This revised version of the author’s 1985 article “Contra Copyright” includes a new, introductory section explaining the background of the author’s path to copyright abolitionism. The main article surveys various libertarian debates on this issue, including the anti-intellectual property views of Benjamin Tucker and the pro-IP views of Lysander Spooner. McElroy argues that the issue of copyright hinges on the question: can ideas be property? Because only scarce goods can be property, and ideas are not scarce, copyright must be (...) rejected as unjustified. (shrink)

The image of a bomb-throwing anarchist is a cultural caric ature but, as with many caricatures, there is some truth behind it. Certain forms of anarchism—specifically, the strain of nineteenthcentury communist anarchism that arose in Russia and Germany— did embrace violence as a political strategy. Other forms of anarchism, however—such as Leo Tolstoi’s Christian anarchism and the indigenously American strain of individualist anarchism—consistently repudiated the use of violence for political ends.1 Indeed, one of the charges brought against early individualist anarchism (...) was that its ideology was too peaceful, and its communities would be defenseless against aggressors. (shrink)

anarchist periodical Liberty (Boston 1881–92, New York 1892–1908) over the propriety of electoral politics, it is necessary to understand the prevailing view of the State expressed by that nineteenth-century tradition.1 The most fundamental and integrating theme of that tradition was the primacy of individuals, which implied an extreme respect for their sovereignty. Accordingly, individualist-anarchists wished to eliminate all but defensive force from human interaction. Tucker proposed what he called “a society by contract” to replace the society by force he saw (...) around him. (shrink)

The second expanded edition of Ayn Rand: The Russan Radical, like the trilogy of which it is a part, aims to radically redefine the methodology of established traditions by wedding the dialectical method to libertarianism. On this overall trilogy, many important questions remain with regard to Chris Matthew Sciabarra's ambitious project. But this does not take away from the fact that the book remains a brilliant and pathbreaking work. Sciabarra inspires us to rethink issues on a fundamental level.

There was a period in the latter nineteenth century when a distinctively American kind of radicalism flourished, a time when key thinkers could be called, and called themselves, individualists, libertarians, anarchists, and socialists all at once. McElroy gives us a window on the people and times involved. But her work is of more than antiquarian interest: their debates and the issues they faced often sound strikingly modern.

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)

Informal political representation can be a political lifeline, particularly for oppressed and marginalized groups. Such representation can give these groups some say, however mediate, partial, and imperfect, in how things go for them. Coeval with the political goods such representation offers these groups are its particular dangers to them. Mindful of these dangers, skeptics challenge the practice for being, inter alia, unaccountable, unauthorized, inegalitarian, and oppressive. These challenges provide strong pro tanto reasons to think the practice morally impermissible. This paper (...) considers the question: On what conditions is the informal political representation of oppressed and marginalized groups permissible? By responding to skeptics’ challenges, I develop a systematic account of moral constraints that, if adopted, would make such representation permissible. The account that emerges shows that informal political representatives (IPRs) must aim to fulfill two sets of sometimes conflicting duties to the represented: democracy within duties, which concern how the representative treats and relates to the represented, and justice without duties, which concern how the representative’s actions advance the aims of the representation. (shrink)

Journal of Political Philosophy, Volume 29, Issue 4, Page 429-455, December 2021.

An underexamined insight of W. E. B. Du Bois’s John Brown is that John Brown worked for much of his life to cultivate democratic relationships with the Black Americans with and for whom he worked. Brown did so through practicing deference and deliberation, and by seeking authorization. However, Brown’s commitment to these practices faltered at a crucial moment in decision making: when he raided Harpers Ferry absent widespread support. Examining this aspect of John Brown brings into relief an overlooked tragic (...) choice Brown made: To act in accordance with his own substantive vision of what justice required, Brown eschewed democratic ideals and practices that grounded the distinctive relations of equality he had cultivated with the Black communities with and for whom he worked. (shrink)

This chapter contains sections titled: Two Killers in Montana Naming, Metaphor, and the Language of Serial Murder What's in a Name? The Wolf and the Widow Naming: Putting Practice into Theory Metaphor: Wolf in Sheep's Clothing Metaphor: White Wolf Revisited I Am Become Wolf: Anthropomorphism and Zoomorphism Strange Bedfellows For Further Contemplation.

