Levonorgestrel is widely used as emergency contraception, yet much confusion surrounds its use. Consensus statements and reviews typically attribute its efficacy to prefertilization mechanisms of action, such as suppression of ovulation and interference with cervical mucus or sperm function, yet studies do not rule out a postovulatory MOA. To yield greater clarity, the authors review recent scientific studies examining the MOAs of LNG-EC. They conclude that LNG-EC exerts minimal effects on cervical mucus and sperm function and that suppression of ovulation (...) is not the dominant MOA accounting for the contraceptive efficacy of LNG-EC. Luteal deficiencies and endometrial changes reported in the literature strongly suggest a postovulatory MOA when LNG-EC is given during the critical preovulatory period. National Catholic Bioethics Quarterly 13.4 : 677–716. (shrink)

This essay explores three issues in respect for autonomy that pose unfinished business for the concept. By this, I mean that the dialogue over them is ongoing and essentially unresolved. These are: whether we ought to respect persons or their autonomous choices; the role of relational autonomy; and whether nonhuman animals can be autonomous. In attending to this particular set of unfinished business, I highlight some critical moral work left aside by the concept of respect for autonomy as understood in (...) Beauchamp and Childress’ Principles of Biomedical Ethics. Specifically, while significant pragmatic traction is gained by the authors’ focus on autonomous choice, carving such a focus out from the broader questions of moral respect and the autonomy of the person leaves aside a number of questions that we might have thought a view about respect for autonomy in biomedicine ought to answer. These include: How should physicians respond when autonomous patients make decisions that appear nonautonomous? What is the impact of the view that autonomy is “relational” for cross-cultural differences in how autonomy is respected? If chimpanzees can be autonomous, what does that mean for how they should be treated? (shrink)

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled (...) to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages. (shrink)

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)

Ghostwriting scandals are pervasive in industry-funded biomedical research, and most responses to them have presumed that they represent a sharp transgression of the norms of scientific authorship. I argue that in fact, ghostwriting represents a continuous extension of current socially accepted authorship practices. I claim that the radically collaborative, decentralized, interdisciplinary research that forms the gold standard in medicine is in an important sense unauthored, and that this poses a serious problem in applied social epistemology. It is no easy matter (...) to find procedural or architectural solutions that can secure epistemic trust and accountability for collaborative publishing in biomedicine. (shrink)

What role does audience uptake play in determining whether a speaker refuses or consents to sex? Proponents of constitution theories of uptake argue that which speech act someone performs is largely determined by their addressee’s uptake. However, this appears to entail a troubling result: a speaker might be made to perform a speech act of sexual consent against her will. In response, we develop a social constitution theory of uptake. We argue that addressee uptake can constitute a speaker’s utterance of (...) ‘no’ as a speech act of consent under some conditions, but that this does not prevent us from judging that an addressee committed rape. Second, we claim that addressee uptake is not the only form of uptake that matters—the uptake of other members of the discursive community matters too, and can override the addressee’s uptake, constituting the speaker’s utterance as the speech act it was intended to be. (shrink)

There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inhe...

Games Studies reveals the performative nature of playing a character in a virtual-game-world (Nitsche 2008, p.205; Pearce 2006, p.1; Taylor 2002, p.48). Tbe Player/Character relationship is typically understood in terms of the player’s in-game “presence” (Boellstorff 2008, p.89; Schroeder 2002, p.6). This gives the appearance that living-into a game-world is an all-or- nothing affair: either the player is “present” in the game-world, or they are not. I argue that, in fact, a constitutive phenomenology reveals the Player/Character relationship to be a (...) multi-dimensional matter of empathy. I advance a broadly Schutzian framework, drawing on his 1932 discussions of “face-to-face encounters” and ”historical predecessors,” showing how at- tention to empathy reveals a variety of “presences” that different kinds of Player/Character relationships afford. The central determinants of empathetic affordances which I focus on here are (i) how much players know about a character (especially the character’s past) and (ii) how players learn this information.The purpose of this discussion will be to show that a phenomenological analysis reveals that the relationship between a player and their character is complex, highly variable, and inherently social. Furthermore, it will add to the growing body of scholarship that demonstrates that video games are rich social objects deserving of study. (shrink)

Research-oriented universities are known for prolific research activity that is often supported by students in faculty-guided research. To maintain ethical standards, universities require on-going training of both faculty and students to ensure Responsible Conduct of Research (RCR). However, previous research has indicated RCR-based training is insufficient to address the ethical dilemmas that are prevalent within academic settings: navigating issues of authorship, modeling relationships between faculty and students, minimization of risk, and adequate informed consent. U.S. universities must explore ways to identify (...) and improve RCR concerns for current (faculty) and future researchers (students). This article reports the findings of a self-study (_N_ = 50) of research stakeholders (students and faculty) at a top tier research institution. First, we report on their perceived importance of applying RCR principles. Second, we explore relationships between stakeholder backgrounds (e.g., prior training, field, and position) and how they ranked the degree of ethical concerns in fictitious vignettes that presented different unethical issues university students could encounter when conducting research. Vignette rankings suggested concerns of inappropriate relationships, predatory authorship and IRB violations which were judged as most unethical, which was dissimilar to what sampled researchers reported in practice as the most important RCR elements to understand and adhere to for successful research. Regression models indicated there was no significant relationship between individuals’ vignette ethics scores and backgrounds, affirming previous literature suggesting that training can be ineffectual in shifting researcher judgments of ethical dilemmas. Recommendations for training are discussed. (shrink)

