This article seeks to describe in general terms what has become the standard way of conceptualizing moral injury in the clinical psychological and psychiatric literature, which is the key source for applications of the concept in other domains. What we call “the standard model” draws on certain assumptions about beliefs, mental states, and emotions as well as an implicit theory of causation about how various forms of harm arise from certain experiences or “events” that violate persons’ moral beliefs and systems. (...) Our analysis makes these assumptions more explicit and subjects them to critical scrutiny. In so doing, we survey the current literature and identify basic features of how moral injuries are defined, how they are thought to occur, and the forms of treatment or repair that appear to be indicated. We caution that it matters how moral experience is characterized and argue that an alternative understanding of what is the moral in moral injury is important for overcoming critical challenges to the standard model. Moreover, recently evolving approaches to moral repair could be more consistent with an alternative model. Our concluding suggestion is that a more robust account of the nature of moral experience and its relations to self-identity and social experience more generally could advance understanding of the etiology of moral injury and promote rehabilitation. (shrink)

The predominant account of the etiology of moral injuries among Veterans and military personnel in the clinical psychological and psychiatric literature construes morality as inherent in belief structures. This supports the conceptualization of moral injuries as intrapsychic phenomena resulting from exposure to high-stakes events in which fixed beliefs are contravened in ways that result in psychological harms, including maladaptive beliefs and distress. We identify several problems with this formulation and offer suggestions for modification, including greater focus on: 1) experiences rather (...) than events in identifying circumstances in which moral injuries occur, and 2) degradation of relevant relationships rather than conflicts with and among moral contents. These shifts in framing could have epidemiological salience, facilitating more robust case characterization and enabling a variety of approaches to reestablishing the moral conditions that support life affirmation. (shrink)

ZusammenfassungÖkonomische Rahmenbedingungen der klinischen Tätigkeit bringen die Ärzteschaft häufig in Konflikte zwischen ihrem Berufsethos und den wirtschaftlichen Zielen der Klinik. Nicht selten werden diese Konflikte zwischen der Ärzteschaft und dem nicht-klinischen Krankenhausmanagement ausgetragen. Obwohl sowohl medizinische als auch ökonomische Ziele relevant sind, um eine ineffiziente Verteilung finanzieller Ressourcen im Gesundheitswesen zu vermeiden, gibt es großes Konfliktpotenzial. Insbesondere die klinische Ärzteschaft steht in der Verantwortung, einen adäquaten Umgang mit den ökonomisch-ethischen Konfliktpotentialen zu erlernen. Denn von ihnen wird erwartet, das ärztliche Ethos (...) zu bewahren, wirtschaftliche Forderungen nicht unkritisch zu übernehmen sowie eine qualitativ hochwertige Patientenversorgung zu gewährleisten. Inwiefern der Umgang mit den Konflikten und deren Auswirkungen auf die Zusammenarbeit zwischen Ärzteschaft und Krankenhausmanagement in der medizinischen Lehre eine Rolle spielt bzw. spielen sollte, wird in der vorliegenden Forschungsarbeit mittels der Analyse der medizinischen Curricula, nationaler und internationaler Publikationen, eines Modellprojektes sowie Experteninterviews untersucht. Anhand dieser Untersuchungen konnte herausgearbeitet werden, dass jene Inhalte vor allem in den Querschnittsbereichen 2 „Geschichte, Theorie und Ethik der Medizin“ und 3 „Gesundheitsökonomie, Gesundheitssystem, Öffentliches Gesundheitswesen“ des Medizinstudiums gelehrt werden. Da diese Lehre von den Hochschulen frei gestaltbar ist, besteht diesbezüglich jedoch eine hohe Heterogenität. Insbesondere die Ergebnisse der Interviews bestätigen die Relevanz einer Integration dieser Inhalte ins Medizinstudium und die Chance, dadurch den Umgang der Ärzteschaft mit den ethischen Konfliktsituationen zu Gunsten der Patientenversorgung zu verbessern. Zudem besteht die Möglichkeit, die Inhalte in interprofessioneller Form zu lehren und dadurch das gegenseitige Verständnis und die Zusammenarbeit der klinischen Ärzteschaft mit dem Krankenhausmanagement zu stärken. (shrink)

