Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

Evidence-based medicine has been rapidly and widely adopted because it claims to provide a method for determining the safety and efficacy of medical therapies and public health interventions more generally. However, as others have noted, EBM may be riven through with cultural bias, both in the generation of evidence and in its translation. We suggest that technological and scientific advances in medicine accentuate and entrench these cultural biases, to the extent that they may invalidate the evidence we have about disease (...) and its treatment. This creates a significant ethical, epistemological and ontological challenge for medicine. (shrink)

This paper traces the development of corporate citizenship as a way of framing business and society relations, and critically examines the content of contemporary understandings of the term. These conventional views of corporate citizenship are argued to contribute little or nothing to existing notions of corporate social responsibility and corporate philanthropy. The paper then proposes a new direction, which particularly exposes the element of "citizenship". Being a political concept, citizenship can only be reasonably understood from that theoretical angle. This suggests (...) that citizenship consists of a bundle of rights conventionally granted and protected by governments of states. However, the more that governmental power and sovereignty have come under threat, the more that relevant political functions have gradually shifted towards the corporate sphere – and it is at this point where "corporate" involvement into "citizenship" becomes an issue. Consequently, "corporate citizens" are substantially more than fellow members of the same community who cosily rub shoulders with other fellow citizens while bravely respecting those other citizens'' rights and living up to their own responsibility as corporations – as the conventional rhetoric wants us to believe. Behind this relatively innocuous mask then, the true face of corporate citizenship suggests that the corporate role in contemporary citizenship is far more profound, and ultimately in need of urgent reappraisal. (shrink)

According to Buddhist philosophies, recognizing the self as impermanent, changing, and interdependent is at the root of virtue. With this realization, desires shift away from inward self-cherishing and toward outward self-transcending. This altruistic outlook underlies virtuous action and flourishing. Our primary research question asks: 1) to what extent do people experience self-transcending and self-cherishing desires in everyday life, and 2) to what extent do these different desires predict behaviors and body physiology that underlie virtue and well-being. As highlighted by the (...) SMV project, one challenge involves measuring both intention and action. To overcome this challenge, we propose a multi­methodological study that will integrate first­person experiences of desires, second­person reports from close others, and third­person laboratory measures of prosocial behavior and body physiology that underlie virtue and flourishing in the context of social relationships. We will use an “experience sampling” method delivered via a smartphone app to capture psychological desires in daily life. In the laboratory, we will examine if desires in daily life are related to prosocial behavior and physiological synchrony during face-to-face social interactions with a romantic partner. Theoretically, we anticipate that integration of Buddhist philosophy into Western psychology research will encourage more emphasis on the deep psychological desires that appear to continually drive behavior. Empirically, we predict that frequent self-transcending desires in daily life will be related to prosocial behavior and physiological synchrony during interactions with romantic partners. Going forward, this project will provide the foundation for future work examining how the moral self can be shaped through contemplative practice in everyday life. (shrink)

In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present‐day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a ‘metaphor’. Rather, we propose decolonization as a political project where (...) nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio‐political and historical context of health care, recognizes dispossession of land and adopts a ‘multilogical’ vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing. (shrink)

Sign languages provide direct evidence for the relation between human languages and the body that engenders them. We discuss the use of the hands to create symbols and the role of the body in sign language verb systems, especially in two quite recently developed sign languages, Israeli Sign Language and Al-Sayyid Bedouin Sign Language.

Values such as justice, fairness, reason, and truth permeate the cultural fabric of societies. A key image of these values in many Western democracies is the legal icon of Justitia or Lady Justice as she embodies notions of justice. Examining such cultural constructions promotes discussion of assumed values and meanings pertaining to iconic representations. Semiotic analysis of Justitia and her compositional elements — the sword of justice, scales of justice, and blind-fold reveal tensions between the rhetoric and reality of our (...) interpretations of justice. This paper makes explicit the iconic representations of societal values imbued in Justitia and raises questions about the invisible power of cultural reproduction. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

This article identifies conditions under which robust predictive modeling results have special epistemic significance---related to truth, confidence, and security---and considers whether those conditions hold in the context of present-day climate modeling. The findings are disappointing. When today’s climate models agree that an interesting hypothesis about future climate change is true, it cannot be inferred---via the arguments considered here anyway---that the hypothesis is likely to be true or that scientists’ confidence in the hypothesis should be significantly increased or that a claim (...) to have evidence for the hypothesis is now more secure. (shrink)

It is increasingly recognised that evidence generated using “real-world data” is crucial for assessing the safety and effectiveness of health-related interventions. This, however, raises a number of issues, including those related to the quality of RWD, and of the scientific methods used to generate evidence from it, and the potential for those gathering and using RWD be driven by commercial, political, professional or personal self-interest. This article is an application of the framework presented in this issue of ABR. Please refer (...) to that article for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end to demonstrate how those generating or using RWD can make use of values when deliberating about ethical issues. (shrink)

First published in 1982. Routledge is an imprint of Taylor & Francis, an informa company.

