The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We a...

The loss of the federally protected constitutional right to an abortion is a threat to the already tenuous autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions. Even before Roe’s demise, pregnancy led to constraints on autonomy evidenced by clinician-led legal incursions against patients who refused obstetric interventions. In Dobbs v. Jackson Women’s Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a (...) pregnant person’s right to an abortion. With Roe’s demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse. Here we discuss how the elevation of fetal and embryonic rights may lead to a cascade of medical intrusions and deprivations of liberty against pregnant persons, and offer an argument opposing these improprieties. (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...

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as home (...) birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states. (shrink)

Along with fresh interpretations of Plato, this book proposes a radically new approach to reading him, one that can teach us about protreptic, as it is called, by reimagining the ways in which Socrates engages in it. Protreptic, as it is conceived in the book, is an attempt to bring about a fundamental change of heart in people so that they want truth more than anything else. In taking the approach developed in this book, one doesn't try to get Plato (...) right but simply uses his dialogues as a theoretical tool for gaining insight into protreptic. The book argues that by analyzing Socrates' behavior in the right way, one can better understand how to foster thoughtfulness nowadays, and there is a need to foster it, in part since the health of democracy is at stake. (shrink)

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

In this paper, I argue that Plato's views on Forms play a central role in his educational philosophy. In response to what certain commentators have recently written, I contend that this interpretation not only is accurate but also is advantageous because of how it can help philosophy of education. I also address the view, proposed by one philosopher of education, that Plato believes that the most valuable sort of knowledge cannot be fully expressed in words and that the objects of (...) this knowledge are something other than transcendent Forms. Preferable to that view, I argue, is the idea that Plato wants knowledge of Forms which is nonrepresentational. (shrink)

Women are routinely subjected to penetrating surveillance during pregnancy. On the surface, this may appear to flow from a cultural commitment to protect babies – a cultural practice of “better safe than sorry” that is particularly vigilant given the vulnerability of fetuses and babies. In reality, pregnancy occasions incursions against human rights and well-being that would be anathema in other contexts. Our cultural practices concerning risk in pregnancy are infused with oppressive norms about women’s responsibility for pregnancy outcomes and the (...) demands of extreme self-sacrifice from women to protect their fetuses. Of particular concern is our culture’s willingness to enforce norms concerning risk during pregnancy using coercive measures including forced cesarean sections and criminal penalties for exposing fetuses to risk. This chapter will consider assaults on self-determination, bodily integrity and privacy inherent in such interventions, as well as the structural violence and “mangled pieties” that buttress such practices in our unjust society. (shrink)

The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and (...) futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care. (shrink)

Futility disputes are increasing and courts are slowly abandoning their historical reluctance to engage these contentious issues, particularly when confronted with inappropriate surrogate demands for aggressive treatment. Use of the judicial system to resolve futility disputes inevitably brings media attention and requires clinicians, hospitals, and families to debate these deep moral conflicts in the public eye. A recent case in Minnesota, In re Emergency Guardianship of Albert Barnes, explores this emerging trend and the complex responsibilities of clinicians and hospital administrators (...) seeking to replace an unfaithful surrogate demanding aggressive therapy. Use of the courts requires the coordinated commitment of significant institutional resources, management of intense media scrutiny and individual and organizational courage to enter the unpredictable world of litigation. Given the dearth of legislative guidance on medical futility, individual clinicians and institutions will continue to bear the difficult responsibility for resolution of individual futility disputes. The Barnes case illustrates how one institution successfully used the judicial system to replace an unfaithful surrogate, cease the provision of inappropriate aggressive care, and stimulate a community dialogue about appropriate care at the end of life. (shrink)

This essay, published shortly before the 2020 U.S. presidential election (mired in controversy over a potential judicial appointment to the Supreme Court), celebrates Daniel Callahan's prescient book Abortion: Law, Choice and Morality. Nothing could be timelier. Callahan's central question was the “moral and social” struggle requisite for coherent policies and laws regulating abortion. He rejected “one‐value” positions and strove to develop an expansive middle ground. He decried emotion untutored by reason, crude polemics, and bludgeoning: his recipe for a “noxious brew.” (...) Callahan's way of thinking preceded the development of a critical health humanities, the advent of moral foundations theory in psychology, and the philosophical concept of a moral imagination. Each of these inheres in his rigorous approach to the abortion problem. His honesty and humility led to a sea change in his position on abortion. Fifty years later, much can still be learned from Callahan's arguments—about abortion and other bioethics issues—most importantly, in how we address wider social issues in these polarized times. (shrink)

Special groups [M. Dickmann, F. Miraglia, Special Groups : Boolean-Theoretic Methods in the Theory of Quadratic Forms, Memoirs Amer. Math. Soc., vol. 689, Amer. Math. Soc., Providence, RI, 2000] are a first-order axiomatization of the theory of quadratic forms. In Section 2 we investigate reduced special groups which are a lattice under their natural representation partial order ; we show that this lattice property is preserved under most of the standard constructions on RSGs; in particular finite RSGs and RSGs of (...) finite chain length are lattice ordered. We prove that the lattice property fails for the RSGs of function fields of real algebraic varieties over a uniquely ordered field dense in its real closure, unless their stability index is 1 . We show that Open Problem 1 has a positive answer for the RSG of the field Q . In the final section we explore the meaning of Open Problem 1 for formally real fields, in terms of their orders and real valuations; we introduce the notion of “parameter-rank” of a positive-primitive first-order formula of the language for special groups. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse or (...) child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