I denne artikel undersøges kroniske patienters beslutninger om forsøgsdeltagelse og betydningen af deltagerinformation. På baggrund af et års feltarbejde på fire danske forskningsklinikker argumenterer jeg for, at de observerede patienter opererer efter andre logikker, når de tager beslutninger om at deltage i kliniske forsøg, end hvad der antages i den gældende forskningsetiske regulering. Feltarbejdet fulgte et klinisk lægemiddelforsøg og inkluderede observationer af forsøgskonsultationer; interviews med investigatorer, projektsygeplejersker, forsøgsdeltagere og virksomhedsrepræsentanter; samt en mindre spørgeskemaundersøgelse blandt de danske forsøgsdeltagere. Resultaterne indikerer, (...) at for en gruppe af erfarne forsøgsdeltagere handler beslutningerne om forsøgsdeltagelse ikke om forsøget i sig selv, men om at opretholde en nær relation til forskningspersonalet. Disse patienter orienterer sig ikke efter deltagerinformation, men i forhold til tillidsrelationer. De agerer ikke som autonome individer, men oplever, at de er afhængige af sundhedssystemet. De udtrykker altruistiske motiver, men håber samtidig, at forsøgsdeltagelse vil give dem bedre helbredskontrol. For dem er forsøgsdeltagelse blevet en måde at leve med kronisk sygdom. Mulige implikationer af denne situation diskuteres, idet det understreges, at tillidsfulde relationer er en forudsætning både for god behandling og god forskning, men at de tætte relationer samtidig kan bevirke, at patienter bliver mindre kritiske, i forhold til hvilke forsøg de accepterer at deltage i, og at en bevidsthed om forsøgsrelaterede risici fortrænges fra forsøgssituationen.Nøgleord: informeret samtykke, deltagerinformation, deltagermotivation, kliniske forsøg, kronisk sygdom, DanmarkEnglish summary: Informed consent in clinical trials: technicalities, trust and intimate relationshipsThis article explores decisions about clinical trial participation in a group of patients with chronic conditions, focusing especially on motivation for trial participation and trial information. Based on ethnographic research in four Danish hospitals in conjunction with a clinical drug trial, I argue that these patients’ decisions follow logics other than those anticipated in research ethics regulations. I build on observations, interviews with physician-investigators, project nurses, patient-participants and trial sponsors, and a survey of the participants. The results indicate that for a group of experienced trial participants, trial information plays a very limited role because their decisions do not concern the trial per se but the sustainment of a close relationship with the research staff. They do not act as autonomous individuals weighing pros and cons based on the written information they receive. Rather, they feel dependent on the healthcare system and navigate in trust relations. For them, trial participation has become a way of living with chronic disease. I discuss implications of this situation underlining that trustful relationships constitute a precondition for high quality chronic care and research, yet the social dynamics may also lead patients to pay less attention to risks associated with trial participation. (shrink)

In this paper, I argue that the supposition of divine omnipotence entails a contradiction: omnipotence both must and must not be intrinsic to God. Hence, traditional theism must be rejected. To begin, I separate out some theoretical distinctions needed to inform the discussion. I then advance two different arguments for the conclusion that omnipotence must be intrinsic to God; these utilise the notions of essence and aseity. Next, I argue that some necessary conditions on being omnipotent are extrinsic, and that (...) this means omnipotence cannot be intrinsic to God. I consider three different ways of resolving this conflict, but contend that each is unsuccessful. Before concluding, I explain why the type of strategy used to resolve the traditional paradoxes of omnipotence cannot be successfully employed against the paradox presented here. (shrink)

A substantial body of evidence shows that people tend to rely too heavily on explanations when trying to justify an opinion. Some research suggests these errors may arise from an inability to distinguish between explanations and the evidence that bears upon them. We examine an alternative account, that many people do distinguish between explanations and evidence, but rely more heavily on unsubstantiated explanations when evidence is scarce or absent. We examine the philosophical and psychological distinctions between explanation and evidence, and (...) show that participants use explanations as a substitute for missing evidence. Experiment 1 replicates the results of other researchers, but further shows that participants generate more evidence when they are not constrained by their lack of data. Merely mentioning a source of data can alter both their evaluation (Experiment 2) and their production (Experiment 3) of explanations and evidence. In Experiment 4, we show that participants can explicitly consider the availability of evidence and other pragmatic factors when evaluating arguments. Finally, we consider the implications of using explanations to replace missing evidence as a strategy in argument. (shrink)