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

Wendy Donner contends here that recent commentators on John Stuart Mill's thought have focused on his notions of right and obligation and have not paid as much attention to his notion of the good. Mill, she maintains, rejects the quantitative hedonism of Bentham's philosophy in favor of an expanded qualitative version. In this book she provides an account of his complex views of the good and the ways in which these views unify his moral and political thought.

Background: The pharmaceutical industry has been responsible for major medical advances, but the industry has also been heavily criticized. Such criticisms, and associated regulatory responses, are no doubt often warranted, but do not provide a framework for those who wish to reason systematically about the moral dimensions of drug development. We set out to develop such a framework using Beauchamp and Childress's “four principles” as organizing categories. Methods: We conducted a qualitative interview study of people working in the “medical affairs” (...) departments of pharmaceutical companies to determine: (1) whether our data could meaningfully be organized under the headings of “autonomy,” “beneficence,” “nonmaleficence,” and “justice”; (2) how principles might be expressed in this particular commercial setting; and (3) if these principles are expressed, whether and how competing principles are balanced. We then critiqued these findings using existing normative theory. Results: Our interviews demonstrated that three of Beauchamp and Childress's four principles were salient to our participants: beneficence, nonmaleficence, and justice. Within each of these principles, participants had two broad ethical orientations: an altruistic public focus (“other-ness”) and a commitment to their companies (“firm-ness”). Our participants also demonstrated efforts to balance these principles and highlighted the importance of phronesis (or practical wisdom) in balancing and enacting principles. Notably, however, our participants did not spontaneously emphasize the importance of autonomy. Conclusions: It is possible to use qualitative empirical research, together with normative analysis, to derive a framework for pharmaceutical ethics. We suggest that our framework would be useful for those who wish to reason ethically within, or in collaboration with, the pharmaceutical industry. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

The landscape in which journalists now work is substantially different to that of the twentieth century. The rise of digital and social media necessitates a new way of considering the ethical questions facing practicing journalists. This volume considers the various individual, cultural and institutional influences that have an impact on journalistic ethics today. It also examines the links between ethics and professionalism, the organizational promotion of ethical values and the tensions between ethics, freedom of information and speech, and the need (...) to disseminate information. By comparing the theoretical underpinnings of journalistic ethics with a variety of international case studies, this volume provides a comparative global analysis of the ethical challenges faced by the media in the twenty-first century. It will be essential reading for students of journalism and practicing journalists. (shrink)

This article explores some of the roles of computer simulation in measurement. A model-based view of measurement is adopted and three types of measurement—direct, derived, and complex—are distinguished. It is argued that while computer simulations on their own are not measurement processes, in principle they can be embedded in direct, derived, and complex measurement practices in such a way that simulation results constitute measurement outcomes. Atmospheric data assimilation is then considered as a case study. This practice, which involves combining information (...) from conventional observations and simulation-based forecasts, is characterized as a complex measuring practice that is still under development. The case study reveals challenges that are likely to resurface in other measuring practices that embed computer simulation. It is also noted that some practices that embed simulation are difficult to classify; they suggest a fuzzy boundary between measurement and non-measurement. 1 Introduction2 A Contemporary View of Measurement3 Three Types of Measurement4 Can Computer Simulations Measure Real-World Target Systems?5 Case Study: Atmospheric Data Assimilation5.1 Why data assimilation?5.2 A complex measuring practice under development5.3 Epistemic iteration6 The Boundaries of Measurement7 Epistemology, Not Terminology. (shrink)

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as (...) silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)

'Is politics gendered? Wendy Brown things so, and argues for this point with elegance, imagination and pungent phrases. Brown's book is challenging, provocative and...original; it does force us to question the degree to which gender controls our politics.'-THE REVIEW OF POLITICS.

Allan Franklin has identified a number of strategies that scientists use to build confidence in experimental results. This paper shows that Franklin's strategies have direct analogues in the context of computer simulation and then suggests that one of his strategies—the so-called 'Sherlock Holmes' strategy—deserves a privileged place within the epistemologies of experiment and simulation. In particular, it is argued that while the successful application of even several of Franklin's other strategies (or their analogues in simulation) may not be sufficient for (...) justified belief in results, the successful application of a slightly elaborated version of the Sherlock Holmes strategy is sufficient. (shrink)

Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyroid cancer are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions such partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side (...) effects. These harms seem to outweigh any putative benefit of knowing about a cancer that would not have caused problems if left undiscovered. In addition to harms to patients, thyroid cancer overdiagnosis leads to significant opportunity costs at a societal level, due to costs of diagnosis and treatment. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. At the individual patient level, use of this risk information might support informed choice and/or shared decision-making, as mandated by clinical ethics frameworks. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals have conflicts of interest. We argue in this article that thyroid cancer overdiagnosis may be usefully understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms. (shrink)

