In this note, we give a representation of distributive Ockham algebras via natural hom-functors. In order to do this, we describe two different structures (one algebraic, and the other order-topological) on the set of subsets of the natural numbers. The topological duality previously obtained by A. Urquhart is used throughout.

In certain judgmental situations where a “correct” decision is presumed to exist, optimal decision making requires evaluation of the decision-makers’ capabilities and the selection of the appropriate aggregation rule. The major and so far unresolved difficulty is the former necessity. This article presents the optimal aggregation rule that simultaneously satisfies these two interdependent necessary requirements. In our setting, some record of the voters’ past decisions is available, but the correct decisions are not known. We observe that any arbitrary evaluation of (...) the decision-makers’ capabilities as probabilities yields some optimal aggregation rule that, in turn, yields a maximum-likelihood estimation of decisional skills. Thus, a skill-evaluation equilibrium can be defined as an evaluation of decisional skills that yields itself as a maximum-likelihood estimation of decisional skills. We show that such equilibrium exists and offer a procedure for finding one. The obtained equilibrium is locally optimal and is shown empirically to generally be globally optimal in terms of the correctness of the resulting collective decisions. Interestingly, under minimally competent (almost symmetric) skill distributions that allow unskilled decision makers, the optimal rule considerably outperforms the common simple majority rule (SMR). Furthermore, a sufficient record of past decisions ensures that the collective probability of making a correct decision converges to 1, as opposed to accuracy of about 0.7 under SMR. Our proposed optimal voting procedure relaxes the fundamental (and sometimes unrealistic) assumptions in Condorcet’s celebrated theorem and its extensions, such as sufficiently high decision-making quality, skill homogeneity or existence of a sufficiently large group of decision makers. (shrink)

9/11 has served as a wake-up call to the entire world.

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates.

Children in North America, some as young as eleven or twelve, routinely don helmets and pads and are trained to move at high-speed for the purpose of engaging in repeated full-body collisions with each other. The evidence suggests that the forces generated by such impacts are sufficient to cause traumatic brain injury among children. Moreover, there is only limited evidence supporting the efficacy of interventions typically used to reduce the risks of such hazards. What kind of risk assessment enables such (...) activities to be a relatively common feature of childhood in Canadian and American society?In order to understand this state of affairs, we must examine the particular risk frame under which such hazards are commonly assumed. Risk assessments are embedded in the cultures in which they are situated and must be evaluated in their social contexts. (shrink)

If funding allocation is an indicator of a field’s priorities, then the priorities of the field of bioethics are misaligned because they perpetuate injustice. Social justice mandates priority for the factors that drive systematic disadvantage, which tend not to be the areas supported by funding within academic bioethics. Current funding priorities violate social justice by overemphasizing technologies that aim to enhance the human condition without addressing underlying structural inequalities grounded in racism, and by deemphasizing areas of inquiry most frequently pursued (...) by Scholars of Color. This lack of attention to upstream determinants of health in bioethics research perpetuates a gap in the resources needed to understand the experiences of communities disproportionately experiencing poor health, which is itself a form of epistemic injustice. Both social and epistemic injustices are apparent in the impact of these funding priorities on people of color, both in the public and in the bioethics community. (shrink)

It is my hope that the book will be widely read and debated."--Axel Leijonhufvud, UCLA and the University of Trento "This is a major and controversial contribution to macroeconomics that cannot fail to make an impact in several areas.

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

This article asserts that traditionally dominant models of health promotion in the US are fairly characterized by methodological individualism. This schema produces a focus on the individual as the node of intervention. Such emphasis results in a number of scientific and ethical problems. I identify three principal ethical deficiencies: first, the health promotions used are generally ineffective, which violates canons of distributive justice because scarce health resources are expended on interventions that are unlikely to produce health benefits. Second, the health (...) promotions used tend to expand health inequalities between the affluent and the least well-off. Third, the health promotions used are likely to intensify stigma against the least well-off, a deficiency that itself may exacerbate the ‘densely-woven patterns of disadvantage’ that characterize life on the tail of the social gradient. Because Powers and Faden’s health sufficiency model of social justice argues that the amelioration of such clusters of disadvantage should be the primary ethical goal of public health policy, methodologically individualist models of health promotion are ethically deficient and should not stand as primary approaches for health promotion in a just social order. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

