Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when no (...) other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of (...) refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act. (shrink)

James Rachels has argued on Utilitarian grounds that since removing life-sustaining treatment and physician-assisted suicide both aim at the very same end,hastening death to limit suffering, there are no morally significant moral distinctions between them. Others have argued for maintaining this distinction based on various forms of deontological and rights-based ethical theories that maintain that all acts of killing are inherently wrong. I argue that the enduring controversy over physician-assisted suicide might not be caused by such fundamental differences of opinion (...) about moral theory, such as that which exists between Utilitarianism and Deontology, so much as by a commonly held misunderstanding of technology. In particular, the conclusion that there are no relevant ethical distinctions between killing and letting die can only be drawn by a Utilitarian, such as Rachels, by ignoring the recent work of philosophers of technology on the non-neutrality thesis. (shrink)

Encounters with illness, impairment, and aging can disrupt one’s experiential relationship with self, body, others, and world. “Healing” takes place when the individual is able to re-integrate his or her world, even if the condition is not medically curable. Drawing on work in the phenomenology of the body, this article examines a series of eight “healing strategies” individuals employ, each representing a different way of orienting toward the painful or impaired body. One may lean into freeing oneself from the body, (...) through strategies of “refusing,” “ignoring,” “objectifying,” or “transcending” its problems. Conversely, one may choose to embrace the body, through strategies such as “accepting,” “listening,” “befriending,” or “witnessing.” It can be beneficial to have a good number of such coping strategies at one’s disposal, enhancing flexible response to chronic challenges. They also are often used in synergistic or complementary combinations. (shrink)

A standard view in contemporary philosophy is that belief is involuntary, either as a matter of conceptual necessity or as a contingent fact of human psychology. We present seven experiments on patterns in ordinary folk-psychological judgments about belief. The results provide strong evidence that voluntary belief is conceptually possible and, granted minimal charitable assumptions about folk-psychological competence, provide some evidence that voluntary belief is psychologically possible. We also consider two hypotheses in an attempt to understand why many philosophers have been (...) tempted to view belief as involuntary: that belief is a prototype concept and that belief is a dual character concept. Altogether, our findings contribute to longstanding philosophical debates about the relationship between the will and the intellect, while also advancing scientific understanding of important social judgments. (shrink)

This chapter examines Merold Westphal's critique on the works of Calvin Schrag about the relationship of philosophy and a theistic belief in God. It talks about why neither devils speak as atheist nor god as theist. It reveals that God refuses to appear on philosophy's terms because in God's transcendence, God would appear more otherwise than Being. Also, theism does not explain why the divine “otherwise” ultimately signifies that a personally loving Creator and Redeemer in loving unconditionally always already love (...) also impersonally. (shrink)

Health-care professionals sometimes appeal to their own consciences in order to justify their exemption from professional duties. I argue that we can only understand the content of a conscientious refusal as either a claim about the psychological dispositions of the refusing professional or as a purely normative claim about the status of the action that is the object of the refusal. If we adopt the former view, we would still need to adjudicate these refusals in terms of the acceptability of (...) the moral views that ground them. If the latter, then we effectively abandon the conception of conscientious refusals that is most widely discussed in the philosophical literature. Whichever option we choose, we must conclude that there is no reason to allow for traditionally understood conscientious refusals by health-care professionals. (shrink)

This paper considers the state of contingent laborers, Ph.D. holders, lovers of robust scholarship, and hopeful academics who toil away in the neoliberal university in the search for the academic good life. The author argues that the academic good life is a fantasy and agrees that the fantasy is cruel, i.e. not attainable or livable, but does suggest the practices of teaching and conducting research, the practices that make up a scholarly life, are sustainable activities of a good life that (...) can and should inform how we use the university. After drawing on Alasdair MacIntyre and Chris Higgins to picture the academic good life, Deane turns to theories of refusal articulated by Sandy Grande and Bonnie Honig to suggest refusal practices for reimagining lives that are academic and good. (shrink)

A large part of the debate around the right to refuse life-prolonging treatment of anorexia nervosa sufferers centers on the issue of competence. Whether or not the anorexic should be allowed to refuse life-saving treatment does not depend solely or primarily on competence. It also depends on whether the anorexic’s suffering is bearable or tractable, and on the degree of involvement of the family in the therapeutic process. Anorexics could be competent to refuse lifesaving treatment (Giordano 2008). (...) However, the anorexic’s refusal of life-saving treatment should not be respected purely because it is a competent decision. In fact, anorexia has two characteristics that weaken the strength of the principle .. (shrink)

Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not turn on whether a (...) given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile. (shrink)

Annotation In Kierkegaard and Modern European Philosophy: An Introduction Michael Weston argues that, despite being acknowledged as a precursor to Nietzsche and post-Nietzschean thinkers such as Heidegger and Derrida, the radical nature of Kierkegaard's critique of philosophy has been missed. Weston examines and explains the metaphysical tradition, as exemplified by Plato and Hegel, and the post-metaphysical critiques of Nietzsche, Heidegger and Derrida. He shows how Kierkegaard's ethical critique of philosophy undermines the former and escapes the latter. He considers another ethical (...) critique of philosophy, that of Levinas, before identifying ethics as the non-philosophical site where philosophy can be criticised. Kierkegaard and Modern European Philosophy: An Introduction argues that, by refusing to allow philosophy jurisdiction over ethics and religion, Kieregaard's critique applies as much to modern continental thought as to the metaphysical thought it seeks to undermine. (shrink)

Aremarkable revival of interest in Romanticism has taken place among some philosophers in recent years. Why should this be so? Romanticism has had a bad reputation among literary critics of a variety of persuasions throughout most of the twentieth century, when it was not even a topic for analytical philosophy in the English-speaking world. The philosophical movement most associated with Romanticism—German idealism—had been shunned by the curricula of a majority of the most prestigious British and American universities by the mid-twentieth (...) century. Literary modernism and then various strains of postmodernism had a self-image of having overcome Romantic illusions. (Of course, Romanticism and Romantic philosophy... (shrink)

Background Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and policymakers with a synthesis of current normative literature. Methods Nine databases covering health and ethics research were searched, and 121 publications identified for the period Jan 1998 to Mar 2022. For articles, source journals were categorised according to Australian Standard Field of Research (...) codes, and normative content was analysed using a framework analytical approach. Results Most of the articles were published in biomedical journals (34%), bioethics journals (21%), and journals that carry both classifications (20%). Two central questions dominated the literature: (1) Whether vaccine refusal is justifiable (which we labelled ‘refusal arguments’); and (2) Whether strategies for dealing with those who reject vaccines are justifiable (‘response arguments’). Refusal arguments relied on principlism, religious frameworks, the rights and obligations of parents, the rights of children, the medico-legal best interests of the child standard, and the potential to cause harm to others. Response arguments were broadly divided into arguments about policy, arguments about how individual physicians should practice regarding vaccine rejectors, and both legal precedents and ethical arguments for vaccinating children against a parent’s will. Policy arguments considered the normative significance of coercion, non-medical or conscientious objections, and possible reciprocal social efforts to offset vaccine refusal. Individual physician practice arguments covered nudging and coercive practices, patient dismissal, and the ethical and professional obligations of physicians. Most of the legal precedents discussed were from the American setting, with some from the United Kingdom. Conclusions This review provides a comprehensive picture of the scope and substance of normative arguments about vaccine refusal and responses to vaccine refusal. It can serve as a platform for future research to extend the current normative literature, better understand the role of cultural context in normative judgements about vaccination, and more comprehensively translate the nuance of ethical arguments into practice and policy. (shrink)

In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case ‘what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived’ (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in (...) such cases, it is the role of the healthcare professional (HCP) to ‘assist patients to think more clearly and rationally’ (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a ‘rational’ decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound. (shrink)

Citing grounds of conscience, pharmacists are increasingly refusing to fill prescriptions for emergency contraception, or the "morning-after pill." Whether correctly or not, these pharmacists believe that emergency contraception either constitutes the destruction of post-conception human life, or poses a significant risk of such destruction. We argue that the liberty of conscientious refusal grounds a strong moral claim, one that cannot be defeated solely by consideration of the interests of those seeking medication. We examine, and find lacking, five arguments for requiring (...) pharmacists to fill prescriptions. However, we argue that in their professional context, pharmacists benefit from liberty restrictions on those seeking medication. What would otherwise amount to very strong claims can be defeated if they rest on some prior restriction of the liberty of others. We conclude that the issue of what policy should require pharmacists to do must be settled by way of a theory of second best. Asking "What is second best?" rather than "What is best?" offers a way to navigate the liberty restrictions that may be fixed obstacles to optimality. (shrink)

And he wondered whether it was not evident to them that it is not possible for human beings to discover these things [sc. divine things, τὰ δαιμόνια]. Since even those who thought most of themselves for their speaking about these things do not hold the same opinions with one another, but are disposed towards one another like madmen.

