Glucocorticoid hormones are effective in controlling inflammation, but the mechanisms that confer this action are largely unknown. Recent advances in this field have shown that both positive and negative regulation of gene expression are necessary for this process. The genes whose activity are modulated in the anti‐inflammatory process code for several cytokines, adhesion molecules and enzymes. Most of them do not carry a classical binding site for regulation by a glucocorticoid receptor, but have instead regulatory sequences for transcription factors such (...) as AP‐1 or NF‐κ. This makes them unusual targets for glucocorticoid action and emphasizes the need for novel regulatory mechanisms. Recent studies describe an important contribution by protein‐protein interactions, in which several domains of the receptor participate; these studies provide a better understanding of the action of the receptor and offer opportunities for the design of steroidal compounds that could function more effectively as anti‐inflammatory drugs. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (shrink)

Taking Parenting Public makes a compelling case that parenting has become dangerously undervalued in America today. It calls for a new investment—both personal and public—into the work of raising children and argues that we are all "stockholders" in the next generation. With a foreword by Sylvia Ann Hewlett and Cornel West, Taking Parenting Public crosses boundaries to bring together thinkers from diverse fields spanning the political spectrum. It features contributions from distinguished experts in economics, political science, public policy, child development, (...) public health, history, and the media. While recent books have focused on working mothers or absent fathers, Taking Parenting Public is the first volume to take a comprehensive look at the common struggles of parents. These essays go beyond the usual chest-beating about busy parents torn between work and family demands to suggest bold solutions. Instead of the typical call for "parent replacement"—more child care, more after school programs and more mentors—the contributors offer fresh strategies for "parent replenishment," ways to put mothers and fathers back into the lives of their children not only as economic providers, but also as emotional and moral providers. (shrink)

Hiller vonGaertringen says of this inscription: ‘Lapis in obscuro loco collocatus est. In ectypis nihil fere dispeximus … Lectio e Koehlero et Velseno componenda est.’ I did not find the stone till my last morning in Athens: it is E.M. 6600; it is extremely illegible, and I had not time to move it to a really good light. But there are a few things to add, and the length of line can, I believe, be determined.

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

This paper is a by-product of two systematic inquiries: one into the Strategia and Strategoi of the fifth century, the other into the military expenditure during the Peloponnesian War. The two inquiries cannot be kept distinct, and both have largely to depend on a minute study of the financial inscriptions.