Despite how revered Socrates is among many educators nowadays, he can seem in the end to be a poor model for them, particularly because of how often he refutes his interlocutors and poses leading questions. As critics have noted, refuting people can turn them away from inquiry instead of drawing them in, and being too directive with them can squelch independent thought. I contend, though, that Socrates' practices are more defensible than they often look: although there are risks in refuting (...) people and posing leading questions, Socrates has sensible ways of minimizing the risks, ways that are feasible even for teachers nowadays, and there are times when the risks are worth taking. I illustrate my point by discussing Plato's _Meno_. (shrink)

The paper deals with pp formulas in the language of reduced special groups, and the question of when the validity of a pp formula on each finite subspace of a space of orderings implies its global validity [18]. A large new class of pp formulas is introduced for which this is always the case, assuming the space of orderings in question has finite stability index. The paper also considers pp formulas of the special type $b\in \Pi _{i=1}^{n}\,D\langle 1,a_{i}\rangle $. Formulas (...) of this type with n = 3 are the simplest sort of pp formula not covered by the result, and are also the source of the recent counterexamples in [9] and [19]. (shrink)

The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse or (...) child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial (...) treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial (...) treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)

The aristocratic city described in Plato's _Republic_ is a hypothetical city, as opposed to a city that exists. But in the _Republic_, Socrates and his interlocutors argue that this city is practicable, meaning, roughly, that it *could* exist. I contend that their argument for that claim is essential to their argument that the city is just. In other words, I maintain that the first argument has to succeed in order for the second argument to succeed: in order to show that (...) the city is just, Socrates and his interlocutors need to demonstrate that it is practicable or, at least, that it could be approximated closely enough by an existing city. (shrink)

It is common to think that clarity is an essential ingredient of good teaching, meaning, in part, that good teachers always make it as easy as possible to follow what they say. We disagree. What we argue is that there are cases in which a philosophy teacher needs to forego clarity, making strategic use of obscurity in the undergraduate classroom.

Daryl Pullman provides a valuable comparison between the Medical Assistance in Dying (MAiD) rates in Canada and California, illuminating the factors that appear to be pushing Canada down a slippery...

Though academic debate over gender-inclusive God-talk seems to have fizzled, the issue is a pressing one within many Christiandenominations today—both within and outside the Church—and for that reason deserves to be briefly revisited. Accordingly, althoughin this essay we approach the issue as professional philosophers, our focus is on the life of the Church—more specifically, those no doubt sizable segments of the Church for which a personal God and Satan exist and evangelism matters. Running an elimination argument, we contend that if (...) a certain sort of feminist concern about traditional God-talk is well-directed, the best response is to speak of not only God but also Satan in both masculine and feminine terms. And in closing, we address the possible worry that this response to the God-talk problem would not be Christian enough. (shrink)

We prove that it is not possible to define an appropriate notion of rank in set theories without the axiom of foundation.

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Most scholars have thought that in the _Republic_ democracy is supposed to be worse than timarchy or oligarchy, but lately certain commentators have denied that it is. Is it, then? We argue that pursuing this question leads to a dead end: it simply is not clear how bad democracy is supposed to be in the _Republic_. To make our case, we first marshal the strongest available evidence that democracy is supposedly better than timarchy and oligarchy. Next we lay out the (...) strongest available evidence that democracy is supposedly worse. And then we explain why there is an impasse. (shrink)

The aristocratic city described in Plato's _Republic_ is a hypothetical city, as opposed to a city that exists. But in the _Republic_, Socrates and his interlocutors argue that this city is practicable, meaning, roughly, that it *could* exist. I contend that their argument for that claim is essential to their argument that the city is just. In other words, I maintain that the first argument has to succeed in order for the second argument to succeed: in order to show that (...) the city is just, Socrates and his interlocutors need to demonstrate that it is practicable or, at least, that it could be approximated closely enough by an existing city. (shrink)

A recent legal case involving an ambiguous diagnosis in a woman with a severe disorder of consciousness raises pressing questions about treatment withdrawal in a time when much of what experts know about disorders of consciousness is undergoing revision and refinement. How much should diagnostic certainty about consciousness matter? For the judge who refused to allow withdrawal of artificial nutrition and hydration, it was dispositive. Rather than relying on substituted judgment or best interests to determine treatment decisions, he ruled that (...) withdrawal was categorically prohibited, even as he concluded that Hannah Capes was more likely than not in a permanent vegetative state. In many jurisdictions, his decision would likely be consistent with existing law. Evolving technological advances have demonstrated that biologically distinct diagnoses incorporated into state laws may be difficult to establish even under ideal conditions. We offer the Capes case for purposes of examining the consequences of enshrined legal distinctions between permanent vegetative state and other severe disorders of consciousness. Insistence on proof of the permanent absence of consciousness before treatment withdrawal is allowed fails to respect the rights of persons with disorders of consciousness. Even the well-established rights to treatment withdrawal for those in a permanent vegetative state may be in jeopardy if reform is not undertaken. (shrink)