True stories about people who triumphed over seemingly impossible medical diagnoses using untraditional, inventive therapies and perseverance--and about what scientists are discovering on the psychology of healing and the mind-body connection--from the author of theNew York TimesMagazinearticle about her own son, "The Boy with the Thorn in his Joints," which led to this book about other families.

_Querying Consent_ examines the ways in which the concept of consent is used to map and regulate sexual desire, gender relationships, global positions, technological interfaces, relationships of production and consumption, and literary and artistic interactions. From philosophy to literature, psychoanalysis to the art world, the contributors to _Querying Consent_ address the most uncomfortable questions about consent today. Grounded in theoretical explorations of the entanglement of consent and subjectivity across a range of textual, visual, multi- and digital media, _Querying Consent_ considers (...) the relationships between consent and agency before moving on to trace the concept’s outcomes through a range of investigations of the mutual implication of personhood and self-ownership. (shrink)

This essay examines the presence of Kant, Fichte, Schelling and Hegel in Merleau-Ponty’s thought. The perspective adopted here is methodological. Central to this is the choice of “transcendental phenomenology,” understood as a rehabilitation of the idealism and subjectivism proper to the transcendentalism of Kant and Fichte—the choice by which Merleau-Ponty refuses to abandon transcendental philosophy, like Hegel on the contrary did with his dialectical-speculative philosophy, and follows instead the phenomenological perspective suggested for the first time by Schelling.

The new introduction to the second edition of Habits of the Heart is a very helpful reminder of the main points of the first edition. Moreover, it is very useful in situating, indeed resituating the book’s concerns, given the lapse of time since the book’s first appearance. It provides new insights made possible by second thoughts, as well as by the questions and criticisms of others. The problem of individualism and the slackening, not to say refusal, of traditional communal ties, (...) has accelerated in American society since the first writing. We find phenomena such as middle class ‘cocooning,’ as well as an often low grade civil war, let us say the culture wars. There is a widespread disquiet — to the left, to the right, in the anxious middle — about the future direction of society. One thing is noted from the beginning as common across the divisions, namely, a certain view of the economy. Correspondingly, the authors themselves seem more insistent on issues of class than they were previously: “the festering secret that Americans would rather not face.”I will confine myself to two points: first, the issue of economy in terms of more basic metaphysical assumptions in the whole notion of ‘use.’ I will suggest some connections between serviceable disposability and the culture of autonomy, and between these and the equivocal relation to the other that besets the identification of freedom with autonomy. I work towards the question: must not our communal relations to others be placed in a deeply ambivalent position, if economic relations are dominated by serviceable disposability and freedom as autonomy is idolized?Second, I want to remark on how far we dwell in an ethos of will to power of which use and autonomy serve as masks. I must summon to our discussion the roaming, uninterred ghost of Nietzsche. Whence comes the spell that spoils our taste for the good? Whence comes this, this blandness of the good? The issue of nihilism and religion cannot be buried. Is this issue even more urgent than Bellah and his collaborators, in their essential decency, acknowledge? (shrink)

In this book Jeremy Dunning-Davies deals with the influence that "conventional wisdom" has on science, scientific research and development. He sets out to explode' the mythical conception that all scientific topics are open for free discussion and argues that no-one can openly raise questions about relativity, dispute the 'Big Bang' theory, or the existence of black holes, which all seem to be accepted facts of science rather than science fiction. In today's modern climate with "Britain's radioactive refuse heap already (...) big enough to fill the Royal Albert Hall" (Edmund Conway, Economics Editor The Daily Telegraph 28.11.06), it is alarming that there are potential advances in hadronic mechanics which could conceivably pave the way for new clean energies and even a safe in-house method for the disposal of nuclear waste, that have not even been considered by the present establishment. These examples are from the field of physics but there can be little doubt that outside factors have affected the progress of most, if not all, branches of science for many years. Factors other than purely scientific ones still appear to be exerting tremendous influences on progress in a wide variety of fields. Is it too idealistic or nai;ve, to expect that science should remain pure and stay unaffected by such factors? Dr Dunning-Davies presents a beautifully written argument that if science is to progress, and be of any real use, these external factors must be held at bay. (shrink)