Plutarch concludes his chapter on the Rhetra with six lines of Tyrtaios: φοβου κοςσαντες Πυθωνθεν οκαδ' νεικαν1 μαντεας τε θεο κα τελεντ' πεα ρχειν μν βουλῦς θεοτιμτους βασιλας οσι μλει Σπρτας μερεσσα πλις πρεσβτας τε γροντας, πειτα δ δημτας νδρας πθεαις τραις ντααπαμειβομνους. These lines are quoted to confirm Plutarch's statement, that the Kings who added the last clause to the Rhetra ‘persuaded the city [to accept this addition] on the grounds that it was part of the God's command'. On (...) Plutarch's view, the two Kings added an extra clause to an oracle, and justified their action by alleging that Delphi had authorized the clause. It is not immediately obvious how Tyrtaios’ lines confirm this view. The Delphic utterance whose substance is given in lines 3–6 approximately paraphrases parts of Clauses I and I I , but where is Clause III ? The burden has to be borne by the one word εθεαις: ‘the Kings and gerontes shall initiate business, the demos shall reply with undistorted rhetrai’ or ‘shall respond to the rhetrai without distorting them’ . If εθεαις is given enough weight, the oracle which Tyrtaios quotes may be held to forbid the ‘excessive amendment’ against which Clause III was aimed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:102. ONE CONSEQUENCE OF HUME'S NOMINALISM It is commonly assumed, and sometimes argued, that Hume held the Uniformity Thesis regarding causation : something, a, is the cause of something else, b, if and only if when a occurs, b occurs contiguous with and successive to a and whenever anything relevantly similar to a, "no matter where or when, observed or unobserved," something relevantly similar to b occurs. Everyone knows (...) that Hume denies there is any necessary connection between a cause and its effect. Since the invariability of conjunctions of causes and effects follows from their necessary connection and its possibility is not affected by the denial of that conjunction, the Uniformity Thesis seems a plausible retrenchment. Besides, we should deny that a causes b were any similar a to occur without the occurrence of a similar b. So the assumption of the Uniformity Thesis seems natural. When the issue is argued on textual grounds, the appeal is to Hume's first definition of cause at the end of his long analysis of causation. A cause is An object precedent and contiguous to another, and where all the objects resembling the former are plac'd in like relations of precedency and contiguity to those objects, that resemble the latter (T 170). This is construed as Hume's real definition of the causal relation and taken to state the Uniformity Thesis. Both the argument and the assumption presuppose that Hume was concerned with the conditions for something 's being a cause. But, I wish to argue, in the Treatise at any rate Kume was concerned not with causal relations, but with causal judgments. He was 103. concerned with what must be true for us to call or judge a a cause and, only as a consequence of that concern, with what is true of a for a to be a cause. We must take seriously his asking us to cast our eye on any two objects, which we call cause and effect (T 75, my emphasis), and his saying, after introducing constant conjunction, that contiguity and succession are not sufficient to make us pronounce any two objects to be cause and effect, unless we perceive, that these two relations are preserv'd in several instances (T 87, my emphasis). To determine the conditions for causal judgments, one must determine what we observe of a cause, but in making that determination, I am claiming, Hume is not addressing the question he is commonly assumed to have answered. Making that claim plausible requires a detailed analysis of what Hume is about when he gives two 4 definitions of the causal relation and an explication of how what he does in regard to causal judgments fits the paradigm of analysis for judgments in the 17th and 18th centuries, viz. that given by Boyle, Locke, and --- 5 others of such judgments as "That ball is red^" I shall do neither here. I wish to concern myself with another point which is not necessary to make my claim plausible, but would help were it true. I shall develop this point informally, for it is prima facie implausible and I would like to see how it fares unadorned. If it fares well, there will be time enough to deck it out in symbols. The point is that for Hume one literally cannot think the Uniformity Thesis. If this is true, it would certainly help my claim, for it would not help Hume to claim of him that he answers a question with what for him cannot even be thought. But it is certainly an implausible point prima facie. We can think it. Why can't Hume? The answer lies with his 104. nominalism. Hume holds that everything that exists in nature is individual (T 19) and that this is true of- ideas as well as of anything else that exists (T 19-20). Thus, when someone says, "Smoking causes cancer," then, if we understand what is being said and if anything comes to mind, what must come to mind according to those who hold the Uniformity Thesis is a particular instance of smoking, a, and a particular instance of cancer, b, and particular instances of the relations of... (shrink)

This chapter argues that the only tenable unconscious inferences theories of cognitive achievement are ones that employ a theory internal technical notion of representation, but that once we give cash-value definitions of the relevant notions of representation and inference, there is little left of the ordinary notion of representation. We suggest that the real value of talk of unconscious inferences lies in (a) their heuristic utility in helping us to make fruitful predictions, such as about illusions, and (b) their providing (...) a high-level description of the functional organization of subpersonal faculties that makes clear how they equip an agent to navigate its environment and pursue its goals. (shrink)

As we stand on the precipice of a world without Roe v. Wade and its constitutional protection for the right to terminate a pregnancy, new arguments, approaches, and conceptual frames for understand...

Cet article présente mes réflexions en leur état au début de l’année 2020 quant à la situation de la méthodologie économique et de la philosophie de l’économie (ou philosophie économique), après quinze années passées à la co-direction (avec Wade Hands) du Journal of Economic Methodology. J’y constate les changements des méta-champs de recherche que sont la méthodologie et la philosophie de l’économie, depuis leur surgissement comme sous-domaines au sein des sciences économiques durant les années 1980. En usant d’une analyse qui (...) prend en considération l’évolution technologique, j’y distingue deux scenarii envisageables pour l’avenir du champ, en rapport aux facteurs de l’environnement l’impactant, et quant à l’influence de la spécialisation croissante de la recherche, à la fois sur ce champ même et sur les sciences économiques ; j’élabore enfin une argumentation transdisciplinaire touchant son évolution future vers la diversité et la pluralité dans la recherche académique. (shrink)