From Booker T. Washington to a neighbor who speaks up at a city council meeting, many of the people who represent us were never elected. Wendy Salkin provides the first systematic analysis of the ubiquitous phenomenon of informal political representation, a practice of immense political value that raises serious ethical concerns.

In this paper, I argue that considerations of epistemic bubbles can give us reason to defend censorship of hate speech. Although censoring hate speech leads to epistemic bubbles (‘censorship bubbles’), they tend to be less epistemically problematic than epistemic bubbles generated by the circulation of hate speech (‘hate bubbles’). Because hate speech silences its target groups and creates the illusion that the dominant group identities are threatened, hate bubbles are likely more restrictive in structure than censorship bubbles and have a (...) stronger tendency to turn into echo chambers where opposing views are actively discredited. Therefore, I argue that censorship bubbles might be a minor price we ought to pay to avoid hate bubbles. Additionally, my analysis shows that we cannot focus exclusively on the content or the structure of epistemic bubbles, since their content can partly determine their structure, as is in the case of hate bubbles. (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)

ABSTRACT:In a world filled with poverty, environmental degradation, and moral injustice, social enterprises offer a ray of hope. These organizations seek to achieve social missions through business ventures. Yet social missions and business ventures are associated with divergent goals, values, norms, and identities. Attending to them simultaneously creates tensions, competing demands, and ethical dilemmas. Effectively understanding social enterprises therefore depends on insight into the nature and management of these tensions. While existing research recognizes tensions between social missions and business ventures, (...) we lack any systematic analysis. Our paper addresses this issue. We first categorize the types of tensions that arise between social missions and business ventures, emphasizing their prevalence and variety. We then explore how four different organizational theories offer insight into these tensions, and we develop an agenda for future research. We end by arguing that a focus on social-business tensions not only expands insight into social enterprises, but also provides an opportunity for research on social enterprises to inform traditional organizational theories. Taken together, our analysis of tensions in social enterprises integrates and seeks to energize research on this expanding phenomenon. (shrink)

ABSTRACT:In a world filled with poverty, environmental degradation, and moral injustice, social enterprises offer a ray of hope. These organizations seek to achieve social missions through business ventures. Yet social missions and business ventures are associated with divergent goals, values, norms, and identities. Attending to them simultaneously creates tensions, competing demands, and ethical dilemmas. Effectively understanding social enterprises therefore depends on insight into the nature and management of these tensions. While existing research recognizes tensions between social missions and business ventures, (...) we lack any systematic analysis. Our paper addresses this issue. We first categorize the types of tensions that arise between social missions and business ventures, emphasizing their prevalence and variety. We then explore how four different organizational theories offer insight into these tensions, and we develop an agenda for future research. We end by arguing that a focus on social-business tensions not only expands insight into social enterprises, but also provides an opportunity for research on social enterprises to inform traditional organizational theories. Taken together, our analysis of tensions in social enterprises integrates and seeks to energize research on this expanding phenomenon. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

_John Stuart Mill_ investigates the central elements of the 19th century philosopher’s most profound and influential works, from _On Liberty_ to _Utilitarianism_ and _The Subjection of Women_. Through close analysis of his primary works, it reveals the very heart of the thinker’s ideas, and examines them in the context of utilitarianism, liberalism and the British empiricism prevalent in Mill’s day. • Presents an analysis of the full range of Mill’s primary writings, getting to the core of the philosopher’s ideas. • (...) Examines the central elements of Mill’s writings in easily accessible prose • Places Mill’s work and thought within the larger cultural and social context of 19th century Britain • Illustrates the continued relevance of Mill’s philosophy to today’s reader. (shrink)

Informal political representation—the phenomenon of speaking or acting on behalf of others although one has not been elected or selected to do so by means of a systematized election or selection procedure—plays a crucial role in advancing the interests of groups. Sometimes, those who emerge as informal political representatives (IPRs) do so willingly (voluntary representatives). But, often, people end up being IPRs, either in their private lives or in more public political forums, over their own protests (unwilling representatives) or even (...) without their knowledge (unwitting representatives)—that is, they are conscripted. None of the few theories of informal political representation extant accommodate conscripted IPRs. The account detailed here introduces the phenomenon of conscripted informal political representation and explains its place in a complete theory of informal political representation. Conscripted IPRs can, like their voluntary counterparts, come to have significant power to influence how various audiences regard those for whom the conscripted IPRs speak or act. Upon attaining such power to influence, conscripted IPRs, like their voluntary counterparts, come to have pro tanto duties to those they represent—duties that arise despite IPRs’ unwittingness or unwillingness. Understanding the phenomenon of conscripted informal political representation allows us to surface essential normative questions about informal political representation that are otherwise occluded. (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)

