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)

The author introduces two key issues of the Ebola epidemic very clearly. However, the author could elaborate further on the objections to using experimental drugs. The author does a very good job of enumerating the reasons for using these drugs. In terms of reasons against using the drugs, the author only writes that there are regulations in place that are usually followed. Several supporting facts are given to suggest different regulations should be put in place for a crisis like Ebola. (...) Ebola is a deadly disease with no cure. At present, all we have are these experimental drugs. Ordinarily, such drugs would not be given without extensive testing. However, in this case, there is no time for that to be done. People who contract Ebola have no other alternatives, so an unapproved experimental treatment is better than nothing at all. It is important to weigh the risks and benefits. Some may argue that the risks of using an experimental drug may be too great and that we should wait to administer any experimental drug until it has been proven safe. We do not know what the long-term side effects may be. While that argument may be appropriate for other situations, in the case of Ebola epidemic, I do not think it applies. As I have said, and as the author has said, there is no cure or other treatment available for Ebola. People who contract it will likely die of the disease and these experimental treatments are their only option. In this case, the benefits outweigh the risks. As the author mentions, access to these drugs is very problematic. However, they do not elaborate enough on both sides of the issue. There are reasons supporting and reasons against giving health care workers experimental treatments first and I think including them would have added to the depth of the argument presented here. (shrink)

On October 29, 2013, Texas House Bill 2 went into effect, greatly changing women’s access to an abortion in the state. This bill requires that physicians performing clinic-based abortions obtain admitting privileges at a hospital within 30 miles of the clinic. A few months later, on January 1, 2014, the Texas Health and Safety Code was amended to include the requirement that all abortion clinics must meet the standards of an ambulatory surgical centre. These requirements will result in heavy burdens (...) for women seeking an abortion. Many clinics cannot afford the upgrade and are being forced to close down. On August 29, 2014, a Federal District Court for the Western District of Texas ruling to overturned the two proposed requirements. The court deemed them unconstitutional violations of a woman’s right to obtain an abortion recognizing that their purpose was to create obstacles for women. The ruling was appealed and the Federal Appeals Court allowed for the new regulations, forcing all but eight clinics in Texas to close their doors. Before the enactment of HB2, there were approximately 40 abortion clinics serving Texas’ population of about 26 million. The new regulations would force all except eight clinics to close down. The remaining clinics are located in four cities forcing many women to travel hundreds of miles to access them. For some, it is more feasible to leave Texas to go to an abortion clinic outside the state. Even if every woman seeking an abortion was able to travel to one of the remaining clinics, the clinics could not meet the demand. Both of these requirements, the ambulatory surgical requirement and the admitting privileges requirement, constitute an undue burden for women. But what about the physicians? These requirements also place an undue burden on physicians who want to perform abortions. For affected physicians, it is difficult or impossible to obtain admitting privileges at a nearby hospital. Many hospitals are denying these privileges to physicians because the hospitals have no interest in participating in performing abortions and gain nothing by allowing it. If the majority of abortion clinics are forced to close down, physicians who want to perform abortions would have to relocate to one of the four cities mentioned previously, or even leave the state. Women seeking an abortion have to travel to the clinic once or twice. Physicians would have to relocate permanently. Much of the focus of these rulings has been on women’s rights and what constitutes an undue burden for women. In addition to this, physician’s rights should also be considered. There have been several cases of doctors facing harassment and even death threats for performing abortions. Fear of such treatment has led to many doctors to decline to perform abortions. Doctors do not have an obligation to perform abortions but it is within their rights as physicians to do so. However, given this harsh treatment by anti-abortion groups, not a lot of doctors are willing. The new regulations will leave open clinics in four cities in Texas making it more difficult for those few doctors who want to perform abortions to do so. The new regulations impose undue burdens on women and doctors alike. On Tuesday, October 14, the Supreme Court struck down the new requirements allowing thirteen clinics in Texas to reopen. (shrink)