Corporations, which in the past have been hesitant to contribute to conversations regarding political and social issues, are increasingly speaking out on current issues such as race, sexual orientation, gender, immigration, and environmental issues. Despite this trend, limited academic research has focused on how corporate sociopolitical activism (CSA) efforts impact firm value. In addition, extant studies have not fully identified the extent to which the firm and their message influence the outcomes of this approach. The current study explores how sociopolitical (...) stances communicated on Twitter affect firms’ stock prices. Results from an event study of 260 incidents of CSA show that CSA efforts decrease firm value by an average of 0.22%, indicating that wading into social or political issues is a risky strategy. However, further analysis highlights the importance of clearly articulating stances on social issues that align with the firm’s core values. (shrink)

Abortion is an especially salient issue for considering the general problematic of religiously based conversation in the public square. It remains deeply divisive, fully thirty-four years after Roe v. Wade. Such divisiveness cannot be interpreted as merely an expression of profound differences between “secular” and “religious” voices, because differences also emerge among Christian denominations, reflecting different sources of moral authority, different accounts of moral discernment, and different judgments about the appropriate relations between law and morality in the context of pluralism. (...) As this paper explores, however, despite those differences, a generally identifiable “Christian” position concerning the moral status of abortion can be distinguished from secular philosophical judgments on the issue, which is important for Christian engagement with public policy debate. (shrink)

The stated intent of this book is to use the art of today as an introduction to philosophy and to describe the aesthetic experience. The author also says he wants to take a stand which he solidly does. The issues dealt with are the standard meat of aesthetic discussions and complexities: a comparison of ordinary and aesthetic vision, the art-object, qualities of the aesthetic experience, form, content, process, expression, tragedy, comedy, beauty, and the sublime. Anderson's arguments are based on three (...) main assumptions. Art is separate from life and, since it is external to man, he must struggle to cross into the realm of art, often wading through intentionally ambiguous elements to get to the content of the art-work. A successful art-object revives in the viewer the process of perception and articulation learned as a child. The crux of the aesthetic experience is the disclosure of content to the spectator. Based on this last assumption, the author's standard for judging artists is that some artists are more profound than others because their participation in this disclosure of content is deeper. Therefore, the better artist will try to relate both his activities and his nature to this all-important process. Positive aspects of this book are refreshingly unstereotyped views on the role of art critics and art history ; a recognition that aesthetic response is intuitive and the aesthetic experience is transient; and the raising of some provocative questions regarding the importance of the artist's judgment in determining the value of his own work. Unfortunately, this last point is not discussed after its initial mention. On the negative side, despite Anderson's stated intentions, all specific examples of art-works are drawn from non-contemporary sources. Also, idealism lends itself to a rigid aesthetic hermeneutics which is contrary to the majority of art movements in this century. Indeed, one of the outstanding characteristics of the contemporary arts has been the steady destruction of canons and boundaries. Anderson presents these same canons as relevant and absolute. His emphasis on the disclosure of content and content itself is particularly open to question in the light of conscious attempts by artists to eliminate content as a contentable element.. Some justification for endorsing interpretive aesthetics is needed and is not given. Anderson's greatest success is that he has, indeed, most clearly taken a stand.--B. T. (shrink)

