Oregon is the only state in the United States where a physician may legally prescribe a lethal dose of barbiturate for a patient intending suicide. The Oregon Death with Dignity Act was passed by voters in 1994 and came into effect after much legal wrangling in October of 1997. At the same time, a cabinetmaker named Pat Matheny was struggling with progressive weakness from amyotrophic lateral sclerosis, or ALS. I met with Pat and his family for a lengthy interview in (...) October 1998 in Coos Bay, Oregon, for a television news report on his decision to get a lethal prescription. Below is an extract from that interview. On the day this introduction was written, 10 March 1999, Pat took the prescribed lethal overdose of barbiturates and died at home. His illness was taking his voice, he could not move his hands or legs, and breathing was becoming very difficult. His mother told me he knew that was for him. (shrink)

As the structure of healthcare delivery undergoes a breathtaking transformation, many ethics committees are wondering how and if they will be affected. Although the impact has not yet been widely felt, hospital-based ethics committees cannot avoid the pressures and upheaval caused by the reorganization of healthcare. This article will briefly review some of the factors contributing to the transformation of medicine, and suggest a number of ways in which ethics committees can respond proactively.

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay.The term managed care describes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, and (...) philosophy exist among the different types of managed care organizations. While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine. (shrink)

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay. The term managed care describes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, (...) and philosophy exist among the different types of managed care organizations. While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine. (shrink)

In the U.S. there has been considerable interest in connecting low-income households to alternative food networks like Community Supported Agriculture. To learn more about this possibility we conducted a statewide survey of CSA members in California. A total of 1149 members from 41 CSAs responded. Here we answer the research question: How do CSA members’ socioeconomic and demographic backgrounds, household conditions potentially interfering with membership, and CSA membership experiences vary between lower-income households and higher-income households? We divided members into LIHHs (...) and HIHHs. We present comparisons of LIHHs’ and HIHHs’ employment, race/ethnicity, household composition and education, use of food support, and enjoyment of food-related activities; conditions interfering with membership and major life events; and sources of information influencing decision to join, reasons for joining, ratings of importance of and satisfaction with various CSA attributes, gaps between importance of and satisfaction with various CSA attributes, valuing of the share and willingness to pay more, and impacts of membership. We find that LIHHs are committed CSA members, often more so than HIHHs, and that CSA members in California are disproportionately white, but that racial disproportionality decreases as incomes increase. We conclude by considering: the economic risks that LIHHs face in CSA membership, the intersection of economic risks with race/ethnicity and cultural coding in CSA; and the possibilities of increasing participation of LIHH in CSA. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

‘There is no place in the phenomenology of fully absorbed coping’, writes Hubert Dreyfus, ‘for mindfulness. In flow, as Sartre sees, there are only attractive and repulsive forces drawing appropriate activity out of an active body’1. Among the many ways in which history animates dynamical systems at a range of distinctive timescales, the phenomena of embodied human habit, skilful movement, and absorbed coping are among the most pervasive and mundane, and the most philosophically puzzling. In this essay we examine both (...) habitual and skilled movement, sketching the outlines of a multidimensional framework within which the many differences across distinctive cases and domains might be fruitfully understood. Both the range of movement phenomena which can plausibly be seen as instances of habit or skill, and the space of possible theories of such phenomena are richer and more disparate than philosophy easily encompasses. We seek to bring phenomenology into contact with relevant movements in psychological theories of skilful action, in the belief that phenomenological philosophy and cognitive science can be allies rather than antagonists. (shrink)

We argue the need for academics to resist and challenge the hegemonic discourse of sustainable development within the corporate context. Laclau and Mouffe’s discourse theory provides a useful framework for recognizing the complex nature of sustainable development and a way of conceptualizing counter-hegemonies. Published empirical research that analyzes sustainable development discourse within corporate reports is examined to consider how the hegemonic discourse is constructed. Embedded assumptions within the hegemonic construction are identified including sustainable development as primarily about economic development, progress, (...) growth, profitability, and “responsibly” managed levels of resource depletion. We call for multiple voices in the discursive field to debate and to resist closure and highlight the possibilities for academic researchers to actively resist the hegemonic construction. Specifically, we advocate vigilance and awareness, critical and reflective analyses, challenge and resistance based on other frames of reference, and strategies for communicating both within and outside the academy. (shrink)

