The U.S. Court of Appeals for the Third Circuit held, in Brader v. Allegheny General Hospital, 167 E3d 832, that the Health Care Quality Improvement Act, 42 U.S.C. §§ 11101-11152, shields a Pennsylvania hospital from a surgeon's claims of contract violations.The plaintiff, Alan Brader, M.D., joined Allegheny General Hospital's provisional medical staff in July 1988. During the next two years, he performed several abdominal aortic aneurysm repairs and various other operations. Several of Brader's patients sustained serious injuries or died during (...) surgery from complications. In 1989, Brader's supervisors, Drs. Daniel Diamond and George Magovern, met to discuss their dissatisfaction with Brader's behavior, his departures from hospital protocol, as well as his disruptive presence in the hospital. From 1989 to 1990, Brader continued to perform surgical procedures on incoming patients, and he continued to violate hospital notification protocol and lost a patient during surgery. In spring 1990, the Quality Assurance Department compiled data on AAA procedures for the hospital's physicians. (shrink)

Secrecy and ethics are often seen as opposing forces within organizations. Secret work is viewed as unethical, as it excludes others from knowing and is associated with self-interested behavior. We contend that this view does not account for the dynamic inherent to secrecy and to the fact that ethics is embedded in social relations. This paper suggests an alternative view. We consider secrecy as a social process which allows employees to maintain their ethics when faced with managerial policies that affect (...) the quality of their work. Building on an in-depth case study of a team of journalists who worked in secret after their managers decided to prioritize the interests of shareholders and advertising firms, we show how these journalists managed to maintain collective ethics through secrecy and to do their work according to their own moral principles. This paper offers two primary contributions. First, we show a mutually beneficial relationship between ethics and secrecy in organizations, wherein secrecy helps maintaining ethics in everyday work. Second, the paper shows how secrecy can lead to ethical resistance, via a transformation of the power relationship with managers. (shrink)

ObjectiveApproximately half of all people living with amyotrophic lateral sclerosis experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.DesignIn a cross-sectional (...) design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.Main Outcome MeasuresQuestionnaires assessed emotional distress, physical functioning, repetitive negative thinking, metacognitive beliefs, and demographic factors.ResultsMaladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.ConclusionsThese data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches. (shrink)

KJORVEN M, RUSH K and HOLE R. Nursing Inquiry 2011; 18: 325–335 A discursive exploration of the practices that shape and discipline nurses’ responses to postoperative deliriumAlthough delirium is classified as a medical emergency, it is often not treated as such by health care providers. The aim of this study was to critically examine, through a poststructural, Foucauldian concept of discourse, the language practices and discourses that shape and discipline nurses' care of older adults with postoperative delirium (POD) with a (...) purpose to question accepted nursing practice. The study was based on data collected from face‐to‐face, in‐depth, personal interviews with six nurses who work on an acute postoperative patient care unit. Five analytic readings of the data identified two prominent discourses at work in nursing practice which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse – the biomedical/scientific discourse – served to direct, legitimize and govern all other discourses. The findings of this study have implications for nursing knowledge and practice, length of hospital stay and improved patient outcomes. This study builds on previous work and is the first study to conduct a discourse analysis illuminating nurses’ responses to POD through comparison with other acute medical emergencies from a poststructural perspective. (shrink)

Calls for the “translation” of research from bench to bedside are increasingly demanding. What is translation, and why does it matter? We sketch the recent history of outcome-oriented translational research in the United States, with a particular focus on the Roadmap Initiative of the National Institutes of Health (Bethesda, MD). Our main example of contemporary translational research is stem cell research, which has superseded genomics as the translational object of choice. We explore the nature of and obstacles to translational research (...) and assess the ethical and biomedical challenges of embracing a translational ethos. (shrink)

Calls for the “translation” of research from bench to bedside are increasingly demanding. What is translation, and why does it matter? We sketch the recent history of outcome-oriented translational research in the United States, with a particular focus on the Roadmap Initiative of the National Institutes of Health. Our main example of contemporary translational research is stem cell research, which has superseded genomics as the translational object of choice. We explore the nature of and obstacles to translational research and assess (...) the ethical and biomedical challenges of embracing a translational ethos. (shrink)

