These essays are concerned with developing a dialogue between humanism and historical materialism in human geography, and to demonstrate the creative tension which emerges through the mediation of their different frames of reference.

summary, crtiques, strengths and limitation of the article.

When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

The modern biological definition of a chimera is a single organism composed of cells with multiple distinct genotypes. Chimeras combining human and nonhuman cells are invaluable for various kinds of research, providing a platform for the study of human cell development while avoiding the ethical issues involved in conducting this research on human subjects. There is also the possibility that human/nonhuman chimeras could one day be used to produce human organs for transplant. Yet human/nonhuman chimeras raise a number of unique (...) ethical challenges as well. Critics worry that they are ‘unnatural’, or will cause a kind of ‘moral confusion’, or pose a threat to human dignity. There are also concerns about the kinds of treatment we might owe to human/nonhuman chimeras. For example, introducing human pluripotent stem cells into a gorilla blastocyst could result in the animal developing a ‘humanlike’ brain, or developing human behaviours or characteristics. Would we need to treat such a being as we do our fellow humans? This chapter examines various arguments concerning research involving human/nonhuman chimeras, and the implications of these arguments for research policy. I conclude that research involving human/nonhuman chimeras is not intrinsically morally wrong, though it may be morally impermissible in some cases. However, I criticize the standard approach to evaluating the treatment of nonhumans in research, arguing that the moral treatment of nonhuman animals, including human/nonhuman chimeras, depends on contextual factors, rather than their moral status. (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Translator's Preface LA LOGIQUE DE HUSSERL, etude sur "Logique for- melle et logique transcendentale" the original of the present translation, was published ...

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...) not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this (...) question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

: This essay examines the increasing commodification of the body with respect to tissues, gametes, and embryos. Such commodification contributes to a diminishing sense of human personhood on an individual level, even as it erodes commitments to human flourishing at the societal level. After the case for social harm resulting from the increasing commodification of the body is made, the question becomes whether that harm is best remedied by following any of three approaches by which government traditionally seeks to promote (...) the flourishing of its citizens. The author concludes that it is not, and that what is needed is a pragmatic and somewhat casuistic approach to the regulation of contested commodities--that which legal scholar Margaret Jane Radin calls "incomplete commodification.". (shrink)

Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation”, can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these (...) patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported. (shrink)

In his recent book Reflective Democracy, Robert Goodin argues that 'external-collaborative' models of democratic deliberation procedures need to be supplemented by 'internal-reflective' deliberation. The exercise of the moral imagination plays a central role in Goodin's account of 'democratic deliberation within'. By imaginatively putting ourselves in the place of a range of others, he argues, including those who maybe not be able to represent their own interests, we can make their points of view 'communicatively present' in deliberation. Goodin's argument emphasizes the (...) role of art and other forms of cultural representation in helping to bring about this expansion of moral imagination. Drawing on debates in philosophy of mind concerning the scope and limits of our capacities to simulate other minds, I argue that Goodin's analysis of 'democratic deliberation within' conflates different kinds of imaginative project. In doing so, it underestimates both the difficulties of imaginatively putting ourselves in the place of others and the political risks in doing so. I argue, alternatively, that moral engagement with others involves the capacity for sympathy and that art and other forms of cultural representation can enlarge the scope of our sympathies, by assisting us to overcome imaginative resistance to alien points of view. In developing this argument, I provide a qualified defense of Iris Young's claim that respect for others involves 'asymmetrical reciprocity'. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

Discusses the ethical issues involved in the use of human embryonic stem cells in regenerative medicine.

Has exclusion of Darwin's views on evolution distorted 20c philosophy? Cunningham suggests a reappraisal.

