The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Abstract:This paper is a preliminary attempt to better understand the concept of legitimacy in stakeholder theory. The normative component of stakeholder theory plays a central role in the concept of legitimacy. Though the elaboration of legitimacy contained herein applies generally to all “normative cores” this paper relies on Phillips’s principle of stakeholder fairness and therefore begins with a brief description of this work. This is followed by a discussion of the importance of legitimacy to stakeholder theory as well as (...) the general ambiguity of the term. A distinction is then drawn between normative and derivative legitimacy. Reference to this distinction helps distinguish between a relationship with the organization based on direct moral obligation and one based on the power to help or harm the organization. It is concluded that stakeholders who retain the ability to affect the organization arelegitimate(derivatively), but that this legitimacy is derived from the moral obligation owed other (normative) stakeholders and that the two sorts of legitimacy are importantly different from one another. An example of the normative/derivative distinction at work in managerial decision making is elaborated upon and managerial and research implications are then suggested. (shrink)

Fact-finding hearings may be held to determine disputed allegations of domestic violence in child contact cases in England and Wales, and can play a vital role for mothers seeking protection and autonomy from violent fathers. Drawing on the author’s empirical study, this article examines the implications for the holding of fact-finding hearings of judges’ and professionals’ understandings of domestic violence and the extent to which they perceive it to be relevant to contact. While more judges and professionals are developing their (...) understanding of domestic violence, the ambit of when and how it is considered relevant to contact has grown increasingly narrow, which suggests that many disputed allegations of domestic violence are disregarded and women and children continue to be put at risk from violent fathers. This bifurcated approach is likely to have significant implications for recent developments in this area of family law which are considered in this article. (shrink)

Algorithms wield increasing control over our lives—over which jobs we get, whether we're granted loans, what information we're exposed to online, and so on. Algorithms can, and often do, wield their power in a biased way, and much work has been devoted to algorithmic bias. In contrast, algorithmic neutrality has gone largely neglected. I investigate three questions about algorithmic neutrality: What is it? Is it possible? And when we have it in mind, what can we learn about algorithmic bias?

Leading philosopher of religion D. Z. Phillips argues that intellectuals need not see their task as being for or against religion, but as one of understanding it. What stands in the way of this task are certain methodological assumptions about what enquiry into religion must be. Beginning with Bernard Williams on Greek gods, Phillips goes on to examine these assumptions in the work of Hume, Feuerbach, Marx, Frazer, Tylor, Marett, Freud, Durkheim, Le;vy-Bruhl, Berger and Winch. The result exposes (...) confusion, but also gives logical space to religious belief without advocating personal acceptance of that belief, and shows how the academic study of religion may return to the contemplative task of doing conceptual justice to the world. Religion and the Hermeneutics of Contemplation extends in important ways D. Z. Phillips' seminal 1976 book Religion Without Explanation. It will be of interest to scholars and students of philosophy, anthropology, sociology and theology. (shrink)

ABSTRACTThe standard view in philosophy of mind is that the way to understand the difference between perception and misperception is in terms of accuracy. On this view, perception is accurate while...

What exactly is hope and how does it influence our decisions? In How We Hope, Adrienne Martin presents a novel account of hope, the motivational resources it presupposes, and its function in our practical lives. She contends that hoping for an outcome means treating certain feelings, plans, and imaginings as justified, and that hope thereby involves sophisticated reflective and conceptual capacities. Martin develops this original perspective on hope--what she calls the "incorporation analysis"--in contrast to the two dominant philosophical conceptions (...) of hope: the orthodox definition, where hoping for an outcome is simply desiring it while thinking it possible, and agent-centered views, where hoping for an outcome is setting oneself to pursue it. In exploring how hope influences our decisions, she establishes that it is not always a positive motivational force and can render us complacent. She also examines the relationship between hope and faith, both religious and secular, and identifies a previously unnoted form of hope: normative or interpersonal hope. When we place normative hope in people, we relate to them as responsible agents and aspire for them to overcome challenges arising from situation or character. Demonstrating that hope merits rigorous philosophical investigation, both in its own right and in virtue of what it reveals about the nature of human emotion and motivation, How We Hope offers an original, sustained look at a largely neglected topic in philosophy. (shrink)