Discussion of the role which religious experience can play in warranting theistic belief has received a great deal of attention within contemporary philosophy of religion. By contrast, the relationship between experience and atheistic belief has received relatively little focus. Our aim in this paper is to begin to remedy that neglect. In particular, we focus on the hitherto under-discussed question of whether experiences of God’s absence can provide positive epistemic status for a belief in God’s nonexistence. We argue that there (...) is good reason to accept an epistemic parity between experiences of God’s presence and experiences of God’s absence. (shrink)

Purpose Existing algorithms for predicting suicide risk rely solely on data from electronic health records, but such models could be improved through the incorporation of publicly available socioeconomic data – such as financial, legal, life event and sociodemographic data. The purpose of this study is to understand the complex ethical and privacy implications of incorporating sociodemographic data within the health context. This paper presents results from a survey exploring what the general public’s knowledge and concerns are about such publicly available (...) data and the appropriateness of using it in suicide risk prediction algorithms. Design/methodology/approach A survey was developed to measure public opinion about privacy concerns with using socioeconomic data across different contexts. This paper presented respondents with multiple vignettes that described scenarios situated in medical, private business and social media contexts, and asked participants to rate their level of concern over the context and what factor contributed most to their level of concern. Specific to suicide prediction, this paper presented respondents with various data attributes that could potentially be used in the context of a suicide risk algorithm and asked participants to rate how concerned they would be if each attribute was used for this purpose. Findings The authors found considerable concern across the various contexts represented in their vignettes, with greatest concern in vignettes that focused on the use of personal information within the medical context. Specific to the question of incorporating socioeconomic data within suicide risk prediction models, the results of this study show a clear concern from all participants in data attributes related to income, crime and court records, and assets. Data about one’s household were also particularly concerns for the respondents, suggesting that even if one might be comfortable with their own being used for risk modeling, data about other household members is more problematic. Originality/value Previous studies on the privacy concerns that arise when integrating data pertaining to various contexts of people’s lives into algorithmic and related computational models have approached these questions from individual contexts. This study differs in that it captured the variation in privacy concerns across multiple contexts. Also, this study specifically assessed the ethical concerns related to a suicide prediction model and determining people’s awareness of the publicness of select data attributes, as well as which of these data attributes generated the most concern in such a context. To the best of the authors’ knowledge, this is the first study to pursue this question. (shrink)

Studies on surrogate motherhood have mostly explored paid arrangements through the lens of a contract model, as clinical work or as a maternal identity-building project. Turning to the under-examined case of unpaid, so-called altruistic surrogate motherhood and based on an analysis of interviews with women who had been unpaid surrogate mothers in a full gestational surrogacy with a friend or relative in Canada, the United States or Australia, this article explores altruistic surrogate motherhood as relational work. It argues that this (...) form of surrogate motherhood within close interpersonal relations can be conceptualised through the relational work involved in hosting a child for the intended parents. The article explores how relational work in this context implies an embodied, asymmetrical and far-reaching sense of responsibility that surrogate mothers describe as characteristic of their surrogacy experience. In this way, the article sheds light on feminist concerns about surrogacy as an embodied and objectifying work of women while at the same time illuminating how surrogate mothers respond to the intended parents in light of their pre-surrogacy relationship, how meanings are negotiated by them and how relationships are managed during the pregnancy. (shrink)