Recent calls for retraction of a large body of Chinese transplant research and of Dr Jiankui He’s gene editing research has led to renewed interest in the question of publication, retraction and use of unethical biomedical research. In Part 1 of this paper, we briefly review the now well-established consequentialist and deontological arguments for and against the use of unethical research. We argue that, while there are potentially compelling justifications for use under some circumstances, these justifications fail when unethical practices (...) are ongoing—as in the case of research involving transplantations in which organs have been procured unethically from executed prisoners. Use of such research displays a lack of respect and concern for the victims and undermines efforts to deter unethical practices. Such use also creates moral taint and renders those who use the research complicit in continuing harm. In Part 2, we distinguish three dimensions of ‘non-use’ of unethical research: non-use of published unethical research, non-publication, and retraction and argue that all three types of non-use should be upheld in the case of Chinese transplant research. Publishers have responsibilities to not publish contemporary unethical biomedical research, and where this has occurred, to retract publications. Failure to retract the papers implicitly condones the research, while uptake of the research through citations rewards researchers and ongoing circulation of the data in the literature facilitates subsequent use by researchers, policymakers and clinicians. (shrink)

In the biomedical field, calls for the generation of new regulations or for the amendment of existing regulations often follow the emergence of apparently new research practices (such as embryonic stem cell research), clinical practices (such as facial transplantation) and entities (such as Avian Influenza/’Bird Flu’). Calls for regulatory responses also arise as a result of controversies which bring to light longstanding practices, such as the call for increased regulation of human tissue collections that followed the discovery of unauthorised post-mortem (...) organ retention. Whilst it seems obvious that new regulations should only be generated if existing regulations are inadequate (a practice referred to in this paper as ‘regulatory syncretism’), this does not always occur in practice. This paper examines the conceptual steps involved in generating regulatory responses to emerging phenomena. Two decision points are identified. First, a stance is taken as to whether the emerging phenomenon raises unique ethical or legal issues (exceptionalism versus non-exceptionalism). Second, the decision is made as to whether new regulation should be generated only for truly unique phenomena (syncretism versus asyncretism). It is argued here that it is important to make a careful assessment of novelty, followed by a reflective and deliberate choice of regulatory syncretism or asyncretism, since each type of regulatory response has advantages which need to be harnessed and disadvantages which need to be managed—something that can only occur if regulators are attentive to the choices they are making. (shrink)

In order to summarize a story, it is necessary to access a high level analysis of the story that highlights its central concepts. A technique of memory representation based on plot units appears to provide a rich foundation for such an analysis. Plot units are conceptual structures that overlap with each other when a narrative is cohesive. When overlapping intersections between plot units are interpreted as arcs in a graph of plot units, the resulting graph encodes the plot of the (...) story. Structural features of the graph then reveal which concepts are central to the story, and which concepts are peripheral. Plot unit analysis is currently being investigated as a processing strategy for narrative summarization by both computer simulation and psychological experiments. (shrink)

Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has (...) been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem. (shrink)

In this paper we explore the nature of the emerging purpose ecosystem and its role in transforming and supporting business to help address the UN Sustainable Development Goals. We argue that interactions among its ‘private actors’, who share efforts and belief in changing and redefining the purpose and nature of business by advocating broader non-financial performance outcomes, have the potential to contribute to a wider sustainability-oriented transformation of the business sector. Through interview data collected in the UK and Australia, we (...) identify six main roles that characterise the activities and interactions among its actors and their stakeholders. Our research contributes to expanding knowledge on the emerging phenomenon of the purpose ecosystem and how its actors support the achievement of the UN SDGs by seeking to change the purpose of business and integrating the goals into their operations and engagements with stakeholders. (shrink)

According to an adequacy-for-purpose view, models should be assessed with respect to their adequacy or fitness for particular purposes. Such a view has been advocated by scientists and philosophers...

Bioethics, Volume 35, Issue 7, Page 623-633, September 2021.

The Trafficking Victims’ Protection Act of 2000 has been presented as an important tool in combatingthe exploitation and abuse of undocumented workers, especially those forced into prostitution. Through a close reading of the legislation and the debates surrounding its passage, this article argues that the law makes strategic use of anxieties over sexuality, gender, and immigration to further curtail migration. The law does so through the use of misleading statistics creating a moral panic around “sexual slavery,” through the creation of (...) a gendered distinction between “innocent victims” and “guilty migrants,” and through the demand that aid to victims be tied to their willingness to assist in the prosecution of traffickers. As a result, the legislation is less a departure from, than of a piece with, other recent antisex and antiimmigrant policies. (shrink)

On the 24th June 2015, Feminist Legal Studies and the London School of Economics Law Department hosted an afternoon event with Professor Wendy Brown, Class of 1936 First Professor of Political Science, University of California. Professor Brown kindly agreed to discuss her scholarship on feminist theory, and its relationship to both the law and neoliberalism. The event included an interview by Dr Katie Cruz and a Q&A session, which are presented here in an edited version of the transcript. Sumi (...) Madhock, Professor of Gender Studies, LSE chaired the interview and discussion and introduced Professor Brown’s work. Katie Cruz asked Wendy Brown to reflect upon topics that span her scholarship and activism, including the state of critical, feminist, and Left approaches to rights, neoliberalism, despair and utopianism, and the future of feminist theory and practice in the context of neoliberalism and current debates about intersectionality. Participants in the discussion asked questions on a wide range of issues, including the limits of feminist engagement with law as a tool for social change, the dominance of neoliberalism, imperialist feminism, Islamophobia, secularism, and our attachment to the figure of homo politicus. (shrink)