Previous research has demonstrated that speakers adapt individual characteristics of speech production to the social context, for example via phonetic convergence. Studies have measured the impact of social dynamics on convergence in typical speakers, but the impact of individual differences is less well-explored. The present study measures phonetic convergence before and after a cooperative interaction with an undergraduate student by comparing teens with a history of autism spectrum disorder (ASD) and with typical development. Results revealed a small temporal convergence effect (...) for typically developing dyads; in contrast, dyads including autistic teens showed no convergence. Furthermore, the degree of convergence was negatively related to severity of ASD symptomatology and atypical sensory profiles. While social and sensory processing abilities may play a role in phonetic convergence, high covariance between these measures makes it difficult to differentiate their contributions in isolation. (shrink)

In recent years, the construct of character has received substantial attention among developmental scientists, but no consensus exists about the content and structure of character, especially among children and early adolescents. In a study of positive development among racially diverse Cub Scouts in the greater Philadelphia area, we assessed the construct and concurrent validity of a new measure of character, the Assessment of Character in Children and Early Adolescents, among 906 Scouts and 775 non-Scout boys and girls. We identified an (...) eight-correlated-factor model as providing the best fit with our data. We further established measurement invariance and explored latent mean differences for ACCEA scores across two Scout groups, non-Scout boys and non-Scout girls. Girls were generally superior than boys on all character attributes. We further examined concurrent validity of ACCEA by correlating the character attributes with youth sense of school competence, intentional self-regulation and parental perception of youth school performance. We discuss implications for future character research and point to the value of the ACCEA measure being used by practitioners in character development programs. (shrink)

Researchers have documented negative physical and emotional consequences for both family caregivers of persons with cancer as well as caregivers of persons with a neurologic disorder. However, there is a unique subset of caregivers who must provide care for someone who may suffer from both a short, terminal trajectory of disease, as well as neurological and neuropsychiatric sequelae — the caregiver of a person with a primary malignant brain tumor. The purpose of this article was to describe a conceptual framework (...) for providing care for a person with a primary malignant brain tumor. The demands of this particular care situation are described, as well as potential resources available to the caregiver to meet those demands. Finally, the stress response that results from the balance between care demands and caregiver resources is illustrated. Development of a conceptual framework for this caregiving population is the first step in assisting nurses to identify factors that place caregivers of persons with a primary malignant brain tumor at risk for negative consequences, and to design interventions to improve caregiver health. (shrink)

IntroductionApproaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing.Current StudyIn this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used (...) as a control group condition.MethodsHeart rate variability measures were assessed via electrocardiogram and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate. A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period.ResultsConditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals, low frequency HRV, and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video.ConclusionsAlthough the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed. (shrink)

Recent arguments claim that behavioral science has focused – to its detriment – on the individual over the system when construing behavioral interventions. In this commentary, we argue that tackling economic inequality using both framings in tandem is invaluable. By studying individuals who have overcome inequality, “positive deviants,” and the system limitations they navigate, we offer potentially greater policy solutions.

Previous research indicates that individuals with depressive disorders have aberrant resting state functional connectivity and may experience memory dysfunction. While resting state functional connectivity may be affected by experiences preceding the resting state scan, little is known about this relationship in individuals with DD. Our study examined this question in the context of object memory. 52 individuals with DD and 45 healthy controls completed clinical interviews, and a memory encoding task followed by a forced-choice recognition test. A 5-min resting state (...) fMRI scan was administered immediately after the forced-choice task. Resting state networks were identified using group Independent Component Analysis across all participants. A network modeling analysis conducted on 22 networks using FSLNets examined the interaction effect of diagnostic status and memory accuracy on the between-network connectivity. We found that this interaction significantly affected the relationship between the network comprised of the medial prefrontal cortex, posterior cingulate cortex, and hippocampal formation and the network comprised of the inferior temporal, parietal, and prefrontal cortices. A stronger positive correlation between these two networks was observed in individuals with DD who showed higher memory accuracy, while a stronger negative correlation was observed in individuals with DD who showed lower memory accuracy prior to resting state. No such effect was observed for HC. The former network cross-correlated with the default mode network, and the latter cross-correlated with the dorsal attention network. Considering that the DMN and DAN typically anticorrelate, we hypothesize that our findings indicate aberrant reactivation and consolidation processes that occur after the task is completed. Such aberrant processes may lead to continuous “replay” of previously learned, but currently irrelevant, information and underlie rumination in depression. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Helping people to die may involve killing and/or alleviation of pain in a dying person. A dual commitment to the avoidance of killing and the alleviation of pain raises the question of whether these two ways of helping people are always compatible. This paper addresses the question through use of sources in classical American pragmatism and contemporary bioethics. First, I apply Charles Peirce’s notion of pragmatism to the concept of killing through consideration of the empirical consequences of alternative interpretations. James (...) Rachels’ account of the distinction between active and passive euthanasia is critiqued in this analysis. Second, I examine what it means to relieve pain by relating Jane Addams’ concept of maternal nurturance to an ethic of care and opposition to killing. Utilizing these concepts, I apply William James’ notion of pragmatism as a method of mediating or straddling different theoretical approaches to resolve the apparent incompatibility between pain relief and the avoidance of killing. To address social concerns raised by the practice of helping people to die, I propose a corrective insight of Addams, along with John Dewey, about the role of the philosopher as social critic. Thus understood, pragmatism is a means of avoiding abuses that may occur in the process. I conclude that so long as permissive practices are restrained sufficiently to avoid injustices, it is morally both possible and desirable to resist killing while relieving pain. (shrink)