Interest is growing in the relocalization of staple crops, including wheat, in western Washington (WWA), a nontraditional wheat-growing area. Commercial bakers are potentially important food chain intermediaries in the case of relocalized wheat production. We conducted a mail survey of commercial bakers in WWA to assess their interest in sourcing wheat/flour from WWA, identify the characteristics of bakeries most likely to purchase wheat/flour from WWA, understand the factors important to bakers in purchasing regionally produced wheat/flour, and identify perceived barriers to (...) making such purchases. Sixty-one percent of survey respondents were interested in purchasing WWA wheat/flour. Bakers who used retail strategies to market their products were more likely to be interested in WWA wheat/flour compared to those not using retail methods. Bakers’ current purchases of Washington wheat/flour were not related to their interest in purchasing WWA flour. The most important factors bakers would consider in purchasing regionally produced wheat/flour were consistency of flour quality, quality of flour, and reliability of supply. Cost was the most frequently mentioned barrier to the purchase of regionally produced wheat/flour. Our results are relevant for other areas attempting to reconnect grain producers, commercial bakers, and consumers in mutually beneficial ways. (shrink)

This article argues that positioning disclosure as a primary remedy in addressing the ethical problems posed by conflicts of interest in medicine and health is an error. Instead, bioethical resources should be devoted to the problems associated with sequestration, defined as the elimination of relationships between commercial industries and health professionals in all cases where it is remotely feasible. The argument begins by arguing that adopting Andrew Stark’s conceptual framework for COIs leads to advantages in understanding COIs and in ordering (...) priorities for intervention. The article then draws on prior work establishing that COIs are, under ordinary epidemiologic standards, properly regarded as population health hazards. This justifies attention to possible remedies, of which disclosure generates by far the most analysis. Such primacy is unwarranted given the extensive evidence suggesting that disclosure as a remedy for COIs is at best ineffective. ‘At best’ is justified because the evidence also shows that disclosure may have a perverse effect, intensifying biased behaviors. Expending significant attention on an ineffective or even deleterious intervention is unjustified and also crowds out devotion of resources to the real problems that attend sequestration. Therefore, disclosure ought to be regarded as a lower priority among possible COI interventions. (shrink)

In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and (...) pain in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US. (shrink)

The point of departure for this essay is the question of why pain is seriously undertreated in the United States. Some kinds of pain (for example, chronic nonmalignant pain) are treated worse than others (acute pain secondary to cancer), but there is excellent evidence that no matter what kind of pain, astonishingly large percentages of pain sufferers are undertreated (Furrow 2001; Hill 1995; Kirou-Mauro et al. 2009; Martino 1998; Morris 1991; NCHS 2006; Resnik, Rehm, and Minard 2001). Although some kinds (...) of pain are difficult to treat, we generally possess the technical armamentarium to significantly ameliorate the vast majority of pain experiences. Yet we do not. And, for as long as anyone in the United States .. (shrink)

Svirsky, Howard, and Berman’s paper “E-Cigarettes and the Multiple Responsibilities of the FDA” offers a significant contribution to a knowledge domain that might be called “harm reduction e...

One of six commentaries on “Obesity: Chasing an Elusive Epidemic,” by Daniel Callahan, from the January‐February 2013 issue.

The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those (...) that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes. (shrink)

Pain policy is not drug policy. If society wants to improve the lives of people in pain and compress the terrible inequalities in its diagnosis and treatment, we have to tailor policy to the root causes driving our problems in treating pain humanely and equitably. In the United States, we do not. Instead, we have proceeded to conflate drug policy with pain policy, relying on arguably magical thinking for the conclusion that by addressing the drug overdose crisis, we are simultaneously (...) addressing the pain crisis. This is a category error, decades of commitment to which have resulted mostly in a worsening of both public health problems. Disentangling our problems in treating pain fairly and equitably from our problems with drugs and substance use is the only path to humane and ethical policy for each. (shrink)

Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by critiquing one (...) of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)

In El Salvador from 1978 to 1988, contraceptive use among married women 15–44 years of age increased from 34% to 47%, and the total fertility rate declined from 6·3 to 4·6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay (...) the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception. (shrink)

In this account, we explain the meaning of a priori voting power and outline how it is measured. We distinguish two intuitive notions as to what voting power means, leading to two approaches to measuring it. We discuss some philosophical and pragmatic objections, according to which a priori (as distinct from actual) voting power is worthless or inapplicable.

