Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within (...) the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

Exploring the idea of knowledge as embodied, engendered and embedded in place and space, gender and sexuality are re-examined through the methodological and conceptual lenses of cartography, fieldwork, resistance, transgression and the divisions between local/global and public/private space. BodySpace brings together some of the best known geographers writing on gender and sexuality today to explore the role of space and place in the performance of gender and sexuality. The book takes a broad perspective on feminism as a theoretical critique, and (...) aims to reassess notions of sexuality, citizenship, work, violence, "race" and disability in their geographical contexts. (shrink)

_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

The Making of British Bioethics provides the first in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It details how British bioethics emerged thanks to a dynamic interplay between sociopolitical concerns and the aims of specific professional groups and individuals who helped create the demand for outside involvement and transformed themselves into influential 'ethics experts'. Highlighting this interplay helps (...) us appreciate how issues such as embryo research and assisted dying became high-profile 'bioethical' concerns in the late twentieth century, and why different groups now play a critical role in developing regulatory standards and leading public debates. The book draws on a wide range of original sources and will be of interest to historians of medicine and science, general historians and bioethicists. (shrink)

Ever since David Hume, empiricists have barred powers and capacities from nature. In this book Cartwright argues that capacities are essential in our scientific world, and, contrary to empiricist orthodoxy, that they can meet sufficiently strict demands for testability. Econometrics is one discipline where probabilities are used to measure causal capacities, and the technology of modern physics provides several examples of testing capacities (such as lasers). Cartwright concludes by applying the lessons of the book about capacities and probabilities to the (...) explanation of the role of causality in quantum mechanics. (shrink)

This is a study of Hume's political thought based on a survey of all his writings in their original and revised versions, with very full reference to the works of predecessors and contemporaries, including journalists, pamphleteers and historians. Hume's political thinking is presented in its historical context as a modem, 'philosophical', empirically based system of politics for a new post-revolutionary age, and a political education for parochial, backward-looking party men.

(No abstract is available for this citation).

Liberalism is a term employed in a dizzying variety of ways in political thought and social science. This essay challenges how the liberal tradition is typically understood. I start by delineating different types of response—prescriptive, comprehensive, explanatory—that are frequently conflated in answering the question “what is liberalism?” I then discuss assorted methodological strategies employed in the existing literature: after rejecting “stipulative” and “canonical” approaches, I outline a contextualist alternative. Liberalism, on this account, is best characterised as the sum of the (...) arguments that have been classified as liberal, and recognised as such by other self-proclaimed liberals, over time and space. In the remainder of the article, I present an historical analysis of shifts in the meaning of liberalism in Anglo-American political thought between 1850 and 1950, focusing in particular on how Locke came to be characterised as a liberal. I argue that the scope of the liberal traditionexpanded during the middle decades of the twentieth century, such that it came to be seen by many as the constitutive ideology of the West. This capacious understanding of liberalism was a product of the ideological wars fought against “totalitarianism” and assorted developments in the social sciences. Today we both inherit and inhabit it. (shrink)

The status of boundaries and borders, questions of global poverty and inequality, criteria for the legitimate uses of force, the value of international law, human rights, nationality, sovereignty, migration, territory, and citizenship: debates over these critical issues are central to contemporary understandings of world politics. Bringing together an interdisciplinary range of contributors, including historians, political theorists, lawyers, and international relations scholars, this is the first volume of its kind to explore the racial and imperial dimensions of normative debates over global (...) justice. (shrink)

A common criticism of the use of algorithms in criminal justice is that algorithms and their determinations are in some sense ‘opaque’—that is, difficult or impossible to understand, whether because of their complexity or because of intellectual property protections. Scholars have noted some key problems with opacity, including that opacity can mask unfair treatment and threaten public accountability. In this paper, we explore a different but related concern with algorithmic opacity, which centers on the role of public trust in grounding (...) the legitimacy of criminal justice institutions. We argue that algorithmic opacity threatens the trustworthiness of criminal justice institutions, which in turn threatens their legitimacy. We first offer an account of institutional trustworthiness before showing how opacity threatens to undermine an institution’s trustworthiness. We then explore how threats to trustworthiness affect institutional legitimacy. Finally, we offer some policy recommendations to mitigate the threat to trustworthiness posed by the opacity problem. (shrink)

(No abstract is available for this citation).

