Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within (...) the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

Exploring the idea of knowledge as embodied, engendered and embedded in place and space, gender and sexuality are re-examined through the methodological and conceptual lenses of cartography, fieldwork, resistance, transgression and the divisions between local/global and public/private space. BodySpace brings together some of the best known geographers writing on gender and sexuality today to explore the role of space and place in the performance of gender and sexuality. The book takes a broad perspective on feminism as a theoretical critique, and (...) aims to reassess notions of sexuality, citizenship, work, violence, "race" and disability in their geographical contexts. (shrink)

_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

It is argued that the two main accounts of ignorance in the contemporary literature—in the terms of the lack of knowledge and the lack of true belief—are lacking in key respects. A new way of thinking about ignorance is offered that can accommodate the motivations for both of the standard views, but which in the process also avoids the problems that afflict these proposals. In short, this new account of ignorance incorporates the idea that ignorance essentially involves not just the (...) absence of a certain epistemic good, but also an intellectual failing of inquiry. It is further contended that making sense of this normative dimension to ignorance requires one to situate one’s account of ignorance within a wider epistemic axiology. (shrink)

Thomas Hobbes often includes powers and abilities in his descriptions of the world. Meanwhile, Hobbes’s philosophical picture of the world appears quite reductive, and he seems sometimes to say that nothing exists but bodies in motion. In more extreme versions of such a picture, there would be no room for powers. Hobbes is not an eliminativist about powers, but his view does tend toward ontological minimalism. It would be good to have an account of what Hobbes thinks powers are, and (...) how they fit into his understanding of the world. In this chapter, I investigate Hobbes’s account of the metaphysics of powers and abilities. Section 1 considers three important aspects of Hobbes’s account of powers: the connection between powers and causes; the modal aspects of powers; and the connection between powers and motions. Sections 2 and 3 then consider interpretive arguments about whether Hobbes identifies powers with underlying corporeal features. (shrink)

Donald Davidson famously argued, contra radical skepticism, that belief is in its nature veridical. In assessing whether Davidson was successful in this regard, it is first necessary to establish the exact philosophical basis Davidson was adducing for this claim, which is far from clear. In particular, a lot of the critical focus on Davidson's approach to radical skepticism has tended to focus on his appeal to an omniscient interpreter, and yet a closer evaluation of Davidson's antiskepticism reveals that this notion (...) is almost certainly dialectically inessential. Following some introductory remarks, in Section 2, I outline how the project of radical interpretation, and the associated principle of charity, are key parts of the philosophical background to Davidson's argument against radical skepticism. In Section 3, I critically evaluate Davidson's appeal to an omniscient interpreter. In Section 4, I demonstrate the role that Davidson's specific brand of content externalism plays in his antiskepticism, in particular in virtue of his notion of triangulation. Finally, in Section 5 I consider, and defend, an interpretation of Davidson's view that treats it as a kind of transcendental argument against skepticism. (shrink)

This advanced textbook, now in its second edition, provides an accessible overview of some of the main issues in contemporary epistemology. Written by an expert in the field, it covers such key topics as virtue epistemology, anti-luck epistemology, epistemological disjunctivism, epistemic value, understanding, radical scepticism, and contextualism. This book is ideal as a set text for an advanced undergraduate or postgraduate course in epistemology, and will also be of general interest to researchers in philosophy.

The Making of British Bioethics provides the first in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It details how British bioethics emerged thanks to a dynamic interplay between sociopolitical concerns and the aims of specific professional groups and individuals who helped create the demand for outside involvement and transformed themselves into influential 'ethics experts'. Highlighting this interplay helps (...) us appreciate how issues such as embryo research and assisted dying became high-profile 'bioethical' concerns in the late twentieth century, and why different groups now play a critical role in developing regulatory standards and leading public debates. The book draws on a wide range of original sources and will be of interest to historians of medicine and science, general historians and bioethicists. (shrink)

Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and (...) greater appreciation of the profound health implications of global warming. (shrink)

Should you wash your hands? -- Are workarounds ethical? -- Turfing, bending, and gaming -- Dirty hands and the semiclear conscience -- Problems of humanity -- Ethics without heroics : foreseeing moral problems in complex systems.