If K is an index of relative voting power for simple voting games, the bicameral postulate requires that the distribution of K -power within a voting assembly, as measured by the ratios of the powers of the voters, be independent of whether the assembly is viewed as a separate legislature or as one chamber of a bicameral system, provided that there are no voters common to both chambers. We argue that a reasonable index – if it is to be used (...) as a tool for analysing abstract, ‘uninhabited’ decision rules – should satisfy this postulate. We show that, among known indices, only the Banzhaf measure does so. Moreover, the Shapley–Shubik, Deegan–Packel and Johnston indices sometimes witness a reversal under these circumstances, with voter x ‘less powerful’ than y when measured in the simple voting game G1 , but ‘more powerful’ than y when G1 is ‘bicamerally joined’ with a second chamber G2 . Thus these three indices violate a weaker, and correspondingly more compelling, form of the bicameral postulate. It is also shown that these indices are not always co-monotonic with the Banzhaf index and that as a result they infringe another intuitively plausible condition – the price monotonicity condition. We discuss implications of these findings, in light of recent work showing that only the Shapley–Shubik index, among known measures, satisfies another compelling principle known as the bloc postulate. We also propose a distinction between two separate aspects of voting power: power as share in a fixed purse (P-power) and power as influence (I-power). (shrink)

In this paper I argue that RadicalInterpretation (RI), taken to be a methodological doctrine regarding the conditions under which an interpretation of an utterance is both warranted and correct, has unacceptable implications for the conditions on (ascriptions of) understanding. The notion of understanding at play is that which underwrites the testimonial transmission of knowledge. After developing this notion I argue that, on the assumption of RI, hearers will fail to have such understanding in situations in which we should want to (...) maintain otherwise. The overall effect of the argument is to provide a heretofore unexamined source of motivation for anti-individualistic approaches to the semantics of utterances. (shrink)

Agents and Lives offers a new and important rethinking of the traditional "humanist" view of literature. That tradition's valuation of literature for its "moral import" is extended in a wider, more complex, open and exploratory understanding of those terms. Goldberg's argument ranges across literature since the Renaissance, focusing on examples from George Eliot's novels and Pope's poetry. An appendix assesses the relationship of his argument to recent accounts of literature offered by moral philosophers such as Iris Murdoch, Bernard Williams, (...) Martha Nussbaum and Richard Rorty. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

The primary claim of this paper is that COVID-19 stigma must be understood as a structural phenomenon. Doing so will inform the interventions we select and prioritize for the amelioration of such stigma. Thinking about stigma as a macrosocial determinant of health driven by structural factors suggests that downstream remedies are unlikely to be effective in significantly reducing stigma. This paper develops and defends this claim, setting up a recommendation to use a “bundle” of legal and policy levers at meso- (...) and macro- levels to reduce the adverse and inequitable impact of COVID-19 stigma.Historians of public health have long pointed out that outbreaks of communicable disease track social fault lines (Rosenberg... (shrink)

I offer a novel two-stage reconstruction of Hume’s general-point-of-view account, modeled in part on his qualified-judges account in ‘Of the Standard of Taste.’ In particular, I argue that the general point of view needs to be jointly constructed by spectators who have sympathized with (at least some of) the agents in (at least some of) the actor’s circles of influence. The upshot of the account is two-fold. First, Hume’s later thought developed in such a way that it can rectify the (...) problems inherent in his Treatise account of the general point of view. Second, the proposed account provides the grounds for an adequate and well-motivated modest ideal observer theory of the standard of virtue. (shrink)

Bioethics, Volume 36, Issue 8, Page 819-820, October 2022.

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

We consider a singular event of the following form: in a simple voting game, a particular division of the voters resulted in a positive outcome. We propose a plausible measure that quantifies the causal contribution of any given voter to the outcome. This measure is based on a conceptual analysis due to Braham [1], but differs from his solution to the problem of measuring causality of singular events.

A variant 'evil demon' case is used to argue against internalism about doxastic justification. The argument is not merely novel but surprising, since evil demon cases have long been used by internalists against externalist accounts of doxastic justification.