Political Freedom By George G. Brenkert Routledge, 1991. Pp. 278. ISBN 0–415–03372–1. £35 hbk.Wittgenstein: A Bibliographical Guide By Guido Frongia and Brian McGuinness Basil Blackwell, 1990. Pp. x + 438. ISBN 00631–13765–3. £60.00.Metaphysics By Peter van Inwagen Oxford University Press, 1993. Pp. xiii + 222. ISBN 0–19–8751400. £11.95 pbk.The Nature of Moral Thinking By Francis Snare Routledge, 1992. Pp. 187. ISBN 0–415–04709–9. £9.99 pbk.Filosofía analitica hoy: Encuentro de tradiciones Edited by Mercedes Torrevejano Servicio de Publications Universidade de Santiago de Compostela, (...) 1991. Pp. 284. ISBN 84–7191–722‐X. $15.5 pbk.The Puzzle of Experience By J.J. Valberg Clarendon Press, 1992. Pp. 227. ISBN 0–19–824291–3. £25.Religion and Philosophy Edited by Martin Warner Royal Institute of Philosophy Supplement: 31 Cambridge University Press, 1992. Pp. vi + 155. ISBN 0–521–42951‐X. £10.95 pbk.The Uses of Philosophy By Mary Warnock Blackwell, 1992. Pp. 256. ISBN 0–631–18038–9. £35.00 hbk. £11.95 pbk.The Disappearance of Time: Kurt Godel and the Idealistic Tradition in Philosophy By Palle Yourgrau Cambridge University Press, 1991. Pp. x + 182. ISBN 0–521–41012–6. £27.50. (shrink)

In her recent paper ‘The Epistemology of Propaganda’ Rachel McKinnon discusses what she refers to as ‘TERF propaganda’. We take issue with three points in her paper. The first is her rejection of the claim that ‘TERF’ is a misogynistic slur. The second is the examples she presents as commitments of so-called ‘TERFs’, in order to establish that radical (and gender critical) feminists rely on a flawed ideology. The third is her claim that standpoint epistemology can be used to (...) establish that such feminists are wrong to worry about a threat of male violence in relation to trans women. In Section 1 we argue that ‘TERF’ is not a merely descriptive term; that to the extent that McKinnon offers considerations in support of the claim that ‘TERF’ is not a slur, these considerations fail; and that ‘TERF’ is a slur according to several prominent accounts in the contemporary literature. In Section 2, we argue that McKinnon misrepresents the position of gender critical feminists, and in doing so fails to establish the claim that the ideology behind these positions is flawed. In Section 3 we argue that McKinnon’s criticism of Stanley fails, and one implication of this is that those she characterizes as ‘positively privileged’ cannot rely on the standpoint-relative knowledge of those she characterizes as ‘negatively privileged’. We also emphasize in this section McKinnon’s failure to understand and account for multiple axes of oppression, of which the cis/trans axis is only one. (shrink)

Among Aristotle’s criticisms of the Form of the Good is his claim that the knowledge of such a Good could be of no practical relevance to everyday rational agency, e.g. on the part of craftspeople. This critique turns out to hinge ultimately on the deeply different assumptions made by Plato and Aristotle about the relation of ‘good’ and ‘good for’. Plato insists on the conceptual priority of the former; and Plato wins the argument.