An important goal of ethical investment is to influence companies to improve their ethical and environmental performance. The principal means that many ethical funds employ is passive market signalling, which may not, on its own, have a significant effect. A much more promising approach may be active engagement. This paper reports on a questionnaire study of a sample of 1146 ethical investors in order to assess whether U.K. ethical investors would support more activist ethical investment and whether they would be (...) prepared to invest in companies which are failing ethically in order to do so. The results show general support for the current practice of passive signalling accompanied by "soft" engagement in the form of lobbying and the development of dialogue in order to improve corporate practice. The "harder" options of investing in companies that err in order to change them is, however, favoured by consistent minorities. (shrink)

The aim of this article is to give an account of a methodological link between drama and political theory. This account is drawn primarily from the early philosophical work of Deleuze. Following Deleuze, we will refer to it as ‘the method of dramatization’. We will argue that dramatization is a method aimed at determining the quality of political concepts by ‘bringing them to life’, in the way that dramatic performances bring to life the characters and themes of a play-script. We (...) demonstrate that this can be specified in relation to the development of this method in Deleuze's early philosophical work as a practical, critical and artistic method and, in relation to the ontological assumptions he articulated and defended in Difference and Repetition, as a process of intensification of the Idea of the political. By way of example, we discuss how the dramatization of the concept of ideology functions in Deleuze and Guattari's Anti-Oedipus and A Thousand Plateaus. We conclude with some lines of inquiry that could be pursued by political theorists looking to investigate further the dramatic nature of method in political theory. (shrink)

Rho GTPases are critically important and are centrally positioned regulators of the actomyosin cytoskeleton. By influencing the organization and architecture of the cytoskeleton, Rho proteins play prominent roles in many cellular processes including adhesion, migration, intra‐cellular transportation, and proliferation. The most important method of Rho GTPase regulation is via the GTPase cycle; however, post‐translational modifications (PTMs) also play critical roles in Rho protein regulation. Relative to other PTMs such as lipidation or phosphorylation that have been extensively characterized, protein oxidation is (...) a regulatory PTM that has been poorly studied. Protein oxidation primarily occurs from the reaction of reactive oxygen species (ROS), such as hydrogen peroxide (H2O2), with amino acid side chain thiols on cysteine (Cys) and methionine (Met) residues. The versatile redox modifications of cysteine residues exemplify their integral role in cell signalling processes. Here we review prominent members of the Rho GTPase family and discuss how lipidation, phosphorylation, and oxidation on conserved cysteine residues affects their regulation and function. (shrink)

This paper takes up the problem of the qualitative dimension from the perspectives of enactivism and John Dewey’s pragmatic naturalism. I suggest that the pragmatic naturalism of Dewey, combined with recent work on enactivism, points the way to a new account of the qualitative dimension, beyond the bifurcation of nature into the subjective and objective, or the qualitative and quantitative. The pragmatist-enactivist view I sketch here has both methodological-explanatory and ontological dimensions. Following the work of Francisco Varela and Evan Thompson, (...) I suggest that the qualitative dimension should be explained in experientialist and ecological terms. Following Dewey, I suggest that the ontology of the qualitative dimension should be understood in dynami c, relational, and ‘transactional’ terms. (shrink)

In this paper, we give an account of some of the necessary conditions for an effectively functioning public sphere, and then explore the question of whether these conditions allow for the expression of ideas and values that are fundamentally incompatible with those of liberalism. We argue that speakers who advocate or glorify violence against democratic institutions fall outside the parameters of what constitutes legitimate public debate and may in fact undermine the conditions necessary for the flourishing of free speech and (...) public dialogue more generally. (shrink)

Connects the work of Merleau-Ponty to environmental studies.

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

_Philosophically explores the topic of emotional depth._.

Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (shrink)

Scientists and decision makers rely on climate models for predictions concerning future climate change. Traditionally, physical processes that are key to predicting extreme events are either directly represented or indirectly represented. Scientists are now replacing physically based parameterizations with neural networks that do not represent physical processes directly or indirectly. I analyze the epistemic implications of this method and argue that it undermines the reliability of model predictions. I attribute the widespread failure in neural network generalizability to the lack of (...) process representation. The representation of climate processes adds significant and irreducible value to the reliability of climate model predictions. (shrink)