This article adopts a population-level bioethics approach to analyzing the ethical implications of novel deep-brain stimulation (DBS) technologies. I claim that a microlevel focus on costs and benefits is necessary but insufficient to address the concerns of social justice and health equity that attend the potential utilization of DBS technologies. A macrosocial, population-based analysis notes two ethically significant trends regarding novel health technologies: (1) that they are the prime mover of hyperinflationary health cost trajectories, and (2) that even where they (...) improve overall population health such technologies may expand health inequalities. Such an expansion could exacerbate what Powers and Faden have identified as “densely-woven patterns of disadvantage,” and therein could contravene mandates of social justice. Such concerns of justice and equity are sharpened by the fact that those populations that bear the highest risk of suffering the injuries and illnesses for which DBS technologies might be warranted are among the most disadvantaged groups in American society. Accordingly, ethical analysis of DBS technologies must include an assessment of the evidence suggesting that in their capacity to improve health and compress health inequalities, whole-population approaches that address the upstream factors that shape distributions of neuropsychiatric injuries and illness may be preferable to acute health interventions. However, the article warns against the false-choice fallacy, and notes that whole-population policies and acute care interventions can be simultaneously endorsed. The article concludes by suggesting that the ethical issue of relative priority between these approaches is best framed via a population-level analysis. (shrink)

This book describes Carmeli's cosmological general and special relativity theory, along with Einstein's general and special relativity. These theories are discussed in the context of Moshe Carmeli's original research, in which velocity is introduced as an additional independent dimension. Four- and five-dimensional spaces are considered, and the five-dimensional braneworld theory is presented. The Tully-Fisher law is obtained directly from the theory, and thus it is found that there is no necessity to assume the existence of dark matter in the (...) halo of galaxies, nor in galaxy clusters.The book gives the derivation of the Lorentz transformation, which is used in both Einstein's special relativity and Carmeli's cosmological special relativity theory. The text also provides the mathematical theory of curved space?time geometry, which is necessary to describe both Einstein's general relativity and Carmeli's cosmological general relativity. A comparison between the dynamical and kinematic aspects of the expansion of the universe is made. Comparison is also made between the Friedmann-Robertson-Walker theory and the Carmeli theory. And neither is it necessary to assume the existence of dark matter to correctly describe the expansion of the cosmos. (shrink)

Two problems seem to plague Adam Smith’s account of sympathy and approbation in The Theory of Moral Sentiments (TMS). First, Smith’s account of sympathy at the beginning of TMS appears to be inconsistent with the account of sympathy at the end of TMS. In particular, it seems that Smith did not appreciate the distinction between ‘self-oriented sympathy’ and ‘other-oriented sympathy’, that is, between imagining being oneself in the actor’s situation and imagining being the actor in the actor’s situation. Second, Smith’s (...) account of approbation, according to which a sentiment of approval arises when there is recognition of concordance between the spectator’s sympathetic passion and the actor’s original passion, seems to face the following problem: since the spectator attains both his own sympathetic passion and the actor’s original passion by sympathizing with the actor, the sympathetic passion of the spectator and the original passion of the actor will necessarily be identical. Therefore, Smith’s account of approbation requires that the spectator utilize both self-oriented and other-oriented sympathy (‘the double-sympathy model of approbation’). I offer a novel developmental account of sympathy in TMS that renders Smith’s account of sympathy consistent and allows for the utilization of the double-sympathy model of approbation. (shrink)

In the voting-power literature the rules of decision of the US Congress and the UN Security Council are widely misreported as though abstention amounts to a `no' vote. The hypothesis (proposed elsewhere) that this is due to a specific cause, theory-laden observation, is tested here by examining accounts of these rules in introductory textbooks on American Government and International Relations, where that putative cause does not apply. Our examination does not lead to a conclusive outcome regarding the hypothesis, but reveals (...) that the rules in question are also widely misreported in these textbooks. A second hypothesis---that the widespread misreporting is explicable by the relative rarity and unimportance of abstention in the two bodies concerned---is also tested and found to be untenable. (shrink)

This essay explores the long Western history of anxieties about feigned illness connected specifically to social policy. There is a remarkable consistency of such anxieties across time, as they appear in almost every major historical period in the West since the Middle Ages.