How fixed are the happenings in Nature and how are they fixed? One - very orthodox - account teaches that the sciences offer general truths that we combine with local facts to derive our expectations about what will happen, either naturally or when we build a device to design, be it a laser, a washing machine, an anti-malarial bed net, or an auction for the airwavse. Nancy Cartwright offers a different picture, one in which neither we nor Nature have (...) such nice rules to go by. This volume includes her Paul Carus Lectures plus four additional papers that further develop some of the central ideas. Cartwright offers an original view on the age-old question of scientific realism in which our knowledge is genuine, yet our scientific principles are neither true nor false but are, rather, templates for building good models. (shrink)

Does Augustine put his finger on time? -- Time for history -- Determination -- Self-determination -- Time, knowledge and truth.

Language was central to Hobbes's understanding of human beings and their mental abilities, and criticism of other philosophers' uses of language became a favorite critical tool for him. This paper connects Hobbes's theories about language to his criticisms of others' language, examining Hobbes's theories of propositions and truth, and how they relate to his claims that various sorts of proposition are absurd. It considers whether Hobbes in fact means anything more by 'absurd' than 'false'. And it pays particular attention to (...) Hobbes's categorization of causes of absurdity and of types of incoherent proposition, arguing that Hobbes's approach is only loosely related to later discussions of category mistakes. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

Fumerton’s distinctive brand of metaepistemological scepticism is compared and contrasted with the related position outlined by Stroud. It is argued that there are at least three interesting points of contact between Fumerton and Stroud’s metaepistemology. The first point of contact is that both Fumerton and Stroud think that (1) externalist theories of justification permit a kind of non-inferential, perceptual justification for our beliefs about non-psychological reality, but it’s not sufficient for philosophical assurance. However, Fumerton claims, while Stroud denies, that (2) (...) direct acquaintance with facts is sufficient for philosophical assurance. And this is important because Stroud thinks that (3) we have direct perceptual access or acquaintance with facts about the external world, while Fumerton denies this. (shrink)

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics’ (IAB’s) selection of Qatar to host the 2024 World Congress of Bioethics. IAB’s choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets (...) forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles.One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing? (shrink)

Affect Theory, Genre, and the Example of Tragedy employs Silvan Tomkins' Affect-Script theory of human psychology to explore the largely unacknowledged emotions of disgust and shame in tragedy. The book begins with an overview of Tomkins' relationship to both traditional psychoanalysis and theories of human motivation and emotion, before considering tragedy via case studies of Oedipus, Hamlet, and Death of a Salesman. Aligning Affect-Script theory with literary genre studies, this text explores what motivates fictional characters within the closed conditions of (...) their imagined worlds and how we as an audience relate to and understand fictional characters as motivated humans. (shrink)

What would it mean to have a suitably ‘realistic’ account of political liberty? On the one hand, I don’t think we can properly understand liberty without an underlying account of personhood or agency.2 In making sense of liberty, we need to ask: What kind of agency does it presuppose or promote? What kind of independence do we care most about? What does it mean to exercise control, or to be self-guiding, in the kind of world we live in today? At (...) the same time, a conception of moral and political personhood needs to be appropriately ‘realistic’: It shouldn’t be over-idealized (or over-simplified), nor demand more than can be reasonably expected, given the kind of creatures we are. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of mistaken moral (...) self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

This chapter discusses the fundamental question of the defense industry’s role and legitimacy for societies. It begins with a parable of a psychopath doing something self-serving that has beneficial moral consequences. Analogously, it is argued, the defense industry profiting by selling weapons that can kill people makes it useful in solving moral problems not solvable by people with ordinary moral scruples. Next, the chapter argues that while the defense industry is a business, it is also implicated in the security of (...) its home nations. In addition, its products can be used for good or evil. Thus, it must navigate conflicting values, with the result that the rules often thought to rightly regulate the industry—codes of business ethics, engineering ethics, procurement ethics, plus laws of the land, and dicta of conscience—need supplementing by general moral reflection. This chapter argues for a principle that tells how to decide when to violate the rules, for a theory of rational choice on which choosing by this principle is rational, and for teaching that theory to defense industry employees to ensure their ethical behavior. (shrink)

