Though much progress has been made on inclusion of non-pregnant women in research, thoughtful discussion about including pregnant women has lagged behind. We outline resulting knowledge gaps and their costs and then highlight four reasons why ethically we are obliged to confront the challenges of including pregnant women in clinical research. These are: the need for effective treatment for women during pregnancy, fetal safety, harm from the reticence to prescribe potentially beneficial medication, and the broader issues of justice and access (...) to benefits of research participation. Going forward requires shifting the burden of justification from inclusion to exclusion and developing an adequate ethical framework that specifies suitable justifications for excluding pregnant women from research. (shrink)

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

In recent years, critics of modern obstetrics have cited technology as responsible for women's discontent regarding childbirth. In this essay, I investigate and pry apart the connection between the quality of childbirth experience and technology. After identifying three factors considered constitutive of a ‘good birth,’ I demonstrate how technology can either facilitate or hinder each, but how dominant strains of birthing practice that reinforce female shame consistently undermine them all. It is not technology per se, but its sensitive application, which (...) may most effectively promote an optimal and affirming birth experience. (shrink)

In this paper, I reflect on an important article by Bob Veatch in the inaugural issue of the Hastings Center Report, entitled “Experimental Pregnancy.” It is a report and elegant analysis of the Goldzieher Study, in which nearly 400 women were randomized to receive hormonal contraception or placebo absent consent or disclosure about placebo use, resulting in several pregnancies. Noting the study’s limited notoriety, I first consider the narratives that have instead dominated bioethics’ approach to pregnancy and research: thalidomide and (...) diethylstibesterol. These narratives have facilitated a narrow focus on avoiding fetal risk, to the exclusion of other ethically relevant considerations. I then revisit “Experimental Pregnancy” and offer two ways in which Bob’s analysis serves as an important corrective, first, by foregrounding research subjects, and second, by normalizing pregnancy and thus foregrounding foundational ethical considerations that are sometimes lost amidst pregnancy’s presumed exceptionalism. (shrink)

Feminist bioethicists have long shed light on the indignities and injustice of reproductive intrusions, be they coerced gestation or forced interventions during pregnancy and birth. Writing about t...

: In recent years, critics of modern obstetrics have cited technology as responsible for women's discontent regarding childbirth. In this essay, I investigate and pry apart the connection between the quality of childbirth experience and technology. After identifying three factors considered constitutive of a 'good birth,' I demonstrate how technology can either facilitate or hinder each, but how dominant strains of birthing practice that reinforce female shame (hospital-based obstetrics and midwifery) consistently undermine them all. It is not technology per se, (...) but its sensitive application, which may most effectively promote an optimal and affirming birth experience. (shrink)

The use of aggregated quality of life estimatesin the formation of public policy and practiceguidelines raises concerns about the moralrelevance of variability in values inpreferences for health care. This variabilitymay reflect unique and deeply held beliefs thatmay be lost when averaged with the preferencesof other individuals. Feminist moral theorieswhich argue for attention to context andparticularity underline the importance ofascertaining the extent to which differences inpreferences for health states revealinformation which is morally relevant toclinicians and policymakers. To facilitatethese considerations, we present (...) an empiricalstudy of preferences for the timing andoccurrence of health states associated withhormone replacement therapy (HRT). Sixteenwomen between the ages of 45 and 55 wereenrolled in this pilot study. Theirpreferences regarding five health statesassociated with HRT (menopausal symptoms, sideeffects of HRT, breast cancer, myocardialinfarction, and osteoporosis) were assessed inquantitative terms known as utilities. Twostandard methods, the visual analog scale (VAS) and the standard gamble (SG), were used toassess utility and time preference (calculatedas a discount rate). The wide variability ofresponses underlines the importance oftailoring health care to individual women'spreferences. Policy guidelines whichincorporate utility analysis must recognize thenormative limitations of aggregatedpreferences, and the moral relevance ofindividual conceptions of health. (shrink)

