Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

(2010). Levels of Intervention: Communicating with More Precision About Planned Use of Critical Interventions. The American Journal of Bioethics: Vol. 10, No. 1, pp. 78-79.

Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and James Childress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the state of (...) play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities (...) that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly .. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health care. (...) Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile (...) existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence. The most common influencing ethical theory was the Principles Approach. The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

This commentary was submitted to the World Medical Association on behalf of the International Network on Feminist Approaches to Bioethics. Our submission included a description of feminist research ethics, suggestions for specific revisions to the Declaration, and elements found in other international research ethics codes that are important from a feminist perspective. Our goals were to encourage the WMA to craft a declaration that: conceptualizes issues of vulnerability in richer and more nuanced ways, resists the influence of profit motives, and (...) extends the scope of responsibility for ethical research more broadly. (shrink)

Comme son titre l’indique, l’ouvrage, publié en 2012 et édité par Margaret Jolly, Christine Stewart et Carolyn Brewer, vise à réinvestir la question de la violence en Papouasie Nouvelle Guinée (PNG) à partir d’une lecture par le genre : il s’agit de « genrer » (engender) la violence, dans un pays où elle apparaît omniprésente. Les huit chapitres du livre, écrits en majorité par des anthropologues sur un terrain classique de l’anthropologie, s’inscrivent ainsi dans l’abondante littérature prod...

PREFACE Alexius Meinong (1853–1920) wrote an array of books and articles, broad in subject matter and rich in ideas. My book does not pretend to uncover the ...

Doctoral graduates in philosophy are an excellent source of information about the discipline: they are at the cutting edge of research trends, have an inside view of researchfocused departments, and their employment prospects provide early insights on the future health of the discipline. We report on the results of a survey sent to recent PhD graduates and current students, as well as data gathering efforts by Academic Placement Data and Analysis that have taken place over the past ten years. In (...) this report we especially focus on demographic representation, program ratings, academic job placement, and non-academic careers. (shrink)

Introduction:Can nature be controlled?. Autonomous nature -- Greco-Roman concepts of nature -- Christianity and nature -- Nature personified : Renaissance ideas of nature -- Controlling nature. Vexing nature : Francis Bacon and the origins of experimentation -- Natural law : Spinoza on natura naturans and natura naturata -- Laws of nature :Lleibniz and Newton -- Epilogue : rambunctious nature in the twenty-first century.

Although we tend to associate social transformation with major events, historical turning points, or revolutionary upheaval, Revolutionary Routines argues that seemingly minor everyday habits are the key to meaningful change. Through its account of influential socio-political processes – such as the resurgence of fascism and white supremacy, the crafting of new technologies of governance, and the operation of digital media and algorithms – this book rethinks not only how change works, but also what counts as change. Drawing examples from the (...) affective politics of Trumpism and Brexit, nudge theory and behaviour change, social media and the international refugee crisis, and the networked activism of Occupy and Black Lives Matter, Carolyn Pedwell argues that minor gestures may be as significant as major happenings, revealing the powerful potential in our ability to remake shared habits and imaginatively reinhabit everyday life. Revolutionary Routines offers a new understanding of the logics of habit and the nature of social change, power, and progressive politics, illustrating diverse forms of consciousness and co-operation through which political solidarities might take shape. (shrink)

Get ready -- Discover -- Be present -- Appreciate -- Get set, go! -- Renew.