The study of reciprocal altruism, or the exchange of goods and services between individuals, requires attention to both evolutionary explanations and proximate mechanisms. Evolutionary explanations have been debated at length, but far less is known about the proximate mechanisms of reciprocity. Our own research has focused on the immediate causes and contingencies underlying services such as food sharing, grooming, and cooperation in brown capuchin monkeys and chimpanzees. Employing both observational and experimental techniques, we have come to distinguish three types of (...) reciprocity. Symmetry-based reciprocity is cognitively the least complex form, based on symmetries inherent in dyadic relationships (e.g., mutual association, kinship). Attitudinal reciprocity, which is more cognitively complex, is based on the mirroring of social attitudes between partners and is exhibited by both capuchin monkeys and chimpanzees. Finally, calculated reciprocity, the most cognitively advanced form, is based on mental scorekeeping and is found only in humans and possibly chimpanzees. (shrink)

Written over a period of thirty-five years, these essays explore the topics of causation, time, fate, determinism, natural teleology, different conceptions of the human soul, the idea of the highest good and the human significance of leisure. While most of the essays take as their starting-point some theme in Ancient Greek philosophy, they are meant not as exegesis but as distinctive and independent contributions to live philosophizing. Written with clarity, precision without technicality, and philosophical imagination, they will engage a wide (...) range of readers, including scholars and students of Ancient Greek philosophy and others working on more contemporary analytical concerns. (shrink)

The recent expansion of online genetic-genealogical networks has been hailed as a development that could break racial taboos in the United States by providing irrefutable evidence of the myriad historical and genetic links—many originating in slavery—connecting white and black families. These predictions are countered, however, by a scholarly literature on “white ignorance,” defined as an active historical project that works to prevent privileged groups from apprehending their links to, and positionality within, systems of racial oppression. This paper mobilizes concepts from (...) the fields of agnotology and epistemic ethics to assess how far genetic-genealogical technologies can contribute to redressing racialized epistemic inequities between slave and slaveholder descendants, by inducing the latter to respond to the former’s kinship claims and give access to data that could help reconstruct their linked family histories. Drawing on ethnographic and interview data that foreground the experiences of African American genealogists, the study outlines the structural and affective dimensions that have converged to enable white ignorance regarding genealogies of slavery and discusses ethical and technical solutions proposed by genealogical practitioners to redress the racialized power dynamics that continue to condition access to, and public acceptance of, family history knowledge relating to slavery. (shrink)

It is usually supposed that the Dirac and radiation equations predict that the phase of a fermion will rotate through half the angle through which the fermion is rotated, which means, via the measured dynamical and geometrical phase factors, that the fermion must have a half-integral spin. We demonstrate that this is not the case and that the identical relativistic quantum mechanics can also be derived with the phase of the fermion rotating through the same angle as does the fermion (...) itself. Under spatial rotation and Lorentz transformation the bispinor transforms as a four-vector like the potential and Dirac current. Previous attempts to provide this form of transformational behavior have foundered because a satisfactory current could not be derived.(14). (shrink)

This paper takes issue with Tyler Burge's claim that intentional states are nonindividualistically individuated in cognitive psychology. A discussion of current models of children's acquisition of semantic knowledge is used to motivate a thought-experiment which shows that psychologists working in this area are not committed to describing the concepts children attach to words in terms of the concepts standardly attached to those words in the child's community. The content of the child's representational states are thus not individuated with reference to (...) linguistic environment in the manner that Burge's nonindividualistic view requires. The paper concludes that the explanatory states of cognitive psychology are sometimes individualistically individuated. (shrink)

In this important book, Jennifer Scuro's lived experience presents a challenge to common ideas and assumptions about motherhood, femininity, and anti-abortion politics, as well as to the familiar content and form of philosophy. It is centered on an intensely personal, 176-page graphic novel that details the vivid aspects of Scuro's own miscarriage. Her experience serves as a philosophical allegory, challenging neoliberal and ableist assumptions that presume normalcy, expect results, and promise the false freedom of choice. Initially fitting the script of (...) "normal" motherhood and femininity, Scuro's experience brought her to the "razor's edge" of her cisgender, white privilege. The cutting truth of her story is that... (shrink)

(2003). The Bioethics of Fiction: The Chimera in Film and Print. The American Journal of Bioethics: Vol. 3, No. 3, pp. 22-24. doi: 10.1162/15265160360706787.