What form does power take in situations of retaliation against whistleblowers? In this article, we move away from dominant perspectives that see power as a resource. In place, we propose a theory of normative power and violence in whistleblower retaliation, drawing on an in-depth empirical study. This enables a deeper understanding of power as it circulates in complex processes of whistleblowing. We offer the following contributions. First, supported by empirical findings we propose a novel theoretical framing of whistleblower retaliation and (...) the role of mental health, which draws upon poststructuralist psychoanalytic thinking. Specifically, we highlight how intra- and inter-psychic affective and ambivalent attachments to organizations influence the use of normative violence in cases of whistleblower retaliation. The second contribution is empirical and builds upon the existing literature on whistleblower retaliation by highlighting how organizations position whistleblower subjects as mentally unstable and unreliable individuals, to undermine their claims. We conclude by highlighting the implications of normative power for the outcomes of whistleblower struggles. (shrink)

What makes an external whistleblower effective? Whistleblowers represent an important conduit for dissensus, providing valuable information about ethical breaches and organizational wrongdoing. They often speak out about injustice from a relatively weak position of power, with the aim of changing the status quo. But many external whistleblowers fail in this attempt to make their claims heard and thus secure change. Some can experience severe retaliation and public blacklisting, while others are ignored. This article examines how whistleblowers can succeed in bringing (...) their claims to the public’s attention. We draw on analyses of political struggle by Ernesto Laclau and Chantal Mouffe. Specifically, we propose that through the raising of a demand, the whistleblowing subject can emerge as part of a chain of equivalences, in a counter-hegemonic movement that challenges the status quo. An analysis of a high-profile case of tax justice whistleblowing-that of Rudolf Elmer-illustrates our argument. Our proposed theoretical framing builds upon and contributes to literature on whistleblowing as organizational parrhesia by demonstrating how parrhesiastic demand might lead to change in public perception through the formation of alliances with other disparate interests—albeit that the process is precarious and complex. Practically, our article illuminates a persistent concern for those engaged in dissensus via whistleblowing, and whose actions are frequently ignored or silenced. We demonstrate how such actions can move towards securing public support in order to make a difference and achieve change. (shrink)

Legal responses to battered women who kill have long animated scholarly debate and law reform activity. In September 2012 after 47 years of alleged abuse, Frenchwoman Jacqueline Sauvage fatally shot her abusive husband three times in the back. The subsequent contested trial, conviction for murder, unsuccessful appeal and later presidential pardon of Sauvage thrust the French law of self-defence into the spotlight. The Sauvage case raises important questions surrounding the adequacy of the French criminal law in this area, the ongoing (...) proliferation of gendered stereotypes in law and the need for reform. In the wake of the Sauvage case, this article provides a timely analysis of the gendered law of self-defence in France. Drawing from an in-depth analysis of the judgments imposed in the Sauvage case, this article examines the adequacy of French legal responses to battered women who kill and ignites an argument for further law reform. (shrink)

Wayne D. Christensen and Cliff A. Hooker.

Anne-Marie Søndergaard Christensen presents a new account of the role of moral philosophy and its relationship to our ordinary moral lives. She challenges the idea that moral theories have an authoritative explanatory or action-guiding role, and develops instead a descriptive, pluralistic, and elucidatory conception of moral philosophy.

The amount of data available to healthcare practitioners is growing, and the rapid increase in available patient data is becoming a problem for healthcare practitioners, as they are often unable to fully survey and process the data relevant for the treatment or care of a patient. Consequently, there are currently several efforts to develop systems that can aid healthcare practitioners with reading and processing patient data and, in this way, provide them with a better foundation for decision-making about the treatment (...) and care of patients. There are also efforts to develop algorithms that provide suggestions for such decisions. However, the development of these systems and algorithms raises several concerns related to the privacy of patients, the patient–practitioner relationship, and the autonomy of healthcare practitioners. The aim of this article is to provide a foundation for understanding the ethical challenges related to the development of a specific form of data-processing systems, namely clinical algorithms. (shrink)

‘Intersectionality’ is one of the rare pieces of academic jargon to make it out of the university and into the mainstream. The message is clear and well-known: your feminism had better be intersectional. But what exactly does this mean? This paper is partly an exercise in conceptual clarification, distinguishing at least six distinct types of claim found across the literature on intersectionality, and digging further into the most philosophically complex of these claims—namely the metaphysical and explanatory. It’s also partly a (...) reply to Sara Bernstein, who argued recently that the best interpretation of the metaphysical claim is explanatory priority. We’ll argue that duly clarified, it’s far from obvious that feminism had better be intersectional. At the very least, it had better not be only intersectional. (shrink)