We lay groundwork for applying ethnographic methods in philosophy of science. We frame our analysis in terms of two tasks: to identify the benefits of an ethnographic approach in philosophy of science and to structure an ethnographic approach for philosophical investigation best adapted to provide information relevant to philosophical interests and epistemic values. To this end, we advocate for a purpose-guided form of cognitive ethnography that mediates between the explanatory and normative interests of philosophy of science, while maintaining openness and (...) independence when framing such an investigation to achieve robust unbiased results. (shrink)

Charlemagne's monogram -- Introduction -- The problem of consciousness -- The earliest vision -- Truth, being, and mind -- The Kehre -- The essence of truth -- The later Heidegger -- Reading Heidegger after Heidegger -- Being not a soul but the unmediated discovery of being.

A certain conception of the relevance of virtue epistemology to the philosophy of education is set out. On this conception, while the epistemic goal of education might initially be promoting the pupil's cognitive success, it should ultimately move on to the development of the pupil's cognitive agency. A continuum of cognitive agency is described, on which it is ultimately cognitive achievement, and thus understanding, which is the epistemic goal of education. This is contrasted with a view on which knowledge is (...) the epistemic goal. (shrink)

An overview of the import of disjunctivism to the problem of radical scepticism is offered. In particular, the disjunctivist account of perceptual experience is set out, along with the manner in which it intersects with related positions such as naïve realism and intentionalism, and it is shown how this account can be used to a motivate an anti-sceptical proposal. In addition, a variety of disjunctivism known as epistemological disjunctivism is described, and it is explained how this proposal offers a further (...) way of responding to radical scepticism. (shrink)

By bringing together the insights of ecclesial ethics, an approach that emphasizes the distinctive nature of the church as the community that forms its mind and character after its reading of Scripture, with the theory and practice of restorative justice, a way of conceiving justice-making that emerged from the Mennonite-Anabaptist tradition, this book shows why a theological account of the theory and practice of restorative justice is fruitful for articulating and clarifying the witness of the church, especially when faced with (...) conflict or wrongdoing. This can help extend the church's imagination as to how it might better become God's community of restoration as it reflects on the ways in which the justice of God is taking shape in its own community. “How does an ecclesial context shape the theological apprehension and praxis of justice?” This question orientates the book. In particular, it asks how, in view of its members having been admitted into God's restoring justice in Christ, the church might embody in the world this same justice of restoring right relationships. While Christian reflection on the nature of justice has tended to favour a judicial and retributive conception of justice, it will be argued that the biblical understanding of the justice of God is best understood as a saving, liberating, and restorative justice. It is this restorative conception that ought to guide the community that reads Scripture so that it might be embodied in life. (shrink)

Lovescapes introduces the reader to the various meanings and manifestations of love and its many cognates such as compassion, caring, altruism, empathy, and forgiveness. It addresses how love and compassion have been understood in history and the religions of the world. It goes on to explore the ways that our environments and heredity influence our capacity to love and suggests ways to cultivate love and compassion in one's life. The book shows how the values of love and compassion are integral (...) to finding humane solutions to the daunting problems we face as individuals, as a human family, and as an earth community--a world in crisis. (shrink)