This article draws on Gloria Anzaldúa's philosophy to analyze Latina/o cultural forms as responses to the lawful violence that renders migrants and other minoritarian peoples as disposable subjects. The article turns to Latina/o playwrights and undocumented poets whose art forms, produced under the deportation regime, express a desire for freedom from terrorizing governance. Focusing on Lydia, a play by Mexican American playwright Octavio Solis, and poetry by an undocumented artist, Yosimar Reyes, it links these representations of “illegal” migrants to understand (...) how minoritarian aesthetic practices respond to racial terror and lawful violence. It argues that if we are to map the present beyond terrorizing forms of law, we must center our philosophical thought on “illegal” imaginaries of freedom, not on the cultural forms sanctioned by legality—the latter risk reproducing the logic of state-sponsored violence, whereas the former enact freedom as a practice of everyday life. (shrink)

In June 1795, Fichte sent his second contribution to Schiller’s journal, The Hours : his article, Concerning the Spirit and the Letter within Philosophy, where he explains his views on the relation between aesthetic experience and virtue. Schiller, who had until then been rather well-disposed toward Fichte, violently and categorically rejected the article, thus putting an end to their friendship. Scholars commonly understand this conflict as a predictable confrontation between two irreconcilable conceptions of the moral ideal : that of the (...) cold philosopher, personified by Fichte, aiming to repress sensibility, and that of the warm-blooded artist, personified by Schiller, advocating for it. I shall argue that this interpretation is untenable, since Fichte and Schiller not only shared the same conception of virtue, but also agreed concerning the function assumed by the artist in mankind’s moral education. Rather, the conflict arose because Schiller could not bear the idealistic conception of nature – as pure representational activity – which Fichte thought was implied by these views. En juin 1795, Fichte fit parvenir à Schiller sa deuxième contribution destinée aux Heures : l’article Sur l’esprit et la lettre dans la philosophie, où il expose ses idées sur le rapport entre l’expérience esthétique et la vertu. Schiller, jusque-là plutôt bien disposé envers Fichte, lui opposa un refus de publication violent et catégorique, mettant ainsi un terme à leur amitié. On interprète habituellement cette rupture comme la conséquence prévisible d’une rencontre opposant deux conceptions irréconciliables de l’idéal moral : celle du froid philosophe, incarné par Fichte, visant à réprimer la sensibilité, et celle de l’artiste brûlant de passion, incarné par Schiller, souhaitant la glorifier. Je conteste pour ma part cette interprétation, Fichte et Schiller s’accordant non seulement sur la manière dont la vertu devait être conçue, mais également sur la fonction assumée par l’artiste dans l’éducation morale de l’être humain. À l’origine du conflit se trouve plutôt l’aversion de Schiller pour la conception idéaliste de la nature (comme activité purement représentative) qui, selon Fichte, était impliquée par ces idées. (shrink)

In locating friendly fire in contemporary philosophy of religion, D.Z. Phillips shows that more harm can be done to religion by its philosophical defenders than by its philosophical despisers. Friendly fire is the result of an uncritical acceptance of empiricism, and Phillips argues that we need to examine critically the claims that individual consciousness is the necessary starting point from which we have to argue: for the existence of an external world and the reality of God; that God is a (...) person without a body, a pure consciousness; and that to assent to a religious belief is essentially to assign a truth value to a proposition independent of any confessional context. When these products of friendly fire are avoided, we arrive at a new understanding of belief, trust and the soul, and refuse to say more or less than we know about the realities of human life in the service of religious apologetics. (shrink)

In this paper, I examine how a manifest disagreement between Richard Rorty and Alasdair MacIntyre concerning the history of philosophy is but one of a series of deep and interrelated disagreements concerning, in addition, the history of science, the good life for human beings, and, ultimately, the character of and prospects for humankind as well. I shall argue that at the heart of this series of disagreements rests a dispute with regard to the nature of rationality. And this disagreement concerning (...) the norms of rationality, despite its theoretical and practical importance, is one which is, or so I argue, irresolvable. Moreover, the series of disagreements which I examine in the context of the debate between Rorty and MacIntyre is not peculiar or idiosyncratic to them. Their dispute reflects presumptions common to contemporary analytical philosophy. And while analytical philosophers have not made discussions of human nature one of their characteristic concerns, I indicate that such concerns do play a central role in the controversy which I examine. Differences of opinion concerning the political and social nature of human beings are reflected up and down the philosophical line. My argument is in no way concerned with issues of psychological priority or causality (e.g. whether having certain views disposes one psychologically to accepting other views). What I establish are the logical relations, and the points of philosophical contention, among certain epistemo logical and political theses. In Part I, I rehearse Rorty's epistemological views and examine how these views are connected to his views on morality and human nature. In Part II, I begin with MacIntyre's position concerning the virtues and modern moral philosophy and then reconstruct, ex pede Herculem, his views on rationality. Part III examines the prospects of reconciling the perspectives discussed in the first two sections. (shrink)