Proclaimed the “greenest television programme in the world,” the award-winning soap opera Coronation Street is seen as an industry success story. This paper explores how the integration of carbon literacy training led to a widespread transformational change of practice within Coronation Street. Using the theoretical lens of Communities of Practice, this study examines the nature of social learning and the enablers and barriers to change within the organization. Specifically, how boundary spanning practices, objects and people led to the transformation on (...) both a personal and group level. Based on a qualitative analysis of 22 interviews with Heads of Departments and other staff, the paper argues that CLT is a boundary practice which has evolved into a boundary spanning CoP. The importance of infrastructures supporting boundary objects and practices is highlighted as reinforcers of the CLT, both as a boundary object and a community, with the “ultimate” boundary spanning object being the show. A significant enabler in social learning and change in practice is the creation of discursive and creative space, both within CoP and across the boundaries. Findings also highlight the role of “self” in the process of social learning and organizational change. Distinct patterns emerged in the relationship between self-identity, social learning and change across a range of boundary objects, practices and communities both in the CLT and CoP. This suggests that in a diverse social learning setting such as CLT there are different transformational catalysts within the CoP and these identities can influence how knowledge is translated into practice. (shrink)

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other (...) key informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

Kopeikin (forthcoming a, forthcoming b) and Rachels’ (1975) bare-difference cases elicit the intuition that killing is no different than letting die. Hill’s (2018) bare-difference cases elicit the intuition that killing is worse than letting die. At least one of the intuitions must be mistaken. This calls for an error theory. Hill has an error theory for the intuition elicited by the Kopeikin/Rachels’ cases. Kopeikin and Rachels have an error theory for the intuition elicited by Hill’s cases. A (...) natural thought is that we are at an impasse. There is no plausible basis for preferring one error theory to the other. I argue that this natural thought is mistaken. Not all error theories are equal. Preliminary considerations favor Hill’s error theory and disfavor the Kopeikin/Rachels error theory. But preliminary considerations are not decisive. The way forward in the bare-difference debate is not to evaluate intuitions. The intuitions are in. What is left to do now is evaluate the comparative status of the Hill and the Kopeikin/Rachels error theories. (shrink)

Este livro inclui as palestras apresentadas no XIII Congresso Internacional de Estética, ocorrido em Belo Horizonte em outubro de 2017, cujo título, “Os fins da arte”, explora o duplo sentido do termo “fim” que, polissêmico, indica término, conclusão e epílogo, assim como o propósito, a meta, o objetivo, a motivação, e ainda o limite e a decadência. O uso plural desse termo amplifica, ainda, suas possibilidades de interpretação. Os textos deste livro mostram de modo evidente o quanto a questão do (...) “fim” contribui de maneira estratégica para pensar a arte durante o último século e o início deste. O livro conta com textos dos filósofos e filósofas da arte Márcia Ferreira Gonçalves, Gunter Gebauer, Rosa Gabriella Gonçalves, Giorgia Cecchinato, Alessandro Bertinetto, Cliff Hill Kormann, Rodrigo Duarte, Rita Velloso e do filósofo francês David Lapoujade, um dos principais nomes da filosofia na atualidade. (shrink)

ABSTRACT Hill [AJP, 2018] argues that Rachels’s famous bare-difference argument for the moral irrelevance between killing and letting die fails. In this paper, I argue that certain features in Hill’s cases might lead our intuitions astray. I propose new cases and suggest that they support the conclusion that, in itself, intentional killing is morally equivalent to intentional letting-die.

ABSTRACT Hill [AJP, 2018] argues that Rachels’s famous bare-difference argument for the moral irrelevance between killing and letting die fails. In this paper, I argue that certain features in Hill’s cases might lead our intuitions astray. I propose new cases and suggest that they support the conclusion that, in itself, intentional killing is morally equivalent to intentional letting-die.

This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have (...) been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems. (shrink)

Identity Economics provides an important and compelling new way to understand human behavior, revealing how our identities--and not just economic incentives--influence our decisions. In 1995, economist Rachel Kranton wrote future Nobel Prize-winner George Akerlof a letter insisting that his most recent paper was wrong. Identity, she argued, was the missing element that would help to explain why people--facing the same economic circumstances--would make different choices. This was the beginning of a fourteen-year collaboration--and of Identity Economics. The authors explain how (...) our conception of who we are and who we want to be may shape our economic lives more than any other factor, affecting how hard we work, and how we learn, spend, and save. Identity economics is a new way to understand people's decisions--at work, at school, and at home. With it, we can better appreciate why incentives like stock options work or don't; why some schools succeed and others don't; why some cities and towns don't invest in their futures--and much, much more. Identity Economics bridges a critical gap in the social sciences. It brings identity and norms to economics. People's notions of what is proper, and what is forbidden, and for whom, are fundamental to how hard they work, and how they learn, spend, and save. Thus people's identity--their conception of who they are, and of who they choose to be--may be the most important factor affecting their economic lives. And the limits placed by society on people's identity can also be crucial determinants of their economic well-being. (shrink)