I examine the origins of ordinary racial thinking. In doing so, I argue against the thesis that it is the byproduct of a unique module. Instead, I defend a pluralistic thesis according to which different forms of racial thinking are driven by distinct mechanisms, each with their own etiology. I begin with the belief that visible features are diagnostic of race. I argue that the mechanisms responsible for face recognition have an important, albeit delimited, role to play in sustaining this (...) belief. I then argue that essentialist beliefs about race are driven by some of the mechanisms responsible for “entitativity perception”: the tendency to perceive some aggregates of people as more genuine groups than others. Finally, I argue that coalitional thinking about race is driven by a distinctive form of entitativity perception. However, I suggest that more data is needed to determine the prevalence of this form of racial thinking. (shrink)

Our lives are dominated by technology. We live with and through the achievements of technology. What is true of the rest of life is of course true of medicine. Many of us owe our existence and our continued vigour to some achievement of medical technology. And what is true in a major way of general medicine is to a significant degree true of psychiatry. Prozac has long since arrived, and in its wake an ever-growing armamentarium of new psychotropics; beyond that, (...) neuroscience promises ever more technological advances for the field. -/- However, the effect of technology on the field of psychiatry remains highly ambiguous. On the one hand there are the achievements, both in the science and practice of psychiatry; on the other hand technology's influence on the field threatens its identity as a humanistic practice. In this ambiguity psychiatry is not unique - major thinkers have for a long time been highly ambivalent and concerned about the technological order that now defines modern society. For the future, the danger is that the psychiatrically real becomes that which can be seen, the symptom, and especially that which can be measured. Disorders and treatments might become reduced to what can be defined by diagnostic criteria and what can be mapped out on a scale. -/- This book exams how technology has come to influence and drive psychiatry forward, and considers at just what cost these developments have been made. It includes a range of stimulating and thought-provoking chapters from a range of psychiatrists and philosophers. (shrink)

This article defends a theory of diffuse attention and distinguishes it from focal attention. My view is motivated by evidence from psychology and neuroscience, which suggests that we can deploy visual selective attention in at least two ways: by focusing on a small number of items, or by diffusing attention over a group of items taken as a whole. I argue that diffuse attention is selective and can be object‐based. It enables a subject to select an object to guide behavior, (...) albeit in a different way than focusing does. (shrink)

Put relationship-centered communication at the forefront of care Today, physicians face a hypercompetitive marketplace in which they must meet unique and complex patient needs as efficiently as possible. But in a culture prioritizing clinical outcomes above all, there can be a tendency to lose sight of one of the most critical aspects of providing effective care: the communication skills that build and foster physician-patient relationships. Studies have shown that good communication between doctors and patients and among all caregivers who interface (...) with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. In Communication the Cleveland Clinic Way, Dr. Adrienne Boissy and her team tell the story of how Cleveland Clinic created and applied the R.E.D.E. to Communicate: Foundations of Healthcare program, making the world-renowned hospital system a leader in relationship-centered care. They provide a step-by-step guide for healthcare leaders and decision-makers to design, develop, and implement communication skills training in their own institutions. Learn how to: • Craft an effective, colleague-supported communication skills program to include veteran physicians, residents, and medical students • Leverage creative program design and data transparency to engage and facilitate staff physicians and advanced care providers • Identify common misperceptions and myths in healthcare communication and respond to them successfully • Cultivate a true sense of empathy—with patients and fellow caregivers alike—while maintaining professionalism In a field where difficult conversations and stressful relationships are commonplace, clinicians need a structured approach to enable them to deliver the best care possible. Communication the Cleveland Clinic Way is the blueprint for establishing a relationship-centered program that will improve patient experience, reinvigorate doctors’ passion for their work, and elevate any organization. (shrink)

In cases of identity crowding, a subject consciously sees items in a figure, even though they are presented too closely together for her to shift attention to each item. Block uses such cases to challenge the view that attention is necessary for consciousness. I argue that in identity crowding cases, subjects really do attend to the items. Specifically, they attend to the figure as a global object that contains the individual items as parts. To support this view, I provide evidence (...) that attention can be directed to a global object or a local object. My response helps to defend the view that attention is necessary for conscious perception. (shrink)

People with disabilities use more medical care and see health professionals more often than do those of the same age, ethnic group, or economic class who do not have impairments. An indisputable medical goal is.

