these patients.

One of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January‐February 2013 issue.

An important branch of environmental theory frames the climate crisis as a moral problem in need of a moral solution: human hubris is responsible for environmental degradation and must be atoned for through humility. Politically indeterminate, however, such argumentation is vulnerable to de-politicizing and mal-politicizing capture. In an effort to fend off the threat of either, this paper turns to the history of political thought and Jean-Jacques Rousseau, who theorized the environment as both a moral and a political domain. I (...) examine how Rousseau understood the availability of republican self-rule to be contingent both on the natural environment and on the relationship we construct with it such that freedom, in his words, is not automatically ‘a fruit of every Clime.’ This is the case, he suggests, because of the environment’s intersection with political economy and political culture. At the same time, Rousseau contends, republican self-rule is also a moral practice; republican polities afford citizens a public means of achieving and exercising moral agency. Triangulating the relationship between polity, morality, and environment, Rousseau’s thought offers an integrative logic through which to imbue the environment with both moral and political salience, thereby circumventing the dangers of mere moralization alone. (shrink)

Given the prevalence of emotional and psychological problems among professional psychologists, a primary concern to the field is impairment, or problems of professional competence. Graduate students, in particular, are an especially vulnerable subpopulation of mental health care professionals. Despite graduate students' heightened risk of impairment, relatively little attention has been paid in the literature to the handling of impairment in graduate students in academic training programs. Recommendations for a proactive approach to addressing impairment in trainees are discussed with respect to (...) students, supervisors, and training programs. As graduate school is the first major milestone in a therapist's development, psychologists as gatekeepers of the field of psychology must accept an ethical responsibility to appropriately monitor, acknowledge, and manage impairment among trainees. (shrink)

As knowledge increases about the human genome,prenatal genetic testing will become cheaper,safer and more comprehensive. It is likelythat there will be a great deal of support formaking prenatal testing for a wide range ofgenetic disorders a routine part of antenatalcare. Such routine testing is necessarilycoercive in nature and does not involve thesame standard of consent as is required inother health care settings. This paper askswhether this level of coercion is ethicallyjustifiable in this case, or whether pregnantwomen have a right to (...) remain in ignorance ofthe genetic make-up of the fetus they arecarrying. While information gained by genetictesting may be useful for pregnant women whenmaking decisions about their pregnancy, it doesnot prevent harm to future children. It isargued that as this kind of testing providesinformation in the interests of the pregnantwomen and not in the interests of any futurechild, the same standards of consent that arenormally required for genetic testing should berequired in this instance. (shrink)

This chapter discusses eighteenth-century British theories of perception, beginning with George Berkeley’s Essay Towards a New Theory of Vision. The chapter traces Berkeley’s influence through Thomas Reid, David Hume, David Hartley, Adam Smith and Dugald Stewart. The chapter presents theories of perception in this time a place a primarily concerned with metaphysics, mind and methodology rather than epistemology.

Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide realtime feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. The primary (...) purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. (shrink)

This paper explores Cézanne’s art through the lens of disability gain. Disability gain defies the ability-disability binary, which defines disability as a lack of ability, by emphasizing what is gained through different disabilities. Central to my discussion are (1) Tobin Siebers’s description of modern art as vitally and thematically disabled and (2) Rosemarie Garland-Thomson’s concept of misfitting, which allows for a phenomenological account of disability that emphasizes the depth of awareness and creative world-making possibilities that are gained through disability. By (...) bringing Siebers’s approach to disability aesthetics and Garland-Thomson’s concept of misfitting into conversation with Merleau-Ponty’s “Cézanne’s Doubt” and “Eye and Mind,” I will explain how Cézanne’s unique way of perceiving the world and capturing it in paint helps Merleau-Ponty to dismantle abstract, disembodied concepts of visual perception and trace the nuanced contours of lived perspective. In other words, what is gained through Cézanne’s disabilities is a revolutionary optics that overcomes the limitations of Cartesian optics. (shrink)

Most academics in philosophy departments accept that the discipline needs to change for the better. In this piece, Rebecca Buxton and Lisa Whiting offer several proposals for how to make philosophy a more inclusive place for everyone.