In the context of a largely exploratory inquiry, I warn against oversimplifying the relationships among intuitions, emotions, principle-governed reasoning, and responsiveness to reasons. I point out that one cannot determine the normative status of some fact without determining whether a case can be made for this status. But I also note that, though reason is thus autonomous, every episode of reasoning depends causally on the way things nonnormatively are, and this makes it possible for any reasoner to challenge even her (...) most basic normative assumptions. (shrink)

A number of sociologists have identified the emergence of a ‘new paradigm’ of health, based on the principle that the National Health Service should seek to prevent ill-health rather than simply treat the sick. The sociology of health promotion that has emerged over the past 15 years has contributed to debates about risk, lifestyle and consumerism, but the gendered nature of what some refer to as the ‘new morality of health’, and in particular its urging of feminine attributes, has largely (...) been neglected. This article provides a critical examination of the ‘new paradigm’ of health and its relationship to femininity. I suggest that femininity involves a certain attitude to the body that we also find in current health policy, and cultural representations of health more generally: that the body is essentially uncontrollable (yet something we should seek to control, as a matter of virtue), that it is a good in and of itself, and that it is synonymous with the self. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:464 Feminist Studies 44, no. 2. © 2018 by Feminist Studies, Inc. Claire Raymond and Sarah Corse A Distorting Mirror: Educational Trajectory After College Sexual Assault This article focuses on the broad and specific impacts of college sexual assault on student-survivors’ academic performance, academic trajectory, and their sense of self in relation to the university community. We frame this study with, and relate our findings to, the historic (...) and theoretical literatures that provide the context for this essay, including the large and burgeoning literature on the sexual assault of women college students and recent studies analyzing the role of fraternities in sexual assault, students’ fears and perceptions about college assault, bystander intervention training, and survivors’ grade-point averages after assault.1 Our study also builds on the history of feminist resistance to rape, feminist writings about rape, and campus activism against rape, with the 1. Cortney Franklin, Leana Allen Bouffard, and Travis C. Pratt, “Sexual Assault on the College Campus: Fraternity Affiliation, Male Peer Support, and Low Self-Control,” Criminal Justice and Behavior 39, no. 11 (2012): 1457– 80; Christine A. Gidycz, John R. McNamara, and Katie M. Edwards, “Women ’s Risk Perception and Sexual Victimization: A Review of the Literature,” Aggression and Violent Behavior 11, no. 5 (2006): 441–56; Jennifer Katz and Jessica Moore, “Bystander Education Training for Campus Sexual Assault Prevention: An Initial Meta-Analysis,” Violence and Victims 28, no. 6 (2013): 1054–67; Douglas W. Pryor and Marion R. Hughes, “Fear of Rape among College Women: A Social Psychological Analysis,” Violence and Victims 28, no. 3 (2013): 443–65; Carol E. Jordan, Jessica L. Combs, and Gregory T. Smith, “An Exploration of Sexual Victimization and Academic Performance among College Women,” Trauma, Violence, & Abuse 15, no. 3 (2014): 191–200. Claire Raymond and Sarah Corse 465 goal of shedding light on one aspect of the problem. Groundbreaking (and in some cases controversial) works analyzing the cultures of rape, such as Susan Brownmiller’s Against Our Will and Peggy Sanday’s “The Socio-Cultural Context of Rape” (in which Sanday creates the concept of the rape-producing culture—a concept that is central to our argument in this essay), found immediate reception with feminist activists of the 1970s and early 1980s.2 Mary Koss’s work regarding the scope of rape in college settings is also foundational to our study of campus rape.3 Susan Estrich, Catharine MacKinnon, and other feminist theorists in the mid-1980s developed critical apparatuses to shift the understanding of rape, providing a feminist framework wherein rape is interpreted as violence committed against a woman—in opposition to the patriarchal argument that rape is caused by a woman’s actions or is the product of her distortion of events after the fact.4 Angela Davis and bell hooks were deeply influential in framing understandings of the racial and racist aspects of feminist discussions of rape, while legal scholar Sarah Deer has more recently broadened understandings of the racialized discourse of rape, and Lisa Wade has written on twenty-first century hookup culture and the ways that this social landscape promulgates rates of maleon -female rape that are significantly higher on college campuses than in the general population.5 2. Peggy Reeves Sanday, “The Socio-Cultural Context of Rape: A Cross-Cultural Study,” Journal of Social Issues 37, no. 4 (1981): 5–27; Susan Brownmiller, Against Our Will: Men, Women and Rape (New York: Penguin Books, 1976). 3. Mary P. Koss, Christine A. Gidycz, and Nadine Wisniewski, “The Scope of Rape: Incidence and Prevalence of Sexual Aggression and Victimization in a National Sample of Higher Education Students,” Journal of Consulting and Clinical Psychology 55, no. 2 (1987): 162–70. 4. Susan Estrich, Real Rape: How the Legal System Victimizes Women Who Say No (Cambridge, MA: Harvard University Press, 1988); Duncan Chappell, Robley Geis, and Gilbert Geis, eds., Forcible Rape: The Crime, the Victim and the Offender (New York: Columbia University Press, 1977). 5. Angela Davis, “Rape, Racism, and the Myth of the Black Rapist,” in her Women, Race, and Class (New York: Vintage Books, 1983), 172–201; bell hooks, Feminist Theory: From Margin to Center (Boston: South End Press, 1984); Sarah Deer, The Beginning and End... (shrink)