Can we feel emotions about abstract objects, assuming that abstract objects exist? I argue that at least some emotions can have abstract objects as their intentional objects and discuss why this conclusion is not just trivially true. Through critical engagement with the work of Dacher Keltner and Jonathan Haidt, I devote special attention to awe, an emotion that is particularly well suited to show that some emotions can be about either concrete or abstract objects. In responding to a possible objection, (...) according to which we can only feel emotions about things that we take to matter to our flourishing, and thus cannot feel emotions about causally inefficacious abstract objects, I explore how abstract objects can be relevant to human flourishing and discuss someemotions other than awe that can be about abstract objects. I finish by explaining somereasons why my conclusion matters, including the fact that it presents a challenge to perceptual theories of emotion and causal theories of intentionality. (shrink)

Identity Economics provides an important and compelling new way to understand human behavior, revealing how our identities--and not just economic incentives--influence our decisions. In 1995, economist Rachel Kranton wrote future Nobel Prize-winner George Akerlof a letter insisting that his most recent paper was wrong. Identity, she argued, was the missing element that would help to explain why people--facing the same economic circumstances--would make different choices. This was the beginning of a fourteen-year collaboration--and of Identity Economics. The authors explain how (...) our conception of who we are and who we want to be may shape our economic lives more than any other factor, affecting how hard we work, and how we learn, spend, and save. Identity economics is a new way to understand people's decisions--at work, at school, and at home. With it, we can better appreciate why incentives like stock options work or don't; why some schools succeed and others don't; why some cities and towns don't invest in their futures--and much, much more. Identity Economics bridges a critical gap in the social sciences. It brings identity and norms to economics. People's notions of what is proper, and what is forbidden, and for whom, are fundamental to how hard they work, and how they learn, spend, and save. Thus people's identity--their conception of who they are, and of who they choose to be--may be the most important factor affecting their economic lives. And the limits placed by society on people's identity can also be crucial determinants of their economic well-being. (shrink)

This special issue is the result of concerns about the marginalized status of gender within the sociology of religion. The collection of exciting new research in this special issue advocates for the importance of a gender lens on questions of religion in order to highlight issues, practices, peoples, and theories that would otherwise not be central to the discipline. We encourage sociologists who study religion to engage more in interdisciplinary and intersectional scholarship, acknowledge developments in the global South, and develop (...) more compelling theoretical frameworks that analyze religion from a gendered perspective. Our aim is to bring religion to the attention of gender and feminist scholars and to encourage religion scholars to consider gender not just as a variable but as a social structure. We hope that both groups of scholars will consider gender and religion as mutually constitutive social categories. (shrink)

After briefly reviewing some of the empirical and philosophical literature suggesting that there may be an adaptive role for delusion formation, we discuss the results of a recent study consisting of in-depth interviews with people experiencing delusions. We analyse three such cases in terms of the circumstances preceding the development of the delusion; the effects of the development of the delusion on the person’s situation; and the potential protective nature of the delusional belief as seen from the first-person perspective. We (...) argue that the development of the delusional belief can play a short-term protective function and we reflect on the implications that this might have for our understanding of psychotic symptoms, for the stigma associated with mental health issues, and for treatment options. (shrink)

A new reading of Plato's account of conventionalism about names in the Cratylus. It argues that Hermogenes' position, according to which a name is whatever anybody 'sets down' as one, does not have the counterintuitive consequences usually claimed. At the same time, Plato's treatment of conventionalism needs to be related to his treatment of formally similar positions in ethics and politics. Plato is committed to standards of objective natural correctness in all such areas, despite the problematic consequences which, as he (...) himself shows, arise in the case of language. (shrink)

A major goal of this work is to specify some steps of the process by which participants maintain coherency in their conversations.The underlying element of the analysis is a construct called a “context space.” Roughly, a group of utterances that refers to a single issue or episode forms the basis for a context space. Superficially, a conversation is a sequence of utterances; at a deeper level it is a structured entity whose utterances can be parsed into hierarchically related context spaces.As (...) a conversation proceeds, each conversant builds a discourse model that includes the conversation's context space structure, a notion of the present discourse topic, and a list of items being focused upon. Conversational coherency depends upon a lack of conflict between the respective models of the participants. Conflicts are prevented by speakers following high level syntactic and semantic relational rules that enable listeners to identify their discourse models. These rules, given in the study, are highly integrated with the view of conversation presented here—a hierarchy of related context spaces. (shrink)

