We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance of multilevel (...) institutional measures for closing this gap, including consent policies and reporting mechanisms, as well as ongoing education.2 The UK writer seconds the role for education within wider shared decision-making and informed choice approaches, and generously commends our paper for close study by all maternity care providers. Others add a cautionary note. Lee applauds all our recommendations, but notes our proposals cannot fully secure autonomy because of, among others, epistemic injustice and other power differentials.4 Kumar-Hazard and Dahlen worry that opt-out consent is equal to substitute decision-making; weakens women’s rights; and is open to abuse.5 Nelson and Clough object to our willlingness to work within a flawed conceptual framework, which ought to be challenged.6 We agree that there are limits to what our proposal can do. It cannot rectify unequal distributions of epistemic credibilities, either in general or in any particular interaction. Risk communication is never neutral;7 “even the most well-meaning healthcare professionals could unwittingly wield influence over birthing women’s …. (shrink)

This paper is based on the Isaac and Tamara Deutscher Memorial-Prize Lecture given at SOAS in London, on 27 November 2009. It claims that Marxism remains built around a critique of political economy but lacks a parallel critique of international relations. IR naturalises the organisation of inter-state relations along lines comparable to the naturalisation of the capitalist economy by economics. The paper argues that the disciplinary organisation of Western academia is part of the class-discipline in society at large. It was (...) triggered by the abstraction of economics from the field of the broader social sciences. IR, in turn, was codified in the slipstream of Woodrow Wilson’s response to the Russian Revolution that followed on from the US-intervention in World-War I. The discipline was built around a founding myth of global liberalism and national self-determination. It served, among other things, to disqualify the claims of the theory of imperialism on disciplinary grounds, and its initial connections with Western hegemony, capital, and the national-security state remain in place today. Distinguishing modes of foreign relations, and specifying the occupation of space, protection, and exchange for tribal and empire/nomad foreign relations, as well as sovereign equality and global governance, on the other hand make it possible to understand the rise and continuing hegemony of the West in its own right, rather than as a superstructure of the transnationalisation of capital. (shrink)

An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as necessary (...) in context. In their article, ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al reiterate that consent is necessary for episiotomies. They specify, further, that the antenatal period is crucial for exchanging information, establishing trust between the birthing subject and provider, and exploring the birthing subject’s—rather than the care provider’s—values and preferences regarding episiotomies. They recommend an individualised approach, which would enable birthing subjects to choose how and when they want to give consent. I applaud van der Pijl et al on their practicable recommendations regarding consent for episiotomies. This is certainly a step in the right direction where respect for birthing subjects’ bodily autonomy and integrity is concerned. Still, we must be reminded that consent alone is not coextensive with autonomy. The conditions for securing informed consent in healthcare does not guarantee that one’s decision is truly reflective of their values. After all, even valid consent does not rule out ‘normatively significant external influence’.2 Consent acquisition for obstetric procedures present no …. (shrink)

In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond (...) pregnancy-related care. One feature of their model for adequate informed consent is trust in the systems in which prenatal and labour and delivery care are provided. Yet, for some pregnant persons, mistrust in health systems is a reasonable sequela of experiences like racism and epistemic injustice. For a programme in which trust is central to adequate consent, it is important to identify—and counter—forms of mistrust toward pregnant persons within healthcare and acknowledge and rectify reasonable mistrust of pregnant persons toward healthcare. Like other kinds of healthcare disparities, van der Pijl et al note that ‘the burden of unconsented procedures is not evenly distributed over groups’ and tracks with ‘racial, socioeconomic and other disparities in maternity care’. They are drawing on data from a less diverse context than the one …. (shrink)

This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to (...) the status of the genitals as ‘intimate’ anatomy—a status that is not fully erased by being in a medical context. In this editorial, we draw on the work of Talia Mae Bettcher on ‘intimate agency’ to explore why unconsented interventions into the genitalia may constitute a distinctive sort of personal violation compared to unconsented contact with various other parts of the human body. In their feature article, Marit van der Pijl and colleagues1 argue it is unethical for healthcare providers to perform unconsented episiotomies on persons in labour. In particular, they suggest that, outside of certain rare emergencies in which, for example, the person giving birth is incapacitated1 and the procedure cannot be delayed until consent becomes possible without introducing a significant risk of serious harm (call these ‘medically necessary’2 procedures), ‘presumed consent’ is the incorrect standard to apply. Instead, they stress that, especially when a proposed intervention involves a person’s genital, sexual or reproductive organs, the need to obtain their explicit consent in advance of proceeding must be honoured. As the authors note, the broader social significance of our genitalia—widely regarded as ‘private’ anatomy—is not erased by being in a medical context (see also 2–4). Boundaries must still be observed. Ethically, this ‘leaves a very small margin for error because invasion of these body parts …. (shrink)

This paper gives an ethical argument for temporarily waiving intellectual property protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization : the India/South Africa proposal and the WTO Director General proposal. Section I explains the background leading up to the WTO debate. Section II rebuts ethical arguments for retaining current IP protections, which appeal to benefiting society by spurring innovation and protecting rightful ownership. It sets forth positive ethical arguments for a temporary waiver that (...) appeal to standing in solidarity and holding companies accountable. After examining built-in exceptions to existing agreements and finding them inadequate, the paper replies to objections to a temporary waiver and concludes, in section III, that the ethical argument for temporarily waiving IP protection for COVID-19 vaccines is strong. There are no data in this work. (shrink)