Both the nature and aim of human cognition are philosophically divisive topics. On one side, there are the evidentialists who believe that the sole purpose of cognition is to seek and find truths. In contrast, pragmatists appeal to cognition solely as a tool, something that helps people achieve their goals. In this paper, I put forward an account of cognition and its aims fundamentally based on a pragmatic viewpoint.Crucially, however, I claim that an evolutionary pragmatic picture of cognition must assert (...) rationality as a core tenant of human thought, mooring a relative pragmatism within a system logic and rationality. (shrink)

Debate continues to rage among philosophers of religion over Anthony Flew's famous little paper ‘Theology and Falsification’ and the responses it provoked, most notably R. M. Hare's response that religious claims are in no way like scientific hypotheses. For now, twenty years later, we still find many theists taking a similar tack to Hare's. A particularly interesting example is J. F. Miller in Religious Studies, 1969, who replies to Flew that propositions like ‘God loves mankind’ cannot be subject to falsifiability (...) conditions because they are used as claims expressing ‘religious first-order principles of the Judaeo-Christian Weltanschauung and as such are not amenable to falsification’ (p. 50). Miller seems to put his faith in some kind of great gulf fixed between what he would consider decently falsifiable scientific hypotheses and what he takes to be unfalsifiable first-order principles both of theology and of contemporary science. In what follows we will try to sketch a more rational strategy for modern believers of a liberal empiricist type, for those whose interest in appealing and deferring to experience includes but is not restricted to so-called ‘sense experience’. This will involve accepting analogies between theological statements and so-called hypotheses, insofar as the latter are propositions held and put forward in a somewhat tentative spirit with a view to explaining what we experience. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning access (...) to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

Doing research with young children can be challenging for many reasons, but this book provides clear guidance on how to engage in appropriate methods. Focusing on researching through play, careful consideration is given to: · the founding principles of playful research · understanding young children's perspectives · prioritising the rights of the child and the voice of the child · examples of innovative research methods Real life examples and research projects are presented, to enable common challenges to be anticipated and (...) to showcase successful creative approaches, and to inspire new paths in research. (shrink)

Effective robots and autonomous systems must be trustworthy. This chapter examines models of trustworthiness from a philosophical and empirical perspective to inform the design and adoption of autonomous systems. Trustworthiness is a property of trusted agents or organisations that engenders trust in other agent or organisations. Trust is a complex phenomena defined differently depending on the discipline. This chapter aims to bring different approaches under a single framework for investigation with three sorts of questions: Who or what is trustworthy?–metaphysics. How (...) do we know who or what is trustworthy?–epistemology. What factors influence what or who should we trust?–normativity. A two-component model of trust is used that incorporates competence (skills, reliability and experience) and integrity (motives, honesty and character). It is supposed that human levels of competence yield the highest trust whereas trust is reduced at sub-human and super-human levels. The threshold for trustworthiness of an agent or organisation in a particular context is a function of their relationship with the truster and potential impacts of decisions. Building trustworthy autonomous systems requires obeying the norms of logic, rationality and ethics under pragmatic constraints–even though there is disagreement on these principles by experts. Autonomous systems may need sophisticated social identities including empathy and reputational concerns to build human-like trust relationships. Ultimately transdisciplinary research drawing on metaphysical, epistemological and normative human and machine theories of trust are needed to design trustworthy autonomous systems for adoption. (shrink)

Corporate sustainability is an important strategy and value orientation for marketing, but scarce research addresses the organizational drivers and barriers to including it in companies’ marketing strategies and processes. The purpose of this study is to determine levels of commitment to corporate sustainability in marketing, processes associated with sustainability marketing commitment, drivers of sustainability marketing at the functional level of marketing, and its organizational context. Using survey data from 269 managers in marketing, covering a broad range of industries in Sweden (...) and Denmark, we took a structural modelling approach to examine construct relationships, mediation, and moderation effects. Overall, the findings show that marketing capabilities associated with the innovation of new products, services, and business models constitute a strong driver to leverage sustainability marketing commitment. In conjunction with insights into processes related to the enactment of sustainability marketing, this result indicates that companies’ marketing departments have a propensity to drive corporate sustainability. The study provides substance to the idea of aligning substantive marketing capabilities closer to dynamic capabilities. Accordingly, the study reveals that reliance on market orientation alone does not lead to greater sustainability commitment. (shrink)