In 1987, a young woman named Angela Carder, pregnant and dying from cancer, was ordered by a court of law to undergo a cesarean delivery against her and her family’s wishes. She and her baby both died. Three years later, an appeals court took an extraordinary stand: it vacated the order that ended their lives and upheld pregnant women’s rights to informed consent and bodily integrity. The “unkindest cut of all,”1 it seemed, had been condemned by the courts.2 Yet shortly (...) before the twenty-year anniversary of this landmark case, the same rights were stripped from another young pregnant woman. In January of this year, oral arguments were heard in the case of Samantha Burton. She had been twenty-five weeks .. (shrink)

In recent years, tremendous progress has been made toward recognizing the need for improved medical knowledge for pregnant people, a population group that has long been excluded from clinical trial...

When surgery is performed on pregnant women forthe sake of the fetus (MFS or maternal fetalsurgery), it is often discussed in terms of thefetus alone. This usage exemplifies whatphilosophers call the fallacy of abstraction: considering a concept as if it were separablefrom another concept whose meaning isessentially related to it. In light of theirpotential separability, research on pregnantwomen raises the possibility of conflictsbetween the interests of the woman and those ofthe fetus. Such research should meet therequirement of equipoise, i.e., a (...) state ofgenuine uncertainty about the risks andbenefits of alternative interventions ornoninterventions. While illustrating thefallacy of abstraction in discussions of MFS,we review the rationale for explicitacknowledgment of the essential tie betweenfetus and pregnant woman. Next we examinewhether it is possible to meet the requirementof equipoise in research on MFS, focusing on afetal condition called myelomeningocele. Weshow how issues related to equipoise innonpregnant populations appear also in debatesregarding MFS. We also examine evidence insupport of claims that the requirement ofequipoise has been satisfied with respect to``the fetal patient'' while considering risks andbenefits to gestating women only marginally ornot at all. After delineating challenges andpossibilities for equipoise in MFS research, weconclude with a suggestion for avoiding thefallacy of abstraction and achieving equipoiseso that research on MFS may be ethicallyconducted. (shrink)

Bioethics, Volume 36, Issue 9, Page 999-1000, November 2022.

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

“It's almost like putting salt in a wound, for this person who's already made a very difficult decision,” suggested Meghan Patterson, a licensed obstetrician-gynecologist whom we interviewed in our qualitative study of the experiences of North Carolina abortion providers practicing under the state's Woman's Right to Know Act. The act requires that women receive counseling with state-mandated information at least twenty-four hours prior to obtaining an abortion. After the law was passed, Patterson worked with clinic administrators, in consultation with a (...) lawyer, to write a script to be used in the state-mandated counseling procedure. She and her colleagues took particular steps to mitigate the effects of what she described as HB 854's “forced language”—such as referring to the “father of the child.” While HB 854 stipulated that patients must be informed of the medical risks associated with the particular abortion procedure as well as those of carrying the child to term, Patterson's script made explicit the magnitude of comparative risks, emphasizing that the risks of carrying a pregnancy to term are substantially greater than the risks of an early-term abortion. She felt that these contextualization strategies helped to facilitate trust and rapport in a clinical care situation that proved relationally and morally challenging. In this article, we take up and expand on this point by elucidating an empirically grounded approach to ethically justified care when health care providers face legal or institutional policy mandates that raise possible moral conflicts. Our approach builds on recent bioethics discourse addressing conscience in the practice of medicine. While the concept of conscience has broad philosophical underpinnings relating to moral judgment, agency, and discernments of right and wrong, debates in bioethics have tended to engage the concept primarily vis-à-vis rights of conscientious objection or refusal. Here, we suggest a broader frame for thinking about claims of conscience in health care. Our approach draws on the feminist bioethics and the ethics of care literatures to highlight how providers may be motivated by matters of conscience, including relational concerns, in the active provision of certain forms of care. What emerges are two possibilities: not only conscientious refusal to comply with a policy mandate but also conscientious compliance—working conscientiously within a mandate's confines. (shrink)

Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant (...) obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed. (shrink)

Background: Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion...