Background: Nonhuman animals are regularly enhanced genomically with CRISPR and other gene editing tools as scientists aim at better models for biomedical research, more tractable agricultural animals, or animals that are otherwise well suited to a defined purpose. This study investigated how genome editors and policymakers perceived ethical or policy benefits and drawbacks for animal enhancement and how perceived benefits and drawbacks are alike, or differ from, those for human genome editing. Methods: We identified scientists through relevant literature searches as (...) well as conference presentations. Policymakers were identified through rosters of genome editing oversight groups (e.g., International Commission on the Clinical Use of Human Germline Genome Editing, World Health Organization) or efforts aimed at influencing policy (e.g., deliberative democracy groups). Interviews covered participants’ views on ethical differences between interventions affecting somatic or germline cells and distinctions between using gene editing for disease treatment, prevention, and enhancement purposes. Results: Of the 92 participants interviewed, 81 were genome editing scientists, and 33 were policymakers, with 22 interviewees being both scientists and policymakers. Multiple areas were identified in which the ethical implications of genomic enhancements for nonhuman animals differ from those for human animals including with respect to experiential welfare; germline edits; environmental sustainability; and justice. Conclusions: Overall, respondents viewed that animal enhancement is unburdened by the ethical complexities of human enhancement. These views may be related to participant perceptions of animals’ lesser moral status and because germline editing in animals is common practice. (shrink)

In this article, we explore the role of film in educational settings and argue that testimony and narrative are dependent upon each other for developing ethical judgments. We use the film 12 Angry Men to enhance our thesis that the emotional response that sometimes is intended in using film as testimonies in classrooms requires a specific listening; a listening that puts pupils at risk when they relate testimonies to their own life narratives. The article raises the importance of listening in (...) training narrative ethos in relation to violence witnessed in film. The article contributes by enhancing an understanding of a relational dimension to testimony and narrative, which, in an Arendtian sense, is also put forward as a political relation. (shrink)

In 1997, when Oregon became the first U.S. jurisdiction authorizing medical aid in dying (MAID), its law included a requirement that patients be legal residents of the state. Other U.S. jurisdictions legalizing MAID followed Oregon in adopting residency requirements. Recent litigation challenges the legality, as well as the justification, for such requirements. Facing such challenges, Oregon and Vermont eliminated their MAID residency requirements. More states could follow this move, for, in certain circumstances, the U.S. Constitution's privileges and immunities clause protects (...) citizens’ right to travel to secure medical care. Policy considerations could also motivate states to reexamine whether such requirements are justified in light of existing evidence of how MAID laws have been applied. (shrink)

Activists have challenged the reach of the carceral state into higher education. Whether calling out the exclusion of currently and formerly incarcerated people from higher education or the ways campus police perpetuate the racial and economic biases that plague the US criminal legal system, these voices offer insights that higher education leaders should take seriously. Yet, these challenges are often met with appeals to safety, which purport to override concerns about the harms produced by extension of the criminal legal system (...) into educational contexts. Campus safety debates offer an opportunity to examine the role of wilful ignorance in the perpetuation of systemic injustices on college and university campuses, highlighting tensions between the testimony of those challenging these systems and practices and prevailing narratives around safety. In analysing the operation of wilful ignorance in this context, we will focus on campus policing as a manifestation of carcerality in higher education. We argue that the perpetuation of policing in higher education in the USA reflects wilful White ignorance that represents both an epistemic and moral failing on the part of higher education leaders. (shrink)

Philosopher, theologian, philologist, urban sociologist, literary critic, collector, archivist, essayist, memoirist, children's author, allegorist, media theorist, hashish connoisseur, closet surrealist, theorist of fascism, professional melancholic – it is by now habitual to begin any account of Walter Benjamin's work with an inventory of the grafts and incongruities traversing his tangled maze of writings. First known through his rather fraught association with Gershom Scholem and Theodor Adorno (who were effectively responsible for the posthumous dissemination of his corpus); sometime ally and interlocutor (...) of Brecht, Kracauer, Bloch, and Buber; refugee in the Paris of Bataille and company during the 1930s: Benjamin exerts today a fascination all the more striking for its untimeliness. Adopted as spiritual soulmate and precursor of almost every major trend in contemporary Continental thought – from cultural studies to deconstruction, from psychoanalysis to new historicism, from critical theory à la Frankfurt school to poststructural linguistics, from molecular politics to death‐of‐God theology, from radical geography to phantomology, from film theory to Heideggerean hermeneutics, from Foucaultian micrology to cyberpunk aesthetics – he epitomizes that unclassifiable swirl of intellectual impulses we have come to associate with the peregrinations of Weimar culture. (shrink)

From Kant to Croce is a comprehensive, highly readable history of the main currents and major figures of modern Italian philosophy, described in a substantial introduction that details the development of the discipline from 1800 to 1950.