This essay examines Harriet Jacobs’s Incidents in the Life of a Slave Girl (1861) in light of new archival findings on the medical practices of Dr. James Norcom (Dr. Flint in the narrative). While critics have sharply defined the feminist politics of Jacobs’s sexual victimization and resistance, they have overlooked her medical experience in slavery and her participation in reform after escape. I argue that Jacobs uses the rhetoric of a woman-led health reform movement underway during the 1850s to persuade (...) her readers to end slavery. This essay reconstructs both contexts, revealing that Jacobs links enslaved women’s physical and sexual vulnerability with her female readers’ fears of male doctors’ threats to modesty and of their standard bleed-and-purge treatments. Jacobs illustrates that slavery damages women’s health as much as heroic medicine, and thus merits the political activism of her readers. Specifically, Jacobs dramatizes her conflicts with the rapacious physician-master at moments that are crucial to women’s health: marriage, pregnancy, childbirth, and motherhood. Ultimately, this essay advances a new understanding of the role of health reform in social change: it galvanized other movements such as women’s rights and abolition, particularly around issues of bodily autonomy for women and African Americans. (shrink)

Sarah A. Mattice develops a comparative intervention in contemporary metaphilosophy. Drawing on resources from hermeneutics, cognitive linguistics, aesthetics, and Chinese philosophy, she explores how philosophical language is deeply intertwined with the definition and practice of the discipline.

The book situates the works and reception of the French scholar Pierre de la Ramée (Petrus Ramus) in a variety of European cultural and educational contexts, from Britain and France to Eastern Europe, from Germany to the Iberian peninsula, and from Scandinavia to the Netherlands. Pierre de la Ramée or Petrus Ramus (1515-1572) has long been a controversial figure in educational reform and innovation, from the moment of his first public academic statements in the 1530s, to his reception among scholars (...) in the twentieth and twenty-first centuries. What is beyond dispute, however, is the vast reach of his influence throughout Europe. Ramus's ideas were disseminated through copious editions and translations of his own textbooks, and in wave after wave of adaptations and re-imaginings of his ideas that swept across the continent. This volume embarks on a European tour of Ramism, using a wide range of previously unpublished or untranslated archival evidence from throughout the continent to examine the dissemination of Ramus's works and his intellectual influence in geographic and in disciplinary terms. The ten chapters explore the spread of Ramism from his home country of France to Protestant strongholds in Germany, Holland, and Britain, and in the Catholic context of the Iberian peninsula. The book also examines Ramism in the less familiar territories (to most Anglophone readers) of Scandinavia and Hungary, and considers the preceding and contemporary Dutch and German educational reform movements from which Ramus borrowed to forge his own distinctive intellectual method. (shrink)

Placing the question -- Patristic Precedents -- Moltmann's perichoretic spaces for God and creation -- No place for the spirit? Jean-Luc Marion's placial refusal -- Notes toward a Trinitarian theology of Place.