Can Wittgenstein's philosophy help us to see religious diversities? Thomas D. Carroll uses Wittgenstein's thoughts on religion and language to bring a cross-cultural perspective to philosophy of religion. Through a focus on Chinese philosophical and religious traditions and the intertwining of racism and religion in the United States, Carroll highlights two related features of Wittgenstein's philosophy: the relevance of contextual backgrounds to interpreting ways of life and the importance of reflecting on existential purposes in philosophical inquiry. Committed to the essential (...) task of expanding philosophy of religion, Carroll critically studies the term “religion” and goes beyond the traditional categories of belief to consider diverse religious phenomena such as rituals, practices, institutions, forms of belonging, and pragmatic forms of religious engagement. We see the value of paying close attention to social contexts and refusing to oversimplify interpretation of philosophical arguments. By demonstrating how Wittgenstein's ideas can enrich our understanding of the complex phenomenon of religion and the place it has in our lives, this inclusive and timely study asks us to rethink how we approach philosophy of religion. (shrink)

That Jehovah's Witnesses cannot refuse life-saving blood transfusions on behalf of their children has acquired the status of virtual “consensus” among bioethicists. However strong the consensus may be on this matter, this article explores whether this view can be plausibly defended on liberal principles by examining it in light of one particularly well worked-out liberal political theory, that of Rawls. It concludes that because of the extremely high priority Rawls attributes to “freedom of conscience,” and the implication from the (...) original position that parents must act paternalistically toward their children as their protectors, Jehovah's Witnesses cannot legitimately be barred from making decisions on behalf of their children, even when the consequences of such decisions are serious and irremediable. (shrink)

Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned (...) out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended. (shrink)

Heidegger’s position on the relation of the holy and the divine to the truth of being and the possible signification of the word ‘God’ is internally related to his understanding of truth as a double-concealment. Formal indication holds the key to this internal relation. The question of how the deity enters into philosophy forms the framework within which these thoughts are developed.

The line separating the “good life” and the savagery that the “good life” requires, or, perhaps what might be articulated as the line between the space of biopolitics and the space of necropolitics, is maintained in the present through both practices of global policing and imperial war. These practices of policing and war produce the very global refuse that constantly threatens the “good life”—actively wasting the lives and livelihoods of people and non-human lifeworlds Western colonialism established as the raw (...) materials, instruments, and objects of its civilizational goal—against which violence acts to protect a fundamentally human life worth living. At the same time, through capital-intensive projects of “saving” the very targeted populations it destroys, permanent war also produces the subordinated life that will come to serve as the means of maintaining and upholding that “good life.” Beyond this mode of colonial inhabitation, however, subsist other ecologies of life-making practices on the part of those deemed disposable, a planetary remainder which might well be our only hope for a possible future. (shrink)

Is it possible to think of the gift philosophically? How should we think of the gift in a world that seems to be regulated only with economic rules? These are two of the main questions that are treated in this essay. In order to deal with them, the author analyzes Jacques Derrida’s deconstruction of the gift and Jean-Luc Marion’s notion of givenness. Derrida and Marion are in agreement in refusing intentionality as an essential element of the logic of gift because (...) for them intentionality is always connected with economy. But they conceive economics in different ways and, as a consequence, their conceptions of gift are different. For Derrida, economics means credit and debit, while for Marion it means causality. This difference is the reason why Derrida thinks of the gift as either impossible or a moment of madness that overcomes credit and debit, while Marion thinks of it as a pure decision that comes from its givenness. As a result, for neither author does the gift have any element of need, motivation, or cause. The author argues that excess and decision cannot be the essence of the gift, but only reciprocity. This reciprocity is not an economic relation of giving and receiving but an asymmetrical reciprocity. (shrink)

“Great refusals,” the progressive movements that shattered the status quo, can be best understood through the prism of critical theory that sees these mobilizations as responses to the legitimation crises of advanced capitalism that migrated into the realms of subjectivity, rendering identity a contested terrain while eliciting powerful emotions that impelled social mobilizations. Among these emotions, rooted in the Freudo-Marxist philosophical anthropology that enabled the critique of alienated labor, is the capacity for hope. And central to that notion of hope (...) is a vision of utopian possibility in which membership in democratic, identity granting/recognizing communities of meaning allows for the creative self-realization of all. (shrink)