C.H. Waddington is today remembered chiefly as a Drosophila developmental geneticist who developed the concepts of “canalization” and “the epigenetic landscape.” In his lifetime, however, he was widely perceived primarily as a critic of Neo-Darwinian evolutionary theory. His criticisms of Neo-Darwinian evolutionary theory were focused on what he saw as unrealistic, “atomistic” models of both gene selection and trait evolution. In particular, he felt that the Neo-Darwinians badly neglected the phenomenon of extensive gene interactions and that the “randomness” of mutational (...) effects, posited in the theory, was a false postulate. This last criticism dealt with the phenomenon known today as “developmental constraints.” Although population genetics itself has evolved considerably from its form at mid-20th century, much of Waddington’s critique, it is argued here, retains cogency. Yet, he did not attempt to develop a full-fledged alternative theory himself. Perhaps most surprisingly, in retrospect, is that he did not try to marry his work on gene interactions in development with his evolutionary interests, to create a theory of “genetic networks” and their evolution. Whether evolutionary genetics today will incorporate “network thinking” as a central element or whether there will be a general retreat to the more atomistic approach offered by genomics, remains an open question. (shrink)

In this issue of the Hastings Center Report, Daniel Brudney suggests that clinicians have an overly deferential attitude toward their patients’ surrogate decision-makers that is rooted in a wrongful investment of moral authority. He maintains that surrogate decision-makers have no moral right to decide for their loved ones and that their value in the decision-making process is limited to their knowledge of their loved one's preferences. If operationalized, Brudney's framework would ease the way for clinicians to remove a surrogate who (...) cannot provide information relevant to the patient's preferences and to resort to a paternalistic model of decision-making. Brudney fails to consider that the value of the surrogate does not flow from the surrogate, but rather from the patient's moral claim to have decisions made for him or her by a loved one. This claim recognizes that surrogates have intrinsic value through their relationship to and knowledge of the patient. Bioethics consultation services can assist clinical teams in engaging with the human crowd that surrounds each patient and navigating conflicting values and goals. This relational approach embraces the “mire and blood” that is endemic to relationships and clinical encounters. (shrink)

Solves Vann McGee's counterexample to Modus Ponens within classical logic by disclosing the suppressed premises and bringing them /within/ the argument.

Russkiĭ kosmizm v poiskakh absoli︠u︡ta : paralleli i peresechenii︠a︡ v muzykalʹnom, poėticheskom i izobrazitelʹnom tborchestve 1910-1920-kh godov -- Liki Moderna -- Putʹ k modernu : Georgiĭ Lʹvovich Katuar -- Stilʹ modern v tvorchestve Frederika Diliusa : kont︠s︡ert dli︠a︡ fortepiano s orkestrom do minor -- Stilʹ modern i tvorchestvo Bely Bartoka (na primere opery "Zamok gert︠s︡oga Sini︠a︡i︠a︡ Boroda") -- Frit︠s︡ Kreĭsler i stilʹ modern -- Klod Debi︠u︡ssi i Moris Ravelʹ : muzyka dli︠a︡ arfy -- Klod Debi︠u︡ssi : dvenadt︠s︡atʹ ėti︠u︡dov dli︠a︡ fortepiano (...) : ot ėkzersisa do installi︠a︡t︠s︡ii -- O dikhotomii "muzhskogo" i "zhenskogo" v Pi︠a︡toĭ sonate A.N. Skri︠a︡bina (na primere motivnoĭ metriki) -- Pod znakom moderna : A.N. Skri︠a︡bin i S.S. Prokofʹev v 1913 godu -- Avangard i modern v retrospektive -- O proi︠a︡vlenii︠a︡kh "modernizma" v ispolnitelʹskom iskusstve : F. Buzoni, M. I︠U︡dina, G. Gulʹd -- Sudʹba providt︠s︡a : fortepiannai︠a︡ muzyka Ėrika Sati v sovremennom akademicheskom muzykalʹnom mire -- Otgoloski ėpokhi modern : o nekotorykh smyslovykh osobennosti︠a︡kh sovremennykh fortepiannykh sochineniĭ (Ė. Denisov, S. Slonimskiĭ, G. Zaĭt︠s︡ev) -- Zapadnye pianisty - ispolniteli russkogo avangarda pervoĭ volny : Sh. Shleĭermakher, Kh. Khenk, M.-A. Amlen -- Muzyka k filʹmu "Kabinet doktora Kaligari" : mezhdu tvorcheskoĭ rekonstrukt︠s︡ieĭ i istoricheskoĭ imitat︠s︡ieĭ -- Podvodi︠a︡ itogi -- "Pozdniĭ modernizm" v muzyke kont︠s︡a XX - nachala XXI veka : nekotorye nabli︠u︡denii︠a︡ -- Po sledam konferent︠s︡ii "Ot moderna k futurizmu" (virtualʹnai︠a︡ beseda za kruglym stolom). (shrink)