Emotion is at the centre of our personal and social lives. To love or to hate, to be frightened or grateful is not just a matter of how we feel on the inside: our emotional responses direct our thoughts and actions, unleash our imaginations, and structure our relationships with others. Yet the role of emotion in human life has long been disputed. Is emotion reason?s friend or its foe? From where do the emotions really arise? Why do we need them (...) at all? In this accessible and carefully argued introduction, Carolyn Price focuses on some central questions about the nature and function of emotion. She explores the ways in which emotion contrasts with belief and considers how our emotional responses relate to our values, our likes and our needs. And she investigates some of the different ways in which emotional responses can be judged as fitting or misplaced, rational or irrational, authentic or inauthentic, sentimental or profound. Throughout, she develops a particular view of emotion as a complex and diverse phenomenon, which reflects both our common evolutionary past and our different cultural and personal histories. Engagingly written with lots of examples to illuminate our understanding, this book provides the ideal introduction to the topic for students and scholars and anyone interested in delving further into the intricate web of human emotion. (shrink)

Philosophical theories about parental licensing tend to pay insufficient attention to forms of discrimination that may be inherent in, or result from, a system of parental licensing. By situating these theories in relation to the status quo on parental licensing, we aim to show how many of them reinforce what philosophers have called “biologism”: the privileging of families formed through biological reproduction over families formed in other ways. Much of our discussion focuses on biologism, although we also touch on other (...) forms of discrimination that parental licensing can cause or exacerbate, such as classism, sexism, homophobia, racism, and ableism. We firmly believe that any adequate proposal in favour of parental licensing must take worries about discrimination seriously. Unfortunately, most philosophical proposals fail to do so. (shrink)

An examination of the Scientific Revolution that shows how the mechanistic world view of modern science has sanctioned the exploitation of nature, unrestrained commercial expansion, and a new socioeconomic order that subordinates women.

How can head teachers live up to expectations? What makes them fail? What keeps the profession in good standing in the taxpayer's eye, and what undermines it? This book sets out a new vision for school leadership, moving beyond leadership styles and best practice to reflect on the intrinsic motivation in becoming a leader within a school setting, and proposing a way for the profession to develop and maintain ethical standards. Chapters explore the 2017-18 Commission on Ethical Leadership in Schools, (...) considering the core principles and behaviours we should expect from our school leaders, and providing a clear, ethical code for thinking about and reinforcing ethical standards in schools. (shrink)

Fundamental terms in the field of ecology are ambiguous, with multiple meanings associated with them. While this could lead to confusion, discord, or even tests that violate core assumptions of a given theory or model, this ambiguity could also be a feature that allows for new knowledge creation through the interconnected nature of concepts. We approached this debate from a quantitative perspective, and investigated the cost of ambiguity related to definitions of ecological units in ecology related to the general term (...) “community.” We did a meta-analysis of tests associated with two bodies of literature, Hubbell’s unified neutral theory of biodiversity and biogeography and Diamond’s assembly rules, that rely on a specific ecological unit that assumes that species are existing within a local area and that they have overlapping resource needs. We predicted that if ambiguous terminology is widespread, then researchers will have tested them with many different ecological units, that in addition some of these ecological units will violate the core assumptions of the theory, and finally that the overall level of support for a theory will be stronger if appropriate ecological units were used. We found that indeed multiple different ecological units were used in the literature to test both theories, with 65 percent appropriate ecological units for neutral theory tests, and only 6 percent for assembly rule tests. Finally, there was some evidence that the support for a theory depended on whether appropriate ecological units were used for neutral tests, but there was not enough data for the assembly rule tests. These results thus show that ambiguous terminology in ecology is having measurable effects on research and is not of solely philosophical concern. We advocate that authors be explicit in their writing and outline core assumptions of theories, that researchers apply these consistently in their tests, and that readers be attentive to what is written and cognizant of their potential biases. (shrink)

There are two attitudes regarding the historical situation of understanding commonly held today. On the one hand, we believe that we only achieve a real, worthwhile understanding of a topic when our thinking manages to break free from the dogmas of the past. We believe that this transcendence of the historical situation of thought is both possible and desirable. We applaud those whose thought appears to us to proceed unhinged by traditional dogmas, whether those dogmas be old habits of scientific (...) thought or traditional ideas about social life. We celebrate as epistemic heroes those who discover their own way of thinking. On the other hand, many are quick to accept as a general rule that one’s understanding is inevitably bound to one’s particular historical and cultural situation. Nobody understands things in a historical vacuum. Accordingly, we believe that there is no transcending the historicity of the understanding and thus no epistemic heroes to applaud. This chapter examines Gadamer's argument in “The Elevation of the Historicity of Understanding" (a central section in "Truth and Method") as a critique of both of these alternatives -- alternatives that can be traced back to the historical epochs of the Enlightenment and Romanticism. I argue that, for Gadamer, both of these historical models of understanding misconstrue the way that understanding is grounded in historical consciousness. (shrink)