Attention seems to raise a problem for pure representationalism, the view that phenomenal content supervenes on representational content. The problem is that shifts of attention sometimes seem to bring about a change in phenomenal content without a change in representational content. I argue that the representationalist can meet this challenge, but that doing so requires a new view of the representational content of perception. On this new view, the representational content of perception is always relative to a way of attending. (...) I call this the attention-indexed view of perceptual content. (shrink)

Aristotle claims that in some extenuating circumstances, the correct response to the wrongdoer is sungnōmē rather than blame. Sungnōmē has a wide spectrum of meanings that include aspects of sympathy, pity, fellow-feeling, pardon, and excuse, but the dominant interpretation among scholars takes Aristotle’s meaning to correspond most closely to forgiveness. Thus, it is commonly held that the virtuous Aristotelian agent ought to forgive wrongdoers in specific extenuating circumstances. Against the more popular forgiveness interpretation, I begin by defending a positive account (...) of sungnōmē as the correct judgment that a wrongdoer deserves excuse since she was not blameworthy. I then argue that since sungnōmē is merited on the grounds of fairness, this shows that both the forgiveness interpretation and a third, alternative interpretation of sungnōmē as sympathy mischaracterize both the justification for sungnōmē and its nature. Moreover, I argue that Aristotle not only lacks an account of forgiveness but in fact, that his account of blame is incompatible with forgiveness altogether. (shrink)

Ce bref texte en forme de manifeste rappelle que les mouvements de transformation sociale dirigés vers davantage de justice sont d’autant plus forts que leurs membres reconnaissent avec lucidité et compassion leurs propres implications dans les mécanismes générateurs de violences. Plutôt que des gestes de condamnation et d’annulation ( cancel ), ce sont donc des attitudes d’écoute, de soutien et de solidarité active qui sont requis.

It is gratifying that thoughtful philosophers and bioethicists like Mahowald and Nelson are continuing to address the objections to prenatal testing that have been made by disability scholars and advocates. But it is frustrating to see those objections presented in ways that reflect the doubts of those who reject them more than the intentions of those who make them, in ways that make those objections appear censorious toward pregnant women and prospective parents or naïve about nonverbal expression. We recognize that (...) disability critics share the responsibility for these misunderstandings, that their objections to prenatal disability testing have not always been made as clearly or consistently as they might have been. We therefore welcome this opportunity for clarification and rebuttal. Briefly, we will argue against Mahowald that it is not apparent how prospective parents could have a duty to potential offspring requiring them to prevent the birth of any child expected to have a life worth living. And we will remind Nelson that our primary concern is with the perpetuation of stigma; that even if any reason for abortion can be framed in terms of a trait of the fetus to be aborted, only certain reasons for abortion are based on the rejection of future children because of stigmatized traits. (shrink)

In this paper, we critically appraise institutions for people with disabilities, from residential facilities to outpatient clinics to social organizations. While recognizing that a just and inclusive society would reject virtually all segregated institutional arrangements, we argue that in contemporary American society, some people with disabilities may have needs that at this time can best be met by institutional arrangements. We propose ways of reforming institutions to make them less isolating, coercive, and stigmatizing, and to provide forms of social support (...) the larger society denies many people with disabilities. Although these reforms far fall far short of abolition, they draw heavily on the work of disability scholars and advocates who call for the complete replacement of institutional arrangements with systems of supported living. The consideration of non-ideal-solutions is useful not only in reforming existing institutional arrangements, but in bringing disability scholarship and advocacy to bear on bioethics, which has paid little attention to institutions for people with disabilities. We intend this paper to redress the neglect within mainstream bioethics of the complex ethical problems posed by institutions. (shrink)