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)

Recent, well-publicized accounting scandals have shown that the penalties outsiders impose on those found culpable of earnings management can be severe. However, less is known about how colleagues within internal labor markets respond when they believe fellow managers have managed earnings. Designers of responsibility accounting systems need to understand the reputational costs managers impose on one another within internal labor markets. In an experimental study, 159 evening MBA students were asked to assume the role of a manager in a company (...) and respond to a scenario in which another manager (the target manager) has the opportunity to engage in earnings management. Participants provided causal attributions, assessed the morality of the target manager, and indicated whether they would change their judgments about the target manager's reputation. The study manipulated three between-subjects factors: (1) whether the target manager chose to engage in earnings management, (2) whether the company's budgetary control system was rigid or flexible, and (3) whether the target manager's work history was average or above average. We found that causal attributions are affected more by the budgetary systems when the target did not manage earnings than when the manager did. We also found that morality judgments were significantly associated with the target manager's behavior, but not with the budgetary system. In addition, participants' judgments about the target manager's reputation were more strongly associated with morality judgments than with causal attributions. We discuss implications of the role of reputation in management control systems design. (shrink)

Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

T. G. Masaryk’s thought is famous for his concept of the Czech nation as well as his ideals of humanity. As a philosopher, sociologist, and politician, he was confronted with Czech anti-Semitism, and after Czechoslovakia was founded, with issues of the Jewish national minority. He tried to solve all the questions with respect to his ethical conviction and the ideals of democracy and equality. The most difficult personal situation for Masaryk emerged with the ‘Hilsner affair’, when his brave stance against (...) anti-Semitism caused animosity and even hatred from the public. As a consequence of that Masaryk had to abandon his public activities including lecturing at university for some time. The philosopher Jan Patočka analysed Masaryk’s involvement in this case and the following events in his study Masaryk’s struggle against anti-Semitism. Patočka pointed out that there is an interconnection between Masaryk’s involvement in this affair and his engagement in the question of Czech nationality, as Masaryk intended to improve the ethical level of the nation by disposing of bias and namely the ritual murder myth. The second part of the present contribution is focused on Masaryk’s views on Zionism and the assimilation movement and his ambiguity in relation to the issue. It seems that Masaryk’s concept of the Czech nation, formed for the struggle against the Habsburg monarchy, became inadequate in the new republic, as it was not inclusive of the many minorities, the Jewish one included. On the other hand, Masaryk’s ideals of humanity provide a certain solution on the level of ethics. (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.

While the economic and environmental dimensions of the triple bottom line have been covered extensively by management theory and practice, the social dimension remains largely underrepresented. The resource-based view of the firm and the natural resource-based view of the firm are revisited to lay the theoretical foundation for exploring how the social dimension might be addressed. Social capabilities are then explored by looking at the social entrepreneurship literature and illustrative cases with the purpose of elaborating RBV toward a social resource-based (...) view of the firm. Three illustrative cases, which represent social businesses located in catastrophe-ridden Haiti, show how capabilities are used to overcome challenging constraints. The goal for the social entrepreneur is to employ the appropriate capabilities to ensure economic success, a positive environmental impact, and social benefits that leave the local community in a better position than without the business. Just as NRBV is a previous elaboration of RBV, so can SRBV be an elaborated theoretical foundation for future research. The components of a theory are systematically addressed by extending the range of variables, extending the domain, and offering propositions on variable relationships and outcome predictions. By highlighting the social capabilities of social entrepreneurs, this research illuminates the micro-foundations of corporate social responsibility, emphasizing the value of individual level analyses. (shrink)