Ancient Stoics repeatedly stressed the monolithic unity of their philosophy. In this ground breaking "essay" Johnny Christensen takes their claim at face value: "It is a presupposition of the present essay that Stoic philosophy is a coherent and consistent system of thought", he says, and "The Stoic Philosopher is a man caught by the quest for unity. If this life is to make sense, all of it must be taken into account and somehow justified. Therefore Reality must be rational, (...) not random, and organically one". In four concise sections, Christensen lays out the core ideas of Stoicism and their interconnection, never losing himself in details. The exposition is philosophically penetrating and lucid at the same time. Originally published in 1962, when it was far too modern for its time, this small but exceedingly generous study constitutes the most holistic grasp of Stoicism to date. Offering a deep appreciation of, and insightful meditation on, Stoicism, this study is required reading for anyone interested in the history of philosophy. (shrink)

Since 1970 the United Kingdom, like the United States, has developed a “winner-take-all” political economy characterized by widening inequality and spectacular income growth at the top of the distribution. However, Britain’s centralized executive branch and relatively insulated policymaking process are less amenable to the kind of “organized combat” that Hacker and Pierson describe for the United States. Britain’s winner-take-all politics is better explained by the rise of political ideas favoring unfettered markets that, over time, produce a self-perpetuating structural advantage for (...) the richest. That advantage is, in turn, justified and sustained by reference to the same ideas. Inequality growth in the United Kingdom has been primarily driven by the financialization of the economy that began under the Thatcher government and continued under New Labour. The survival of pro-finance policies through the financial crisis provides further evidence that lobbying by a weakened City of London was less decisive in shaping policy than the financial sector’s continuing structural advantage and the tenacity of its supporting political consensus. (shrink)

Webber, Ruth; Jones, Kate This paper is about how three Catholic agencies carved out and adapted over time a role for themselves in assisting in the recovery after the Victorian bushfires of 2009. It tracks the process from the time the Archbishop of Melbourne commissioned Catholic Social Services Victoria to survey the bushfire affected areas and work out where there were gaps in services that the Catholic agencies could fill. A significant amount of funding was allocated to the provision (...) of services by Catholic agencies for a period of up to three years in the bushfire affected regions. This was seen as a Catholic response to an extraordinary natural disaster. This was organisationally difficult because there are in excess of sixty Catholic welfare services in Victoria and it was necessary to determine who would be best able to meet the gaps and deliver appropriate services.1 It was clear that the aim was not to replicate or compete with existing services, it was to meet real needs and to do this in a cooperative and collegial way with existing players. (shrink)

Causation has multiple distinct meanings in genetics. One reason for this is meaning slippage between two concepts of the gene: Mendelian and molecular. Another reason is that a variety of genetic methods address different kinds of causal relationships. Some genetic studies address causes of traits in individuals, which can only be assessed when single genes follow predictable inheritance patterns that reliably cause a trait. A second sense concerns the causes of trait differences within a population. Whereas some single genes can (...) be said to cause population-level differences, most often these claims concern the effects of many genes. Polygenic traits can be understood using heritability estimates, which estimate the relative influences of genetic and environmental differences to trait differences within a population. Attempts to understand the molecular mechanisms underlying polygenic traits have been developed, although causal inference based on these results remains controversial. Genetic variation has also recently been leveraged as a randomizing factor to identify environmental causes of trait differences. This technique—Mendelian randomization—offers some solutions to traditional epidemiological challenges, although it is limited to the study of environments with known genetic influences. (shrink)

The manufacturing industry faces a trend in which employees’ work processes are being redesigned into simple, repetitive tasks that maximize performance and efficiency. This neo-Tayloristic business model reduces social interactions and stifles relationship building, leading to disgruntled employees and raising questions about leaders’ moral obligation as to the mechanisms they use to enhance employees’ performance at work. As an alternative to redesigning work processes, we contend that servant leaders can enhance employees’ overall performance by cultivating positive interpersonal dynamics at work (...) where social connectedness flourishes. Integrating insights from self-determination theory with servant leadership’s moral foundations, we investigate the degree to which servant leadership fosters two elements of a relationally supportive social context, interactional justice climate and coworker support, that facilitate its influence on followers’ intrinsic motivation and, subsequently, their voice and in-role performance. Temporally-separated data collected from a sample of 296 employees and their supervisors situated in 44 teams yielded results that support our hypotheses. Results underscore the importance of servant leadership cultivating a positive relational context to increase employees’ intrinsic motivation and improve their behaviors at work. (shrink)

The editors discuss issues related to the journal, its editing process and publication model.