Despite the increased prevalence of bioethics research that seeks to use empirical data to answer normative research questions, there is no consensus as to what an appropriate methodology for this would be. This review aims to search the literature, present and critically discuss published Empirical Bioethics methodologies.

In this paper, I identify and distinguish different modes of thinking at work in Hannah Arendt’s Denktagebuch and letters. In the Denktagebuch, her thinking is dialogical, as she engages with herself in a dialogue of thought, while her writing is a product of poetic thinking. In the letters, her dialogical thinking is not only with herself, but with friends and correspondents, and poetic thinking takes the form of the material letter itself. Arendt engages in a dialogue of thought both with (...) herself, who is a friend, and her correspondents, who are also friends. Arendt’s personal writings, that is, her letters and her Denktagebuch reveal a close relationship between private, solitary thinking, and thinking and writing that appear in public. (shrink)

This selection consists of extracts from writings of women concerned solely with the pursuit of abstract ideas, historically contextualized. The texts, for the most part, reflect issues widely debated in their contemporary societies. Extracts from lesser-known writers are also included, providing a diversity of arguments spanning four centuries and including some notable contemporary philosophers.

A leader in the modern commentary on ethics and philosophy, Mary Warnock casts a critical eye over her life and times.

Through an examination of the actual research strategies and assumptions underlying the Human Genome Project, it is argued that the epistemic basis of the initial model organism programs is not best understood as reasoning via causal analog models. In order to answer a series of questions about what is being modeled and what claims about the models are warranted, a descriptive epistemological method is employed that uses historical techniques to develop detailed accounts which, in turn, help to reveal forms of (...) reasoning that are explicit, or more often implicit, in the practice of a particular field of scientific study. It is suggested that a more valid characterization of the reasoning structure at work here is a form of case-based reasoning. This conceptualization of the role of model organisms can guide our understanding and assessment of these research programs, their knowledge claims and progress, and their limitations, as well as how we educate the public about this type of biomedical research. (shrink)

How is hope to be found amid the ethical and political dilemmas of modern life? Writer and philosopher Mary Zournazi brought her questions to some of the most thoughtful intellectuals at work today. She discusses "joyful revolt" with Julia Kristeva, the idea of "the rest of the world" with Gayatri Spivak, the "art of living" with Michel Serres, the "carnival of the senses" with Michael Taussig, the relation of hope to passion and to politics with Chantal Mouffe and Ernesto (...) Laclau. A dozen stimulating minds weigh in with their visions of a better social and political order. The result is a collaboration - of writing, of thinking, and of politics - that demonstrates more clearly than any single-authored project could how ideas encountering one another can produce the vision needed for social change. (shrink)

Anthology of readings in moral philosophy.

A joke is amusing if and only if it’s fitting to be amused by it; an act is regrettable if and only if it’s fitting to regret it. Many philosophers accept these biconditionals and hold that analogous ones obtain between a wide range of additional evaluative properties and the fittingness of corresponding responses. Call these the _fit–value biconditionals_. The biconditionals give us a systematic way of recognizing the role of fit in our ethical practices; they also serve as the bedrock (...) of various metaethical projects, such as fitting-attitude analysis of value and the ‘fittingness first’ approach. Yet despite the importance of the biconditionals, there is very little discussion of their proper interpretation. This paper argues that any plausible interpretation of the fit_–_value biconditionals must disarm several kinds of apparent counterexample. For instance, that an achievement is pride-worthy doesn’t imply it is fitting for me to take pride in it because the achievement might not be mine or that of anyone close to me; that a joke is amusing doesn’t imply it is fitting for me to be amused by it for six straight months; and that a person is loveable doesn’t imply it is fitting for me to love him romantically because that person might be my sibling. We consider possible responses to such counterexamples and develop what we consider the most promising interpretation of the biconditionals. The upshot is that certain widespread assumptions about fit and its relation to value and reasons should be reconsidered. (shrink)

All religion and much philosophy has been concerned with the contrast between the ephemeral and the eternal. Human beings have always sought ways to overcome time, and to prove that death is not the end. This book consists then in an exploration of certain closely related ideas: personal identity, time, history and our commitment to the future, and the role of imagination in life.