Dans cette réflexion surgie des premières expériences de la pandémie du Covid-19, l’autrice met en écho nos peurs et nos réactions face aux dangers de la maladie et face aux actes de violence. Les condamnations sommaires et instantanées auxquelles les militant·es se livrent sur les réseaux sociaux reproduisent partiellement des dynamiques de lynchage dont il faut apprendre à davantage se méfier. Avec la distance de l’abstentiel, il est parfois plus facile de dénoncer ( call-out ) les mauvais comportements, que d’interpeler (...) et d’inclure ( call-in ) celleux qui ont fait du mal. Comment croire les survivant·es tout en restant abolitionnistes? Comment croire les survivant·es tout en pratiquant une justice transformatrice? (shrink)

This article addresses an issue overlooked in most of the literature on judicial review: the legitimacy of judicial review of a constitution's federal and structural provisions. Debates about the legitimacy of judicial review—at least as conducted throughout the Commonwealth—are usually focussed on rights. These debates appear to assume that the power of courts like the Australian High Court and the Canadian Supreme Court to interpret and enforce federal and structural provisions is unproblematic. This article tests that assumption and concludes that (...) those who hold democracy-based objections to constitutional rights should seriously reconsider, and perhaps oppose, federal and structural judicial review as well. (shrink)

Research on the capacity to understand others' minds has tended to focus on representations ofbeliefs,which are widely taken to be among the most central and basic theory of mind representations. Representations ofknowledge, by contrast, have received comparatively little attention and have often been understood as depending on prior representations of belief. After all, how could one represent someone as knowing something if one does not even represent them as believing it? Drawing on a wide range of methods across cognitive science, (...) we ask whether belief or knowledge is the more basic kind of representation. The evidence indicates that nonhuman primates attribute knowledge but not belief, that knowledge representations arise earlier in human development than belief representations, that the capacity to represent knowledge may remain intact in patient populations even when belief representation is disrupted, that knowledge (but not belief) attributions are likely automatic, and that explicit knowledge attributions are made more quickly than equivalent belief attributions. Critically, the theory of mind representations uncovered by these various methods exhibits a set of signature features clearly indicative of knowledge: they are not modality-specific, they are factive, they are not just true belief, and they allow for representations of egocentric ignorance. We argue that these signature features elucidate the primary function of knowledge representation: facilitating learning from others about the external world. This suggests a new way of understanding theory of mind – one that is focused on understanding others' minds in relation to the actual world, rather than independent from it. (shrink)

Phillip Cary argues that Augustine invented or created the concept of self as an inner space--as space into which one can enter and in which one can find God. This concept of inwardness, says Cary, has worked its way deeply into the intellectual heritage of the West and many Western individuals have experienced themselves as inner selves. After surveying the idea of inwardness in Augustine's predecessors, Cary offers a re-examination of Augustine's own writings, making the controversial point that in his (...) early writings Augustine appears to hold that the human soul is quite literally divine. Cary goes on to contend that the crucial Book 7 of the Confessions is not a historical report of Augustine's "conversion" experience, but rather an explanation of his intellectual development over time. (shrink)

It follows from Humean principles of plenitude, I argue, that island universes are possible: physical reality might have 'absolutely isolated' parts. This makes trouble for Lewis's modal realism; but the realist has a way out. First, accept absolute actuality, which is defensible, I argue, on independent grounds. Second, revise the standard analysis of modality: modal operators are 'plural', not 'individual', quantifiers over possible worlds. This solves the problem of island universes and confers three additional benefits: an 'unqualified' principle of compossibility (...) can be accepted; the possibility of nothing can be accommodated; and the identity of indiscernible worlds can be decisively refuted. (shrink)

This volume contains eighteen papers, three with new postscripts, that were written over the past 35 years. Five of the papers have not been previously published. Together they provide a comprehensive account of modal reality—the realm of possible worlds—from a Humean perspective, with excursions into neighboring topics in metaphysics. Part 1 sketches an account of reality as a whole, both the mathematical and the modal, defending a form of plenitudinous realism: every consistent proposition is true of some portion of reality. (...) Part 2 presents and defends a realist theory of concrete possible worlds with an absolute ontological distinction between the actual and the merely possible. Part 3 presents and defends a Humean account of modal plenitude, formulating and endorsing principles of recombination, of plenitude of possible structures, and of plenitude of alien contents. Part 4 applies the Humean account to truthmaking, mereology, spacetime, and quantities. I argue that holding fast to Humean strictures leads to views that differ in radical ways from those put forth by contemporary metaphysicians. (shrink)