In this paper we investigate the connection between forms of sustainability and masculinity through a study of everyday life in a Danish alternative slaughterhouse. In contrast to the predominant form of slaughterhouses today in Western contexts, the ‘alternative’ slaughterhouse is characterized as non-industrial in scale and articulating some form of a sustainability orientation. Acknowledging the variability of the term, we firstly explore how ‘sustainability’ is understood and practiced in this place. We then illuminate the situated manifestations of masculinities, which appear (...) predominantly- though not exclusively- hegemonic in nature. We next reflect on how the situated and particular sustainability of this site come to bear on a workplace long characterized as a masculinized site of, e.g., violence and repression, showing how the sustainability of the alternative slaughterhouse has potential to nourish alternative masculinities. We finally call for more attention at this nexus of sustainability and masculinities studies, to examine how the broad sustainability turn in food systems needs to be further examined in relation to what masculinities it perpetuates, as well as how a focus on masculinities may enhance our understanding of varying forms of sustainability, especially their potential for ecologically and socially just food systems. (shrink)

The case studies compiled in _Another Way: Decentralization, Democratization and the Global Politics of Community-Based Schooling_ offer a comparative look at how the global politics of educational decentralization have influenced the democratic aspirations of diverse community-based schooling initiatives in Europe, Africa, Asia and the Americas.

There is a strong disconnect between humans and other species in our societies. Zoos particularly expose this disconnect by displaying the asymmetry between visitors in search of entertainment, and animals often suffering from a lack of meaningful interactions and natural behaviors. In zoos, many species are unable to mate, raise young, or exhibit engagement behaviors. Enrichment is a way to enhance their quality of life, enabling them to express natural behaviors and reducing stereotypies. Prior work on sound-based enrichment and interactivity (...) suggest that a better understanding of animals’ sensory needs and giving them options to shape their surroundings can yield substantial benefits. However, current zoo management and conservation practices lack tools and frameworks to leverage innovative technology to improve animal well-being and zookeepers’ ability to care for them. Ethical considerations are called for in developing such interventions as human understanding of animals’ worlds is still limited, and assumptions can have detrimental consequences. Based on several interventions, four principles are proposed to guide a more systematic implementation of sonic enrichment in zoos. The goal is to lay the groundwork for the design of the zoos of the future, with a focus on sounds, for the benefit of the animals. (shrink)

In the literature on refugeehood in political theory, there has been a recent turn towards what have been called “state system legitimacy” views. These views derive an account of states’ obligations to refugees from a broader picture of the conditions for international legitimacy. This paper seeks to develop the state system legitimacy view of refugeehood by subjecting the most developed version of it—the account developed by David Owen—to critical scrutiny. We diagnose an ambiguity in Owen’s theory of refugeehood, in the (...) concept of political membership, and unpack the implications of this ambiguity for state system legitimacy views. First, we reconstruct the key aspects of Owen’s account of refugeehood and show how it represents an advance over competing theories. Then we discuss the methodological underpinnings of Owen’s account, showing the constraints and opportunities faced by state system legitimacy views. Next, we raise some problems for the conceptual distinctions that Owen develops between different types of refugee protection: asylum, sanctuary, and refuge. The underlying feature that leads to these problems is an ambiguity in the concept of political membership, which is at the core of Owen’s view of refugeehood. Finally, we distinguish two interpretations of political membership in the institution of refugeehood and chart out some possible ways forward for state system legitimacy views. The critique developed here is a sympathetic one, aimed at the further development of state system legitimacy views. (shrink)

Grounded in Mindfulness-to-Meaning Theory, this study examined the relation between dispositional mindfulness and life satisfaction through mediating mechanisms including savoring positive experiences and gratitude. A total of 133 Chinese mindfulness practitioners at 20–72 years old were recruited from a 3-day transnational meditation event in Hong Kong. Findings based on structural equation modeling indicated that controlling for sex, age, education, family income, number of hours of mindfulness practice per week, and type of administration, dispositional mindfulness was associated with satisfaction with life (...) through savoring positive experiences and gratitude as mediators. The findings provided initial evidence for these processes between mindfulness and life satisfaction in the Chinese context. To promote life satisfaction, researchers and mental health practitioners should recognize the chain of mechanisms related to mindfulness. (shrink)

Argues that many popular approaches to questions of social justice are illiberal and offers an alternative vision for social justice based on liberal principles, adapted from the Wall Street Journal bestseller Cynical Theories.

New Zealand has an unspoken commandment: ‘thou shalt not be a tall poppy’. A tall poppy is someone who stands out from the crowd, usually by excelling at one or more pursuits. Sadly, many New Zealanders are all too familiar with this phrase as they have been ‘cut down’ by those around them, taunted for their success and discouraged from celebrating their achievements. This social phenomenon of cutting down tall poppies is called Tall Poppy Syndrome and is present in many (...) areas of New Zealand culture, such as sport, academic achievement, and entrepreneurship. Consequently, the church is not immune to this phenomenon. Tall Poppy Syndrome, whether within or outside the church, discourages excellence and prevents flourishing. This article engages Moral Foundations Theory to understand why Tall Poppy Syndrome exists in New Zealand, and then proposes Christian humility as a remedy for Tall Poppy Syndrome within the church. When humility and excellence can co-exist, then Tall Poppy Syndrome will no longer exist; thus the church could have an important role in enabling New Zealand to be a place where tall poppies can freely flourish. (shrink)