Tolerance is generally regarded as an unqualified achievement of the modern West. Emerging in early modern Europe to defuse violent religious conflict and reduce persecution, tolerance today is hailed as a key to decreasing conflict across a wide range of other dividing lines-- cultural, racial, ethnic, and sexual. But, as political theorist Wendy Brown argues in Regulating Aversion, tolerance also has dark and troubling undercurrents. Dislike, disapproval, and regulation lurk at the heart of tolerance. To tolerate is not to (...) affirm but to conditionally allow what is unwanted or deviant. And, although presented as an alternative to violence, tolerance can play a part in justifying violence--dramatically so in the war in Iraq and the War on Terror. Wielded, especially since 9/11, as a way of distinguishing a civilized West from a barbaric Islam, tolerance is paradoxically underwriting Western imperialism. Brown's analysis of the history and contemporary life of tolerance reveals it in a startlingly unfamiliar guise. Heavy with norms and consolidating the dominance of the powerful, tolerance sustains the abjection of the tolerated and equates the intolerant with the barbaric. Examining the operation of tolerance in contexts as different as the War on Terror, campaigns for gay rights, and the Los Angeles Museum of Tolerance, Brown traces the operation of tolerance in contemporary struggles over identity, citizenship, and civilization. (shrink)

Taking its cue from sign languages, this paper pulls together a range of studies to support the proposal that the recruitment and composition of body actions counts as evidence for linguistic properties. Adopting the view that compositionality is the foundational organizing property of language, we find first that actions of the hands, face, head, and torso in sign languages directly reflect linguistic components, as well as certain aspects of compositional organization among them that are common to all languages, signed and (...) spoken. Work on emerging sign languages strengthens the approach by showing that the gradual recruitment of bodily articulators for linguistic functions directly maps the way in which a new language increases in complexity over time. While compositional communication is almost exclusively restricted to humans, it is not restricted to language. In the spontaneous, intense emotional displays of athletes, different emotional states are correlated with actions of particular face and body features and feature groupings, indicating a much more ancient compositional foundation for language. (shrink)

Using an apparatus in which two scalers register decays from a radioactive source, an observer located near one of the scalers attempted to convey a message to an observer located near the other one by choosing to look or to refrain from looking at his scaler. The results indicate that no message was conveyed. Doubt is thereby thrown upon the hypothesis that the reduction of the wave packet is due to the interaction of the physical apparatus with the psyche of (...) an observer.A. Einstein(1). (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)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from (...) barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (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)

Current conceptions of human language include a gestural component in the communicative event. However, determining how the linguistic and gestural signals are distinguished, how each is structured, and how they interact still poses a challenge for the construction of a comprehensive model of language. This study attempts to advance our understanding of these issues with evidence from sign language. The study adopts McNeill's criteria for distinguishing gestures from the linguistically organized signal, and provides a brief description of the linguistic organization (...) of sign languages. Focusing on the subcategory of iconic gestures, the paper shows that signers create iconic gestures with the mouth, an articulator that acts symbiotically with the hands to complement the linguistic description of objects and events. A new distinction between the mimetic replica and the iconic symbol accounts for the nature and distribution of iconic mouth gestures and distinguishes them from mimetic uses of the mouth. Symbiotic symbolization by hand and mouth is a salient feature of human language, regardless of whether the primary linguistic modality is oral or manual. Speakers gesture with their hands, and signers gesture with their mouths. (shrink)

In the United States, clinical interventions such as epidurals, intravenous infusions, oxytocin, and intrauterine pressure catheters are used almost routinely in births in the hospital setting, despite evidence that the overutilization of such interventions likely plays a key role in increasing the need for cesarean section (CS). In 2010, according to the U.S. Centers for Disease Control and Prevention, approximately 32.8 percent of births in the U.S. were by CS. The U.S. National Institutes of Health has reported that CS increases (...) avoidable maternal and neonatal morbidity and mortality. To increase understanding of what might motivate the overuse of CS in the U.S., we investigated the factors that influenced women’s decision making around childbirth, because women’s conscious and unconscious choices about giving birth could influence whether they would choose or allow delivery by CS.In this article, we report findings about women’s decisions related to place of birth—at home or in a hospital. We found that choosing a place of birth was significant in how women in our study attempted to mitigate their perceptions of the risks of childbirth for themselves and their infant. Concern for the safety of the infant was a central, driving factor in the decisions women made about giving birth, and this concern heightened their perceptions of the risks of childbirth. Heightened perceptions of risk about the safety of the fetus during childbirth were found to affect women’s ability to accurately assess the risk of using clinical interventions such as the time of admission, epidural anesthesia, oxytocin, or cesarean birth, which has important implications for clinical practice, prenatal education, perinatal research, medical decision making, and informed consent. (shrink)