A powerful argument against the counterfactual comparative account of harm is that it cannot distinguish harming from failing to benefit. In reply to this problem, I suggest a new account of harm. The account is a counterfactual comparative one, but it counts as harms only those events that make a person occupy his level of well-being at the world at which the event occurs. This account distinguishes harming from failing to benefit in a way that accommodates our intuitions about the (...) standard problem cases. In laying the groundwork for this account, I also demonstrate that rival accounts of harm are able to distinguish harming from failing to benefit only if, and because, they also appeal to the distinction between making upshots happen and allowing upshots to happen. One important implication of my discussion is that preserving the moral asymmetry between harming and failing to benefit requires a commitment to the existence of a metaphysical and moral distinction between making and allowing. (shrink)

This paper defends Flatland—the view that there exist neither determination nor dependence relations, and that everything is therefore fundamental—from the objection from explanatory inefficacy. According to that objection, Flatland is unattractive because it is unable to explain either the appearance as of there being determination relations, or the appearance as of there being dependence relations. We show how the Flatlander can meet the first challenge by offering four strategies—reducing, eliminating, untangling and omnizing—which, jointly, explain the appearance as of there being (...) determination relations where no such relations obtain. Since, plausibly, dependence relations just are asymmetric determination relations, we argue that once we come mistakenly to believe that there exist determination relations, the existence of other asymmetries (conceptual and temporal) explains why it appears that there are dependence relations. (shrink)

How do novel scientific concepts arise? In Creating Scientific Concepts, Nancy Nersessian seeks to answer this central but virtually unasked question in the problem of conceptual change. She argues that the popular image of novel concepts and profound insight bursting forth in a blinding flash of inspiration is mistaken. Instead, novel concepts are shown to arise out of the interplay of three factors: an attempt to solve specific problems; the use of conceptual, analytical, and material resources provided by the (...) cognitive-social-cultural context of the problem; and dynamic processes of reasoning that extend ordinary cognition. Focusing on the third factor, Nersessian draws on cognitive science research and historical accounts of scientific practices to show how scientific and ordinary cognition lie on a continuum, and how problem-solving practices in one illuminate practices in the other. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

The paper focuses on an employee’s perception of his or her own labour market outcome. It proposes that the basic earnings function, by adopting an approach that ignores perception effects, is likely to result in biased results that will fail to understand the complexities of the wage distribution. The paper uses an orthodox job search framework to illustrate the nature of this problem and then adapts the model to take onboard the theory of cognitive dissonance. The search model indicates how (...) workers may adopt a coping strategy in order to reduce the disutility associated with the wage underpayment that develops. Then, by modelling cognitive dissonance, the paper highlights the weaknesses of using purely human capital proxies to understand labour market outcome. The analysis goes some way to explaining why individuals with equivalent human capital investment can have disparate earnings profiles. (shrink)

In this article I pursue two main lines of argument. First, I seek to delineate two distinctive modes of justifying imperialism found in nineteenth-century political thought (and beyond). The 'liberal civilizational'li model, articulated most prominently by John Stuart Mill, justified empire primarily in terms of the benefits that it brought to subject populations. Its proponents sought to 'civilize'lthe 'barbarian'. An alternative `republican' model focused instead on the benefits - glory, honour and power above all - that accrued to the imperial (...) state. Less concerned with spreading civilization, its proponents concentrated on fortifying the imperial polity. Second, I offer a 'republican' interpretation of the writings of the historian and public moralist J.A. Froude (1818-94), arguing that he both diagnosed the problems of modern Britain and prescribed imperial solutions to those problems, based on his reading of the fate of the Roman republic. (shrink)

The volume brings together for the first time original essays by leading philosophers working on powers in relation to metaphysics, philosophy of natural and social science, philosophy of mind and action, epistemology, ethics and social and political philosophy. In each area, the concern is to show how a commitment to real causal powers affects discussion at the level in question. In metaphysics, for example, realism about powers is now recognized as providing an alternative to orthodox accounts of causation, modality, properties (...) and laws. Dispositional realist philosophers of science, meanwhile, argue that a powers ontology allows for a proper account of the nature of scientific explanation. In the philosophy of mind there is the suggestion that agency is best understood in terms of the distinctive powers of human beings. Those who take virtue theoretic approaches in epistemology and ethics have long been interested in the powers that allow for knowledge and/or moral excellence. In social and political philosophy, finally, powers theorists are interested in the powers of sociological phenomena such as collectivities, institutions, roles and/or social relations, but also in the conditions of possibility for the cultivation of the powers of individuals. The book will be of interest to philosophers working in any of these areas, as well as to historians of philosophy, political theorists and critical realists. (shrink)