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

At no time in recent decades has more attention been paid to ethical issues in pregnancy. Particularly riveting—and alarming, to many—was the passage of Senate Bill 8, a Texas law banning abortion...

In A Good Birth, obstetrician and bioethicist Anne Drapkin Lyerly aims to improve women’s experiences of childbirth in the United States by cutting through the vitriolic, shame-inducing, and blame-assigning language of what she terms “the birth wars”—the “polarized debate over where birth should be undertaken and how, who is the presumptive attendant, which professionals need to be supervised, and which way the money should flow”. Too often, women like Lyerly’s friend Erin, whom Lyerly interviewed for (...) the book, are the casualties of the birth wars, as they feel ashamed, distraught, and guilty for not giving birth according to the dictates of a particular ideology. According to Lyerly, Erin planned to... (shrink)

The need for informed analyses of health policy is now greater than ever. The twelve essays in this volume show that public debates routinely bypass complex ethical, sociocultural, historical, and political questions about how we should address ideals of justice and equality in health care. Integrating perspectives from the humanities, social sciences, medicine, and public health, this volume illuminates the relationships between justice and health inequalities to enrich debates. Understanding Health Inequalities and Justice explores three questions: How do scholars approach (...) relations between health inequalities and ideals of justice? When do justice considerations inform solutions to health inequalities, and how do specific health inequalities affect perceptions of injustice? And how can diverse scholarly approaches contribute to better health policy? From addressing patient agency in an inequitable health care environment to examining how scholars of social justice and health care amass evidence, this volume promotes a richer understanding of health and justice and how to achieve both. -/- The contributors are Judith C. Barker, Paula Braveman, Paul Brodwin, Jami Suki Chang, Debra DeBruin, Leslie A. Dubbin, Sarah Horton, Carla C. Keirns, J. Paul Kelleher, Nicholas B. King, Eva Feder Kittay, Joan Liaschenko, Anne Drapkin Lyerly, Mary Faith Marshall, Carolyn Moxley Rouse, Jennifer Prah Ruger, and Janet K. Shim. (shrink)

There are countless circumstances under which random individuals COULD act together to prevent something morally bad from happening or to remedy a morally bad situation. But when OUGHT individuals to act together in order to bring about a morally important outcome? Building on Philip Pettit’s and David Schweikard’s account of joint action, I will put forward the notion of joint duties: duties to perform an action together that individuals in so-called random or unstructured groups can jointly hold. I will show (...) how this account of joint duties is preferable to one which defends individual duties to cooperate. I then discuss the limits of joint duties and the ways in which one can fail to comply with them. It will become apparent that the circumstances under which individuals in random collectives acquire such joint duties are rare. (shrink)

Why equality cannot be conditional on a shared human “nature” but has to be for all For centuries, ringing declarations about all men being created equal appealed to a shared human nature as the reason to consider ourselves equals. But appeals to natural equality invited gradations of natural difference, and the ambiguity at the heart of “nature” enabled generations to write of people as equal by nature while barely noticing the exclusion of those marked as inferior by their gender, race, (...) or class. Despite what we commonly tell ourselves, these exclusions and gradations continue today. In Unconditional Equals, political philosopher Anne Phillips challenges attempts to justify equality by reference to a shared human nature, arguing that justification turns into conditions and ends up as exclusion. Rejecting the logic of justification, she calls instead for a genuinely unconditional equality. Drawing on political, feminist, and postcolonial theory, Unconditional Equals argues that we should understand equality not as something grounded in shared characteristics but as something people enact when they refuse to be considered inferiors. At a time when the supposedly shared belief in human equality is so patently not shared, the book makes a powerful case for seeing equality as a commitment we make to ourselves and others, and a claim we make on others when they deny us our status as equals. (shrink)