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient’s autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that our answer (...) to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing. (shrink)

There has been renewed interest in whether we should understand standards of decision-making capacity (DMC) to be risk-relative. Critics of risk-relative standards often highlight a puzzling asymmetry that they imply; a patient may have the requisite DMC to consent to a treatment that is in their best interests, whilst lacking the requisite DMC to refuse that same treatment, given the much higher risk that this would entail. Whilst some have argued that this asymmetry suggests that risk-relative standards are nonsensical, (...) in this paper I defend a ‘quality of evidence’ view of such standards. I begin by outlining DMC’s purported gate-keeping role in medical ethics, and identifying three key normative claims that undergird this role. I then explain how two competing theories of risk-relative standards are incompatible with at least one of these claims. Drawing on Douglas’ distinction between standards of ‘true capacity’ and standards invoked in the ‘test’ for capacity, I then outline my ‘quality of evidence’ view. I explain how the view is compatible with the aforementioned normative claims, and outline the nature of the asymmetry it implies. I conclude by responding to the objection that there is no meaningful distinction between ‘true capacity’ and the ‘test’ for capacity. (shrink)

The article discusses the political meaning of refusal. Against the dominating philosophical perspective, praising participation and sense of community, it argues that the acts of refusal may play an important role in resistance against power. Some elements of a possible theory of refusal are to be found in the philosophy of Gilles Deleuze, especially in his famous essay on Herman Melville’s Bartleby, the Scrivener, but also in Dialogues and Mille Plateaux, where he coins the crucial concept of becoming-imperceptible.

Vaccine refusal is not a free rider problem. The claim that vaccine refusers are free riders is inconsistent with the beliefs and motivations of most vaccine refusers. This claim also inaccurately depicts the relationship between an individual’s immunization choice, their ability to enjoy the benefits of community protection, and the costs and benefits that individuals experience from immunization and community protection. Modeling vaccine refusers as free riders also likely distorts the ethical analysis of vaccine refusal and may lead to unsuccessful (...) policy interventions. (shrink)

Environmental epigenetics is increasingly employed to understand the health outcomes of communities who have experienced historical trauma and structural violence. Epigenetics provides a way to think about traumatic events and sustained deprivation as biological “exposures” that contribute to ill-health across generations. In Australia, some Indigenous researchers and clinicians are embracing epigenetic science as a framework for theorising the slow violence of colonialism as it plays out in intergenerational legacies of trauma and illness. However, there is dispute, contention, and caution as (...) well as enthusiasm among these research communities.In this article, we trace strategies of “refusal” (Simpson, 2014) in response to epigenetics in Indigenous contexts. Drawing on ethnographic fieldwork conducted in Australia with researchers and clinicians in Indigenous health, we explore how some construct epigenetics as useless knowledge and a distraction from implementing anti-colonial change, rather than a tool with which to enact change. Secondly, we explore how epigenetics narrows definitions of colonial harm through the optic of molecular trauma, reproducing conditions in which Indigenous people are made intelligible through a lens of “damaged” bodies. Faced with these two concerns, many turn away from epigenetics altogether, refusing its novelty and supposed benefit for Indigenous health equity and resisting the pull of postgenomics. (shrink)

Autonomous decision-making over therapy options is not reducible to the refusal of unwanted medical intervention. This is a myth that has been imported from questionable assumptions in political economy, and is of little benefit to medical practice and the sometimes agonizing decisions which have to be taken by patients and their relatives. An individual's right to therapy abatement can be protected from abuse only in the context of a full understanding of autonomous choice; not merely the right to refuse, (...) but the opportunity to receive assistance and consider alternatives. Limits are also required on the role of the surrogate in the refusal of therapy. Policies endorsing therapy abatement and exercise of the right to forego life-sustaining therapy should carry cast iron guarantees that they will not be disadvantageous to the poor and undereducated members of society. It should also be noted that fears of unlimited life-prolongation have been greatly exaggerated. In an atmosphere of governmental indifference to the plight of the sick, with the notion of welfare tuned to market forces, there is a danger that self-determination can have a restricted meaning; the option of death in the context of an underfunded health service. This may not be the time to campaign for the right to refuse therapy, but rather the time to campaign for improvements to existing therapy. (shrink)