In his final original book, Battling to the End, Girard could hardly have been clearer: "Violence" he wrote, "can no longer be checked. From this point of view we can say that the apocalypse has begun."1Faced with the rise of global Islamist terror and the declaration of a "war against terror," Girard observed the collapse of politics as a mechanism to contain violence. History is not inevitably and dialectically converging on a rational Hegelian Aufhebung but has the pattern of a (...) duel, as observed by the Prussian military theorist Carl von Clausewitz after the defeat of the Prussian army by Napoleon's revolutionary French army at Jena. Far from converging on reconciliation, the logic of mimetic rivalry predicts... (shrink)

This article examines the design and situated employment of reported `private thoughts' in both everyday and institutional interaction. By reported `private thoughts' we mean the `active voicing' of utterances characterized as `private thought' done in the first place for the speaker-feeler, rather than the listener. Examples are drawn from a large UK collection of over 240 instances from domestic telephone calls, interview talk, therapy sessions, and patient—provider interactions. Instead of treating reported `private thoughts' as neutral and transparent descriptions of the (...) inner mind, we focus on their `brought off ' nature. Drawing on the cumulative resources of conversation analysis and discursive psychology, we focus on lexical and non-lexical features of their design and its similarity to direct reported speech. We go on to illustrate the flexibilities of positioning reporting `private thoughts' affords, that is, how they can be done for the self as a `one-off ', as generalized or hypothetical and how they can be done for others. Our analyses draw attention to how `private thoughts' might be considered as a speaker's resource for handling everyday rational accountability in reporting and explaining actions and events. (shrink)

Adam's vision -- Gloomy science -- The severest critic -- On the margins -- Voices in the air -- Grand illusions.

One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Practicing healthcare ethicists in the performance of their role must navigate meanings, choices, decisions and actions embedded in complex cultural and social relationships amongst diverse individuals. In light of the evolving state of modern healthcare ethics practice and the recent move toward professionalization via certification, understanding boundary navigation in healthcare ethics practice is critical. Because healthcare ethics is endowed with many boundaries which often delineate concerns about (...) professional expertise and authority, epistemological reflection on the relationship between theory and practice points toward the social context as relevant to the conceptualization of boundaries. The skills of social scientists may prove helpful to provide data and insights into the conceptualization and navigation of clinical ethics qua profession. Empirical ethics research, which combines empirical description (usually social scientific) with normative-ethical analysis and reflection, is a way forward as we engage and reflect upon issues which have implications for practice standards and professionalization of the role. This requires cooperative engagement of the descriptive and normative disciplines to explore our understandings of boundaries in healthcare ethics practice. This will contribute to the ongoing reflection not only as we envision the professional role but to ensure that it is enacted in practice. (shrink)

Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.

The question as to the relation of the Socrates of the Platonic dialogues to the historical Socrates, over which an apparently endless and irreconcilable controversy has raged, is well raised by a passage from Cornford, Plato’s Theory of Knowledge , at page 28: “Anamnesis appears first in the middle group of dialogues and provides the link between the two Platonic doctrines—the eternal nature of the human soul and the ‘separate’ existence of Forms, the proper objects of knowledge. The probable inference (...) is that Anamnesis was a theory which squared the professions and practice of Socrates with Plato’s discovery of the separately existing Forms and his conversion from Socratic agnosticism to a belief in immortality.”. (shrink)

How the new conspiracists are undermining democracy—and what can be done about it Conspiracy theories are as old as politics. But conspiracists today have introduced something new—conspiracy without theory. And the new conspiracism has moved from the fringes to the heart of government with the election of Donald Trump. In A Lot of People Are Saying, Russell Muirhead and Nancy Rosenblum show how the new conspiracism differs from classic conspiracy theory, how it undermines democracy, and what needs to be (...) done to resist it. (shrink)