Some of the oldest and deepest questions in philosophy fall under the umbrella of consciousness and mind: What is the mind and how is it related to the body? What provides our thoughts with content? How is consciousness related to the natural world? Do we have distinctive causal powers? Analytic philosophers have made significant progress on these and related problems in the last century. Given the high volume of work on such topics, this chapter is necessarily selective. It offers major (...) touchstones but is slanted in favor of work that touches base with the sciences. The chapter starts by describing the progression of thought on the mind-body problem, from dualism and behaviorism to non-reductive materialism. It then describes the problem of intentionality, with a focus on partial solutions from Dretske and Millikan, ending with a brief discussion of 4E theories of mental content. The section on the problem of consciousness starts with the well-known knowledge and modal arguments before describing some attempted initial solutions, such as eliminative materialism and panpsychism. Finally, there is a brief section on agency and free will, which focuses on the link between free will and consciousness. (shrink)

Much recent research has sought to uncover the neural basis of moral judgment. However, it has remained unclear whether "moral judgments" are sufficiently homogenous to be studied scientifically as a unified category. We tested this assumption by using fMRI to examine the neural correlates of moral judgments within three moral areas: (physical) harm, dishonesty, and (sexual) disgust. We found that the judgment ofmoral wrongness was subserved by distinct neural systems for each of the different moral areas and that these differences (...) were much more robust than differences in wrongness judgments within a moral area. Dishonest, disgusting, and harmful moral transgression recruited networks of brain regions associated with mentalizing, affective processing, and action understanding, respectively. Dorsal medial pFC was the only region activated by all scenarios judged to be morally wrong in comparison with neutral scenarios. However, this region was also activated by dishonest and harmful scenarios judged not to be morally wrong, suggestive of a domain-general role that is neither peculiar to nor predictive of moral decisions. These results suggest that moral judgment is not a wholly unified faculty in the human brain, but rather, instantiated in dissociable neural systems that are engaged differentially depending on the type of transgression being judged. (shrink)

A summary of the philosophical literature on trust.

Attention is essential to the life of the mind, a central topic in cognitive science, neuroscience, and psychology. Traditional debates in philosophy stand to benefit from greater understanding of the phenomenon, whether on the nature of the self, the foundation of knowledge, the natural basis of consciousness, or the origins of action and responsibility. This book is at the crossroads of philosophy of mind and cognitive science, offering a new theoretical stance on the concept of attention and how it intersects (...) with other functions of the mind, such as perception, consciousness, and action. It presents attention as directed by a subject, essential for perception, but not consciousness or action. By taking seriously the existence of a subject it stands against current trends in philosophy and cognitive science. This book offers an account of the subject and its role in attention that will both help motivate a subject-centered account and avoid some of the common criticisms regarding its existence. It engages with work by many philosophers, psychologists, and neuroscientists, including Block, Campbell, Dickie, Husserl, James, Koch, Mack and Rock, Merleau-Ponty, Treisman, and Wu. (shrink)

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. (...) Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)

In this adventurous contribution to the project of combining philosophy and biology to understand the mind, Carolyn Price investigates what it means to say that mental states--like thoughts, wishes, and perceptual experiences--are about things in the natural world. Her insight into this deep philosophical problem offers a novel teleological account of intentional content, grounded in and shaped by a carefully constructed theory of functions. Along the way she defends her view from recent objections to teleological theories and indicates how (...) it might be applied to notable problems in the philosophy of mind. (shrink)