"Deleuze plonge la critique kantienne transcendantale dans le bain dissolvant d'un empirisme renouvelé. Ce livre se propose de restituer cette entreprise, et d'analyser l'étonnante création de ce concept, que Deleuze mène depuis ses premières monographies jusqu'à Différence et Répétition dans un dialogue fécond avec l'histoire de la philosophie. Par quelles opérations de distorsion et de collage, Deleuze compose-t-il l'empirisme de Hume, la théorie du signe comme force de Nietzsche, le virtuel et les multiplicités de Bergson, les modes de Spinoza, les (...) individualisations impersonnelles de Simondon pour renouveler la théorie kantienne du transcendantal? C'est tout l'objet de cette enquête, qui permet d'entrer dans le laboratoire du penseur, pour saisir la philosophie se faisant, mais qui permet également d'expliquer l'insistance du transcendantal dans toute son oeuvre"--P. [4] of cover. (shrink)

The most remarkable about the continuity in Chomsky's thought about language is that it takes place against a theoretical landscape in constant flux, the landscape of generative grammar. Chomsky introduced a central distinction between E‐languages and I‐language, the internalized knowledge of language that each speaker has and which is the result of the interaction between his or her language faculty and the (limited) experience that he or she had of his or her mother tongue during language acquisition. The Faculty of (...) Language narrowly understood corresponds to “the abstract linguistic computational system alone, independent of the other systems with which it interacts”. This chapter aims to follow the trail of Chomsky's strongly reiterated claim throughout the years that language is not primarily a tool for communication, but rather, a tool for thought. (shrink)

A long-standing puzzle for moral philosophers and psychologists alike is the concept of psychopathy, a personality disorder marked by tendencies to defy moral norms despite cognitive knowledge about right and wrong. Previously, discussions of the moral deficits of psychopathy have focused on willingness to harm and cheat others as well as reasoning about rule-based transgressions. Yet recent research in moral psychology has begun to more clearly define the domains of morality, en- compassing issues of harm, fairness, loyalty, authority, and spiritual (...) purity. Clinical descriptions and theories of psychopathy suggest that deficits may exist primarily in the areas of harm and fairness, although quantitative evidence is scarce. Within a broad sample of participants, we found that scores on a measure of psychopathy predicted sharply lower scores on the harm and fairness subscales of a measure of moral concern, but showed no relationship with authority, and very small relationships with ingroup and purity. On a measure of willingness to violate moral standards for money, psychopathy scores predicted greater willingness to violate moral concerns of any type. Results are further explored via potential mediators and analyses of the two factors of psychopathy. (shrink)

Our moral obligations can sometimes be collective in nature: They can jointly attach to two or more agents in that neither agent has that obligation on their own, but they – in some sense – share it or have it in common. In order for two or more agents to jointly hold an obligation to address some joint necessity problem they must have joint ability to address that problem. Joint ability is highly context-dependent and particularly sensitive to shared (or even (...) common) beliefs. As such, joint ability can be deliberately generated in a given collection of agents by providing information related to collective goals and contributory actions. As moral agents, we regularly face problems wherein the outcome of our actions depends on how others choose. There are two ways of deliberating about our own choices in such cases. We can either think of our choices as best responses to others’ choices (I-mode reasoning). Or we can think of our own choices as contributions to the collectively best option (even when we do not know how others are (likely) to choose) (we-mode reasoning). In deliberating about the right (individual) course of action vis-à-vis collective action problems, agents regularly we-frame the case at hand, that is, they include options in their deliberation that are only collectively available, and they we-reason with regard to their individual contributory actions. It is a necessary condition for collective obligations that potential collaborators facing a joint necessity case have grounds to privilege we-reasoning over reasoning in I-mode. (shrink)