Bioethics has entered a new era: as many commentators have noted, the familiar mantra of autonomy, beneficence, nonmaleficence, and justice has proven to be an overly simplistic framework for understanding problems that arise in modern medicine, particularly at the intersection of public policy and individual preferences. A tradition of liberal pluralism grounds respect for individual preferences and affirmation of competing conceptions of the good. But we struggle to maintain (or at times explicitly reject) this tradition in the face of individual (...) preferences that we find distasteful, suspect, or even repugnant, especially where the broader social good or respect for equality is at stake. Directed donation presents us with such a dilemma: can we uphold the right of self-determination through respect of individual preferences regarding disposition of transplantable organs while at the same time maintaining an allocation system that reflects values of equity and justice claimed to underlie the socially negotiated practice of transplantation? Or are some preferences simply to be deemed unethical and not respected, even if that leads to a reduction in the number of transplantable organs available and to an apparent disregard for the autonomous decisions of the recently deceased? (shrink)

Recent turmoil in the Middle East and North Africa has prompted renewed concerns about women’s rights in Muslim societies. It has also raised questions about women’s agency and activism in religious contexts. This article draws on ethnographic research with women activists in Indonesia, the country with the world’s largest Muslim population, to address such concerns. My fieldwork shows that some Muslim women activists in democratizing Indonesia manifest pious critical agency. Pious critical agency is the capacity to engage critically and publicly (...) with religious texts. While some scholars have argued that pious and feminist subjectivity are inherently at odds, the emergence of pious critical agency in Indonesia demonstrates that piety and feminism can intersect in surprising and unexpected ways. Moreover, it shows that women’s agency can draw on both secular and religious resources and that religion can be used to promote critical discourses on gender. (shrink)

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

By examining first-person descriptions of thought insertion I show that thought insertion is a complex and heterogeneous phenomenon. People experiencing this phenomenon have huge difficulty explaining what it is like due to the bizarre nature of the experience. Through careful analysis of first-person descriptions I identify some of the characteristics of thought insertion. I then briefly examine some of the philosophical literature regarding agency, ownership and thought insertion and conclude that the standard account of the basic characteristics of thought insertion (...) is inadequate when we consider the phenomenon as it is experienced. First person descriptions suggest that thought insertion is characterised by a lack of personal ownership and not simply by a loss of agency or authorship. This is an important factor that should inform research and therapeutic intervention. We cannot hope to arrive at appropriate therapeutic intervention or identify underlying neuronal mechanisms for the experience if we cannot say what the experience actually is. I further suggest that more analysis of first-person description is required for an improved account of the phenomenology of thought insertion. (shrink)

An assortment of different points of view on conspiracy thinking and conspiracy theories, pro and con.

Increasingly, Deaf activists claim that it can be good to be Deaf. Still, much of the hearing world remains unconvinced, and continues to think of deafness in negative terms. I examine this debate and argue that to determine whether it can be good to be deaf it is necessary to examine each claimed advantage or disadvantage of being deaf, and then to make an overall judgment regarding the net cost or benefit. On the basis of such a survey I conclude (...) that being deaf may plausibly be a good thing for some deaf people but not for others. (shrink)

This article describes a new prenatal genetic test that is painless, early, and increasingly available. State legislatures have reacted by prohibiting abortion for reason of fetal sex or of fetal diagnosis and managing genetic counseling. This article explores these legislative responses and considers how physicians and genetic counselors currently communicate post-testing options. The article then examines the challenges ahead for genetic counseling, particularly in light of the troubling grip of abortion politics on conversations about prenatal diagnosis.