Luce Irigaray's project elaborates an original concept of sexual difference. While this concept is widely discussed in feminist philosophy, there are multiple readings of sexual difference and some of these are contradictory. This essay surveys the various readings of sexual difference in English. Foci include the debate over the status of essentialism, ontology, and the controversy over the primacy of sexual difference, including discussion of whether her oeuvre marginalizes differences of race and sexuality. I conclude by arguing that her thinking (...) of difference is open to the future and non-totalisable in principle. This means that, difference, the concept at the heart of her thinking of sexual difference, cannot be primarily oriented toward engendering sexual difference because it is necessarily open to engendering relations that cannot be predicted. (shrink)

The oblivion of the interval -- Being in place -- The aporia between envelope and things -- Dualism in Bergson -- Interval, sexual difference -- Beyond man: rethinking life and matter -- Conclusion: interval as relation, interval as becoming.

This essay addresses the increasing prominence of ‘performance’ as an analytical frame in recent studies of science. Building on the insights of existing feminist criticism, it identifies two largely unacknowledged features of such performance-oriented studies: first, an implicit recuperation of a pre-discursively real body; and second, a persistent emphasis on the productive character of performances. The essay considers the limitations of these two themes, and concludes by exploring pathways suggested by other theoretical traditions.

Irigaray's critique of the phallocentric subject's implicit dependence on the maternal-feminine “outside” is compelling. Her postulation of nonhierarchical sexual difference gives the relational world of woman specificity and Irigaray brings the subject's worldview to earth as merely the relation of the male human to the world. But the focus of her transvaluation remains largely anthropocentric; and she maintains too many aspects of the privilege of the subject's sovereignty as proper to male subjectivity. I suggest that, we need to extend Irigaray (...) and to think sexual difference beyond the human. Drawing from Elizabeth Grosz, Gilles Deleuze, Henri Bergson and Jakob Von Uexküll, I argue that we need to think life beyond the constitution of the organism as the continuous enmeshment of different milieus. Sexual difference is a force of differentiation that articulates relationships between organisms and organs as crucial aspects of many milieus that make up the Earth. Along with the sexually differentiated aspects of milieus, there are rhythms of difference constitutive of milieus that are not sexed. The first section of the essay describes Irigaray's conceptualization of sexual difference between humans. Then I turn to her engagement with the status of nonhuman animals in “Animal Compassion.” I suggest her approach in this essay is too anthropocentric and move to a discussion of Uexküll's thinking on milieus as a way to extend the concepts of difference and sexual difference into posthuman contexts. The essay concludes by reading Irigaray's concept of difference with Deleuze and Bergson. (shrink)

Acknowledgements -- Introduction: transformation, potential, futures -- Screening affect : images, representational thinking and the actualization of the virtual -- Bringing the image to life : interactive mirrors and intensive experience -- Becoming different : makeover television, proximity and immediacy -- Immanent measure : interaction, attractors and the multiple temporalities of online dieting -- Pre-empting the future : obesity, prediction and change4life -- Conclusion : transforming images : sociology, the future and the virtual -- Bibliography -- Index.

Henri Bergson's philosophy has attracted increasing feminist attention in recent years as a fruitful locus for re-theorizing temporality. Drawing on Luce Irigaray's well-known critical description of metaphysics as phallocentrism, Hill argues that Bergson's deduction of duration is predicated upon the disavowal of a sexed hierarchy. She concludes the article by proposing a way to move beyond Bergson's phallocentrism to articulate duration as a sensible and transcendental difference that articulates a nonhierarchical qualitative relation between the sexes.

Henri Bergson's philosophy presents the relationship between life and matter in both dualistic and monistic terms. Life is duration, a rhythm of incalculable novelty that approaches pure creative activity. In stark contrast, matter is identified with the determinism of homogeneous space. After Time and Free Will, Bergson concedes some share of duration to matter. In this context, his dualism can be understood as a methodological step towards the articulation of a monistic metaphysics of duration. This article suggests that the distinction (...) between life and matter is also motivated by an unconscious imperative to establish a sexed hierarchy. Bergson repeatedly presents life as seminal, while matter is figured in terms of passivity. (shrink)