My aim in this chapter is to take the complexity of our histories of rights as seriously as the nature of rights themselves. Let me say immediately that the point is not to satisfy our sense of moral superiority by smugly pointing out the prejudices found in arguments made over three hundred years ago. We have more than our own share of problems and prejudices to deal with. Rather, in coming to grips with this history, and especially how early-modern political (...) theorists struggled with the extension and application of natural rights to the ‘New World’, we may learn something about our own struggles to extend human rights beyond the boundaries of the state system of which Grotius, Hobbes, Locke and Vattel were among the key intellectual architects. For Richard Tuck, the autonomous rights-bearing agent at the heart of liberal individualism is a product of seventeenth-century theorizing about the nature of the autonomous state acting in the international sphere. The sovereign individual is the ‘traditional cousin of the sovereign state’, argues Tuck, and especially the aggressive, violent, and minimally constrained relative described by Hugo Grotius, Thomas Hobbes, John Locke and Emer de Vattel. Thus the connection between liberalism and imperialism, on this reading, is not merely chronological or historical but metaphysical. The analogy between the sovereign state and the sovereign individual acting on the basis of their natural rights, constrained by the recognition of the basic rights of others (but not much more than that) represents an influential vision of liberal freedom. This minimalist account of freedom represents only one vision, however, and Tuck’s account of the pre-history of liberal rights has to be balanced against other conceptions, including more emancipatory ones. (shrink)

The relevance of Wittgenstein for ethics depends on which Wittgenstein we mean. I argue that we should distinguish not only between Wittgenstein's personal opinions and his philosophy, but also, within his philosophical work, between broadly methodological remarks and what Wittgenstein might call genuinely philosophical remarks (which are not about philosophy but try to bring clarity to the mind bewitched by language). Wittgenstein's personal opinions will be considered irrelevant by most philosophers (although I try to show that they are not as (...) crazy as some people might think), and his philosophical remarks consist only of what he calls ?boring truisms?. It is to his methodology, therefore, that we might expect philosophers to look for ethical implications. If that methodology is well conceived, though, it should be ethically neutral. I argue that it is neutral in this way, that Wittgensteinian philosophy says nothing about ethics, but that its proper use will not likely leave our philosophical beliefs about ethics unscathed. (shrink)

Can liberalism survive? In this edited collection, twenty leading political theorists explore the future and past of liberal political thought. Covering issues such as migration, climate change, the family, multiculturalism, structural injustice, rights, justice, equality, misinformation, illiberalism (and post-liberalism) - amongst others - the essays engage with fundamental normative and conceptual questions, as well as detailed analyses of specific historical and contextual challenges facing liberalism today. Forthcoming in May 2024.

This chapter addresses the close association between withholding and withdrawing futile life-sustaining medical treatments and assisting patients with hastening ending their lives. Section 12.2 sets forth a definition of medical futility and places this concept in the broader context of bioethical principles of autonomy, beneficence, nonmaleficence and justice. Section 12.3 draws out futility’s ethical implications and considers the view that physicians are ethically permitted to refrain from medically futile treatments, should be encouraged to refrain, or have a duty to refrain. (...) Section 12.4 examines ethical arguments that physicians also have a positive duty to assist patients with terminal conditions who are imminently dying to end their lives. It explores ethical arguments for assisted dying that appeal to the physicians’ significant responsibility and relationship with patients, the claimed moral equivalence of actions and omissions, and the medical goal of helping patients have a peaceful and dignified death. (shrink)

Liberalism is a term employed in a dizzying variety of ways in political thought and social science. This essay challenges how the liberal tradition is typically understood. I start by delineating different types of response—prescriptive, comprehensive, explanatory—that are frequently conflated in answering the question “what is liberalism?” I then discuss assorted methodological strategies employed in the existing literature: after rejecting “stipulative” and “canonical” approaches, I outline a contextualist alternative. Liberalism, on this account, is best characterised as the sum of the (...) arguments that have been classified as liberal, and recognised as such by other self-proclaimed liberals, over time and space. In the remainder of the article, I present an historical analysis of shifts in the meaning of liberalism in Anglo-American political thought between 1850 and 1950, focusing in particular on how Locke came to be characterised as a liberal. I argue that the scope of the liberal traditionexpanded during the middle decades of the twentieth century, such that it came to be seen by many as the constitutive ideology of the West. This capacious understanding of liberalism was a product of the ideological wars fought against “totalitarianism” and assorted developments in the social sciences. Today we both inherit and inhabit it. (shrink)