Emotion regulation strategies may reduce the negative relationship between math anxiety and mathematics accuracy, but different strategies may differ in their effectiveness. We recorded electrodermal activity to examine the effect of physiological arousal on performance during different applied ER strategies. We explored how ER strategies might affect the decreases in accuracy attributed to physiological arousal in high math anxious individuals. Participants were instructed to use cognitive reappraisal, expressive suppression, or a “business as usual” strategy. During the ES condition, HMA individuals (...) showed decreases in math accuracy associated with increased EDA, compared to low math anxious individuals. For both HMA and LMA groups, CR reduced the association between physiological arousal and math accuracy, such that even elevated physiological arousal levels no longer had a negative association with math accuracy. These results show that CR provides a promising technique for ameliorating the negative relationship between math anxiety and math accuracy. (shrink)

Paradigmatically, natural kinds are the kinds of thing or stuff that are classified by the natural sciences. The periodic table provides perhaps the best example of the potential importance of natural kinds for science. In the philosophy of psychiatry, debates over whether mental disorders can be natural kinds emerge because kinds of mental disorder are manifestly different from chemical kinds in various ways. While chemical kinds are precise, psychiatric kinds are fuzzy. While chemical kinds are objective, the identification of psychiatric (...) kinds is value-laden. Psychiatric classification involves classifying people, and unlike chemical elements, those people can respond to being classified in various ways. This chapter goes through these differences, one-by-one, and argues that despite them, mental disorders may be natural kinds. (shrink)

Affirmative action programs remain controversial, I suspect, partly because the familiar arguments for and against them start from significantly different moral perspectives. Thus I want to step back for a while from the details of debate about particular programs and give attention to the moral viewpoints presupposed in differenttypesof argument. My aim, more specifically, is to compare the “messages” expressed when affirmative action is defended from different moral perspectives. Exclusively forward-looking (for example, utilitarian) arguments, I suggest, tend to express the (...) wrong message, but this is also true of exclusively backward-looking (for example, reparation-based) arguments. However, a moral outlook that focuses on cross-temporal narrative values (such as mutually respectful social relations) suggests a more appropriate account of what affirmative action should try to express. Assessment of the message, admittedly, is only one aspect of a complex issue, but it is a relatively neglected one. My discussion takes for granted some common-sense ideas about the communicative function of action, and so I begin with these.Actions, as the saying goes, oftenspeaklouder than words. There are times, too, when only actions can effectively communicate the message we want to convey and times when giving a message is a central part of the purpose of action. What our actions say to others depends largely, though not entirely, upon our avowed reasons for acting; and this is a matter for reflective decision, not something we discover later by looking back at what we did and its effects. The decision is important because “the same act” can have very different consequences, depending upon how we choose to justify it. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a framework of analysis. Cultural (...) theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

What would my life have been like if I had been born more intelligent? Or taller? Or a member of the opposite sex? Or a non-biological being? It is plausible that some of these questions make sense, while others stretch the limits of sense making. In addressing questions of how I might have been, genetic essentialism is popular, but this article argues that genetic essentialism, and other versions of origin essentialism for organisms, must be rejected. It considers the prospects for (...) counterpart theory and shows how counterpart theory can be used to illuminate volitional accounts of identity as proposed by Harry Frankfurt. This enables one to make sense of claims that, say, being gay, or Deaf, or Black, can be essential to someone's identity. The discussion is then extended to show how it can be made applicable to the transworld identity theorist who denies that individuals possess essential properties. (shrink)

Epistemology, as I understand it, is a branch of philosophy especially concerned with general questions about how we can know various things or at least justify our beliefs about them. It questions what counts as evidence and what are reasonable sources of doubt. Traditionally, episte-mology focuses on pervasive and apparently basic assumptions covering a wide range of claims to knowledge or justified belief rather than very specific, practical puzzles. For example, traditional epistemologists ask “How do we know there are material (...) objects?” and not “How do you know which are the female beetles?” Similarly,moralepistemology, as I understand it, is concerned with general questions about how we can know or justify our beliefs about moral matters. Its focus, again, is on quite general, pervasive, and apparently basic assumptions about what counts as evidence, what are reasonable sources of doubt, and what are the appropriate procedures for justifying particular moral claims. (shrink)

Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

This essay first distinguishes different questions regarding moral objectivity and relativism and then sketches a broadly Kantian position on two of these questions. First, how, if at all, can we derive, justify, or support specific moral principles and judgments from more basic moral standards and values? Second, how, if at all, can the basic standards such as my broadly Kantian perspective, be defended? Regarding the first question, the broadly Kantian position is that from ideas in Kant's later formulations of the (...) Categorical Imperative, especially human dignity and rational autonomous law-making, we can develop an appropriate moral perspective for identifying and supporting more specific principles. Both the deliberative perspective and the derivative principles can be viewed as “constructed,” but in different senses. In response to the second question, the essay examines two of Kant's strategies for defending his basic perspective and the important background of his arguments against previous moral theories. (shrink)