En este libro, la autora desarrolla su concepción del juicio reflexionante inspirada en Emmanuel Kant y en Hannah Arendt para concentrarse en cómo cierto tipo de narraciones modelan nuestras nociones de lo que consideramos moral. Lara nos ofrece distintas concepciones sobre el mal en su formulación histórica mediante los ejemplos de las tragedias griegas, las diferentes concepciones sobre el mal en la obra de Shakespeare, el uso literario de la metáfora en la obra de Joseph Conrad y en narraciones fílmicas (...) que describen la crueldad humana. Lara sugiere que el aprendizaje moral es un proceso en el que intervienen las instituciones sociales, la voluntad de los individuos y de las sociedades para comprometerse a un debate abierto y con ello modelar los juicios colectivos sobre el pasado. Lara enfatiza que el juicio reflexionante se da entre un evento, una narración de dicho evento y la recepción pública de dicha narrativa. En este libro se aportan importantes métodos para la comprensión del fenómeno moral del mal, porque introducen nuevas verdades desvelatorias acerca de eventos particulares que no pueden ser simplemente captados por medio de categorías conceptuales. Lara utiliza como fuentes a Jürgen Habermas, Walter Benjamin, Primo Levi, Giorgio Agamben y Ariel Dorfman para probar la conclusión de este tipo de narraciones: la acción (de crueldad) ata de manera definitiva al perpetrador con su víctima. (shrink)

Fundamental principles : the nature of the dispute -- Types of euthanasia -- Psychiatric assisted suicide -- Neonates -- Incompetent adults -- Human life is sacred -- The slippery slope -- Medical views -- Four methods of easing death and their effect on doctors -- Looking further ahead.

The dominant approach to understanding Islamic Business Ethics has been based almost exclusively on either interpretations of the Qur’an and Sunna or influenced by Western understanding of Islam and ethics. However, there is a rich—largely ignored-tradition of ethical analysis conducted by Muslim philosophers which would broaden our understanding of Islamic ethics and hence IBE. We seek to correct this imbalance by examining works of Al-Ghazali, an early Muslim philosopher, scholar, and mystic. His approach to Sufism, combining an interpretation of revelation (...) with reason, can contribute to new developments in business ethics scholarship and practice especially in Muslim communities. His thought portrays a vibrant work ethic that, while based in Sufism, has important practical implications for business. We argue that including such historically and contextually recognized perspectives in our understanding of BE, both in theory and in practice, would work well with an audience that looks to Islam as a source of justice and proper moral conduct. (shrink)

What words we use, and what meanings they have, is important. We shouldn't use slurs; we should use 'rape' to include spousal rape (for centuries we didn’t); we should have a word which picks out the sexual harassment suffered by people in the workplace and elsewhere (for centuries we didn’t). Sometimes we need to change the word-meaning pairs in circulation, either by getting rid of the pair completely (slurs), changing the meaning (as we did with 'rape'), or adding brand new (...) word-meaning pairs (as with 'sexual harassment'). A problem, though, is how to do this. One might worry that any attempt to change language in this way will lead to widespread miscommunication and confusion. I argue that this is indeed so, but that's a feature, not a bug of attempting to change word-meaning pairs. The miscommunications and confusion such changes cause can lead us, via a process I call transformative communicative disruption, to reflect on our language and its use, and this can be further, rather than hinder, our goal of improving language. (shrink)

Kant's Critique of Judgment has often been interpreted by scholars as comprising separate treatments of three uneasily connected topics: beauty, biology, and empirical knowledge. Rachel Zuckert's book interprets the Critique as a unified argument concerning all three domains. She argues that on Kant's view, human beings demonstrate a distinctive cognitive ability in appreciating beauty and understanding organic life: an ability to anticipate a whole that we do not completely understand according to preconceived categories. This ability is necessary, moreover, for (...) human beings to gain knowledge of nature in its empirical character as it is, not as we might assume it to be. Her wide-ranging and original study will be valuable for readers in all areas of Kant's philosophy. (shrink)

We present a novel semantic and conversational framework for a class of gradable-like constructions. These include metalinguistic comparatives, like "Ann is more a linguist than a philosopher", as well as metalinguistic equatives, degree modifications, and conditionals. To the extent previous literature discusses such metalinguistic gradability, the focus has been on comparatives. We extend our account of metalinguistic comparatives (Rudolph & Kocurek 2020) to cover a broader range of metalinguistic gradable constructions. On our semantic expressivist view, these all serve in various (...) ways to express speakers' relative commitments to different linguistic interpretations. (shrink)