The traditional concept of prime matter – a purely potential substratum that persists through substantial change and serves to constitute the generated substance – has played a dwindling part in Aristotelian scholarship over the centuries. In medieval interpretations of Aristotle, prime matter was thought to play these two roles in all substantial changes, not only in changes at the level of the four elements. In more recent centuries, traditional prime matter was relegated only to the context of substantial changes between (...) the four elements. And in the last few decades of Aristotelian scholarship, it has become common either to downplay or even to eliminate prime matter’s role in elemental changes too. I will support the traditional concept of prime matter by showing that it aligns Aristotle’s view of elemental change with one of the central constraints on matter imposed in his Physics to a degree that cannot be achieved on the non-traditional interpretations: the need for matter to be in potentiality in a way that avoids the two problematic extremes of mere persistence, on the one hand, and destruction, on the other. This point will be supported by Aristotle’s rejection of both monism and pluralism in On Generation and Corruption. Second, I will argue that Aristotle calls for precisely the same kind of potentiality in a very different context: his critique of Anaxagoras’s view of matter in the Generation of Animals. Here the very same problematic extremes of mere persistence and destruction that plague the alternate views to traditional prime matter also plague the dominant views on the matter for animal generation. Especially since Aristotle takes living things to be paradigmatic substances, these comparisons suggest that the apparent idiosyncrasies of elemental transformation which have motivated interpreters to depart from traditional prime matter may not be so idiosyncratic after all. And if that is so, it may be that the problem lies not so much with traditional prime matter as with our assumptions about how persistence and constitution work in substantial change according to Aristotle. In the end, this line of argument opens the door to three new potential interpretations of the matter for substantial generation in Aristotle, interpretations which align with his concept of potentiality and – to varying degrees – with traditional prime matter as well. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

The effects of non-standard Philosophy on Epistemelogy.

A reference volume and playful devotional object based on the author's research into color theory informed by psychology, mysticism, and early modernism. The Color-Word Value Index has 44 word pairings; 10 colors; 5 suits; and values of positive, negative, and neutral"--Women's Studio Workshop website, viewed December 14, 2021.

This book explores the way in which, working within the investigative tradition associated with the Royal Society, the philosopher John Locke (1632-1704) used ...

School-based education in England has undergone significant changes since 2010, with a huge expansion of academies, schools outside local authority control, funded directly by central government. Academies and local authority (LA) maintained schools are subject to different legislative and regulatory frameworks. This paper focuses on the governance of LA maintained schools, single academy trusts (SATs) and schools that are part of multi-academy trusts (MATs). The research involved analysing legislative provision, policy documents, and documents addressing the governance arrangements of a sample (...) of 23 secondary schools. Our findings reveal a fragmented state-funded secondary school system as regards overall governance, school admissions, the curriculum, and the use of funding. Significantly schools in MATs, which are governed by the trust board, lack the autonomy of either SATs or maintained schools and are instead under the ultimate control of the trust board. The paper argues that there is a need for greater consistency regarding the governance of state-funded schools. (shrink)

Think Like an Economist is a fun introduction to the main concepts of economics. It illustrates how the subject has a clear, practical purpose vital to our daily lives and thinking; includes stories of many of the world's greatest economists; and covers the history of economics from the early barter system through the Industrial Revolution to the emergence of globalization.

In close collaboration with the late Matthew Lipman, Ann Margaret Sharp pioneered the theory and practice of 'the community of philosophical inquiry' (CPI) as a way of practicing 'Philosophy for Children' and prepared thousands of philosophers and teachers throughout the world in this practice. In Community of Inquiry with Ann Margaret Sharp represents a long-awaited and much-needed anthology of Sharp's insightful and influential scholarship, bringing her enduring legacy to new generations of academics, postgraduate students and researchers in the fields of (...) education, philosophy, philosophy of education, Philosophy for Children and philosophy of childhood. Sharp developed a unique perspective on the interdependence of education, philosophy, personhood and community that remains influential in many parts of the world. This perspective was shaped not only by Sharp's work in philosophy and education, but also by her avid studies in literature, feminism, aesthetic theory and ecumenical spirituality. Containing valuable contributions from senior figures in the fields in which Sharp produced her most focused scholarship, the chapters in this book present a critical overview of how Sharp's ideas relate to education, philosophy of education, and the Philosophy for Children movement as a whole. The historical and philosophical nature of this collection means that it will be a vital resource for philosophers and educators. It should also be of great interest to teacher educators and those involved in the study of pragmatism and feminism, as well as the history of education across the globe, particularly in the United States of America. (shrink)