Informed consent is medico-legal orthodoxy and the principal means by which research encounters with the body are regulated in the UK. However, biomedical advancements increasingly frustrate the degree to which informed consent can be practiced, whilst introducing ambiguity into its legal significance. What is more, feminist theory fundamentally disrupts the ideologically liberal foundations of informed consent, exposing it as a potentially inadequate mode of bioethical regulation. This paper explores these critiques by reference to a case study—embryo donation to health research, (...) following fertility treatment, as regulated by the HFEA 1990—and contends that informed consent cannot adequately respond to the material realities of this research encounter. Thereafter, by drawing on feminist theories of vulnerability, this paper proffers an alternative bioethical approach, which calls for structural reform in recognition of the fundamentally bilateral constitution of self and society and a renewed appreciation for the affective/dispositional tenor of lived experience. (shrink)

Over the course of its history, feminist standpoint theory has encountered a number of problems which reveal divisions among its supporters over certain fundamental philosophical commitments. This chapter sketches a phenomenological account of perception that can begin to address these problems, drawn largely from Maurice Merleau-Ponty’s Phenomenology of Perception. Merleau-Ponty can help us resolve these issues by providing an account of perspectival perception wherein a multiplicity of different perceptual standpoints all nonetheless put us in touch with a single external world, (...) and in which some standpoints may be better than others when it comes to accessing certain features of this world. For Merleau-Ponty, the proliferation of standpoints need not lead us into an unacceptably relativistic framework, as long as we are able to conceive of each of these standpoints as giving whoever occupies it access to some particular aspect of a singular, real, shared world. (shrink)

Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with (...) diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name. (shrink)

Hegel was ambivalent about Dutch genre painting’s uncanny ability to find beauty in daily life. The philosopher regarded the Dutch painterly aesthetic as Romanticism avant la lettre, and classifies it as such in his Lectures on Aesthetics, under the section entitled “Die romantischen Künste [The Romantic arts].”1 Dutch art, in Hegel’s reading, is marred by many shortcomings. The most prominent among these are the “subjective stubbornness [subjective Beschlossenheit]” that prevents this art from attaining to the “free and ideal forms of (...) expression” that marked the productions of Italian artists such as Raphael. In contradistinction to their Italian counterparts, Dutch artists in Hegel’s view are apt to. (shrink)

In this essay I will contend that there is something called holy fear, which expresses love for God. First I distinguish holy fear from certain types of unholy fear and from the type of fear regulated by the virtue of courage. Next, relying on the work of Thomas Aquinas, I consider the roles love and power play in holy and unholy fear and extend his analysis of the passion of fear by analogy to the capital vices. I conclude that this (...) extension illuminates the moral significance of John PaulII’s call not to be afraid and shows how this theme of his pontificate is inextricably linked to another great theme of his teaching, that of love as a gift of oneself. (shrink)

(2013). Affirming and Rethinking our Visions and Responsibilities as Social Foundations Scholars and Educators. Educational Studies: Vol. 49, Critical, Interpretive, and Normative Perspectives of Educational Foundations: Contributions for the 21st Century, pp. 101-103.

A biography of the Spanish-born Jewish philosopher, rabbi, and physician of the Middle Ages who spent a good deal of his life in Egypt and whose works influenced the thinking of Jews, Christians, and Moslems.

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person‐centred practice (PCP). Although the idealisation of (...) nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient‐centred care. (shrink)

Although the teaching of medical ethics and law in medical education is an old story that has been told many times in medical literature, recent studies show that medical students and physicians lack confidence when faced with ethical dilemmas and medico-legal issues. The adverse events rates and medical lawsuits are on the rise whereas many medical errors are mostly due to negligence or malpractices which are preventable. While it is true that many medical schools teach their students medical law and (...) ethics, there are wide variations in what is being taught because there is no universally agreed syllabus. Yet the knowledge of medical law and ethics is closely relevant to the medical profession and that failure in abiding the law may result in serious civil or even criminal consequences. While this paper does not propose to lay detailed analysis of the relevant areas of law or ethics, it proposes to cover some legal areas so as to highlight and bring to attention the need for a medical law and ethics course. This article also considers the problems faced and recommendation as to future directions to be taken with respect to teaching medical law and ethics. It concludes with a suggested course outline for the teaching of medical law and ethics. (shrink)

The history of Canadian parks systems, within the realm of environmental history, has been deeply affected by contemporary social, environmental, and political beliefs. The rhetoric of human domination over nature and the inherent separation of the two was entrenched throughout historical works on Canadian parks in the early to mid- twentieth century. The liberalization of history within the past forty years has served to shift this trend. The inclusion of scientific knowledge in historical research, the limitation of past prejudices and (...) biases concerning nature and humanity, and the questioning of political policies affecting nature have aided in the growth of a body of historical research and interpretation that questions past perceptions of the natural. The historiographical exploration of parks history offers researchers an exciting opportunity to identify historical factors impacting the practice of environmental history while also discerning and encouraging future trends in environmental history. Using recent historical publications on Canadian parks history as examples, this paper seeks to both uncover the historical factors impacting past historical practice and acknowledge the major philosophical and practical shifts in historical practice that have fostered an exciting new body of work in environmental history. In questioning what it means to be human, what it means to be Canadian, and what the relationship between humanity and nature is and can be, increasingly nuanced historical work offers readers and historians new realms of exploration – both philosophically and practically. (shrink)