Most traditional accounts of Aristotle's theory of ethical education neglect its cognitive aspects. This book asserts that, in Aristotle's view, excellence of character comprises both the sentiments and practical reason. Sherman focuses particularly on four aspects of practical reason as they relate to character: moral perception, choicemaking, collaboration, and the development of those capacities in moral education. Throughout the book, she is sensitive to contemporary moral debates, and indicates the extent to which Aristotle's account of practical reason provides an alternative (...) to theories of impartial reason. (shrink)

Discussing authorial power, landscape metaphor and the notions of community and sense of place, this explores the ways in which spatial and cultural analysis have found much common ground in making sense of ourselves and the landscape we inhabit.

This article proposes a reading of the lives of teachers through a Deleuzian-Guattarian materialistic approach. By asking the question ‘what kind of life do teachers live?’ this article reminds us that teachers sometimes welcome the imposed policies, procedures and programmes, the consequences of which remove them from students. This desire is compared to another desire—the desire for children. Teachers are seen as machines rather than singular organisms, so that what helps a teacher in her becoming are her connections to students. (...) Activities are seen in terms of intensities and flows, rather than as actions which crystallise such flows. Roald Dahl's story of Matilda is used as a fictional example of the above. (shrink)

The notion of an extended simple region (henceforth ESR) has recently been marshalled in the service of arguments for a variety of conclusions. Exactly how to understand the idea of extendedness as it applies to simple regions, however, has been largely ignored, or, perhaps better, assumed. In this paper we first (§1) outline what we take to be the standard way that philosophers are thinking about extendedness, namely as an intrinsic property of regions. We then introduce an alternative picture (§2), (...) according to which extendedness is extrinsic. In §3 we argue that it matters which way of thinking about extendedness is the right one, since how ESRs behave is sensitive to what extendedness consists in, and various arguments that appeal to ESRs turn out to be unsound if extendedness is extrinsic rather than intrinsic. (shrink)

This article engages in debates about the potential for aesthetics to be a positive, ethical, and moral frame for relating to the environment. Human‐environment relations are increasingly tied up with aesthetics. We problematize this trend by contending that aesthetics is an insufficient paradigm to motivate and shape environmentalism because it exceptionalizes some landscapes while devaluing others. This article uses four illustrative case studies to complicate aesthetic environmentalist frames. These case studies indicate that even when positive aesthetic qualities are deployed in (...) environmentalist advocacy, their usefulness is mitigated by a range of factors including: sensationalization, obfuscation, and further degradation. (shrink)

In this article, I explore recent work on realist political theory and international politics. I discuss how scholarship on the topic emanates from two different fields—International Relations and political philosophy—and argue that there is a good case for greater engagement between them. I open by delineating various kinds of realism, showing that the term covers a wide variety of methodological and political approaches. In particular, I suggest, it is important to recognize the difference between liberal and radical approaches. The remainder (...) of the essay examines assorted examples of realist international political theorizing, work that ranges from attempts to rewrite the canon of 20th century political thought to contributions to the vibrant global justice debates. (shrink)

I introduce the topic of this special issue of Synthese, and give an overview of the articles collected here.

How the new conspiracists are undermining democracy—and what can be done about it Conspiracy theories are as old as politics. But conspiracists today have introduced something new—conspiracy without theory. And the new conspiracism has moved from the fringes to the heart of government with the election of Donald Trump. In A Lot of People Are Saying, Russell Muirhead and Nancy Rosenblum show how the new conspiracism differs from classic conspiracy theory, why so few officials speak truth to conspiracy, and (...) what needs to be done to resist it. Classic conspiracy theory insists that things are not what they seem and gathers evidence—especially facts ominously withheld by official sources—to tease out secret machinations. The new conspiracism is different. There is no demand for evidence, no dots revealed to form a pattern, no close examination of shadowy plotters. Dispensing with the burden of explanation, the new conspiracism imposes its own reality through repetition and bare assertion. The new conspiracism targets democratic foundations—political parties and knowledge-producing institutions. It makes it more difficult to argue, persuade, negotiate, compromise, and even to disagree. Ultimately, it delegitimates democracy. Filled with vivid examples, A Lot of People Are Saying diagnoses a defining and disorienting feature of today's politics and offers a guide to responding to the threat. (shrink)