Inferencjalizm semantyczny Roberta B. Brandoma jest ważną i nową teorią znaczenia we współczesnej, analitycznej filozofii języka. Wyłożona została w bardzo obszerny sposób w monografii pt. Making It Explicit: Reasoning, Representing and Discursive Commitment. Jest to teoria jednocześnie pragmatyczna, normatywna, holistyczna i dyskursywna. Stanowisko Brandoma jest z jednej strony gloryfikowane, natomiast z drugiej strony wzbudza kontrowersje. Powstaje zatem metafilozoficzne pytanie: Jak ocenić wkład tej teorii w filozofię języka? Inferencjalizm akcentuje wnioskowania materialne, askrypcje de re i użycie wyrażeń deiktycznych. Są to kategorie (...) „wertykalne”, akcentujące „związek” z rzeczywistością. Brandom jednak kładzie nacisk także na anaforyczną koncepcję referencji i prawdy. To czyni jego podejście wartościowym, anaforyczne bowiem rozumienie referencji i prawdy dostarcza dodatkowego objaśnienia użycia słów „odnosi się” i „ jest prawdziwe”. Ale kategorie te są „horyzontalne”. Brandom dostrzega problem nabywania empirycznego znaczenia przez wyrażenia inicjujące łańcuchy anaforyczne i proponuje — jako próbę rozwiązania problemu — zmodyfikowanie inferencjalizmu semantycznego przez poszerzenie go o epistemologią rewizyjną i fallibilistyczną. Dodatkowo wspomaga on swoją teorię przez pragmatykę normatywną, aplikującą kategorię asercji, uprawnienia, różnorodnych zobowiązań, czy „zdobywania punktów”. Wydaje się jednak, że wciąż brakuje pojęcia prawdziwości mocniejszego niż to zaproponowane w koncepcji anaforycznej — pojęcie prawdy, wyrażone przy użyciu relacji korespondencji między językiem a rzeczywistością. Idea korespondencji ma tę wadę, że trudno jest ją satysfakcjonująco zdefiniować. Ważną jednak zaletą takiej relacji jest to, że jest ona relacją „język–rzeczywistość”, a nie tylko anaforyczną relacją „język–język”. Postawiony zarzut nie dyskwalifikuje inferencjalizmu. Wyraża on jedynie ogólno-epistemologiczną trudność z definicją prawdy. Natomiast doniosłością inferencjalizmu jest to, że próbuje on łączyć różne elementy, a przez to — w bardziej adekwatny sposób — objaśnić czym jest znaczenie i wyjaśnić, jak wyrażenia je nabywają. (shrink)

This paper considers recent heated debates led by Jerry A. Coyne andMichael J. Wade on issues stemming from the 1929–1962 R.A. Fisher-Sewall Wrightcontroversy in population genetics. William B. Provine once remarked that theFisher-Wright controversy is central, fundamental, and very influential.Indeed,it is also persistent. The argumentative structure of therecent (1997–2000) debates is analyzed with the aim of eliminating a logicalconflict in them, viz., that the two sides in the debates havedifferent aims and that, as such, they are talking past each other. (...) Given aphilosophical analysis of the argumentative structure of the debates,suggestions supportive of Wade's work on the debate are made that areaimed, modestly, at putting the persistent Fisher-Wright controversy on thecourse to resolution. (shrink)

The present author developed a calculus for the logic of ‘because’. In a recent paper in this journal, it has been claimed that the central inference rules for the logic are invalid and that the intuition upon which the rules are based is not accounted for. This note criticises these arguments and presents an independent argument in favour of the rules used in the logic.

After the US Supreme Court’s reversal of Roe v. Wade, a number of states have immediately banned abortion. Pro-choice activists are responding by promoting medication abortions – a do-it-yourself form of abortion. Women can take pills at home to induce an abortion in the first few weeks of pregnancy. -/- The Biden Administration [1] has backed the abortion pill, too. Attorney-General Merrick B. Garland and Health and Human Services Secretary Xavier Becerra both issued statements endorsing it. -/- “We stand ready (...) to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care,” said the Attorney-General. “In particular, the F.D.A. has approved the use of the medication mifepristone. States may not ban mifepristone based on disagreement with the F.D.A.’s expert judgment about its safety and efficacy.” -/- As the New York Times [1] has noted, this sets the scene for legal battles. The obvious one is: will anti-abortion states prosecute medication abortions? -/- But – based on experience in the United Kingdom - the use of the abortion pill could give pro-life doctors headaches as well. -/- In the past year, UK has witnessed the saga of two Catholic doctors who have been brought in front of the professional regulator, the General Medical Council, after accusations of professional misconduct. Their crime? They had supplied abortion pill reversal (APR) treatment to women. Accusations of this misconduct have been brought forward by pro-choice organisations [2]. -/- The problem is that some women might panic when they discover that they are pregnant or are pressured to make a rash decision. They obtain abortion pills, often without seeing a doctor faceto- face, and soon after taking the first pill, they regret their decision. -/- Is it too late for them to save their pregnancy? Not necessarily. -/- A treatment developed in the US works about half the time. It involves the woman taking progesterone after the first abortion pill to counteract the abortifacient action of the drug. -/- Seventy-three women in the UK are reported to have taken a full APR course, of whom, 38 – more than half — successfully remained pregnant. Admittedly, the procedure is controversial [3], with pro-choice writers denouncing it as unproven, unscientific, and unethical. This has triggered some healthcare practitioners and scholars to analyse the commitments of the pro-choice movement to APR. In a recently published paper in The New Bioethics [4], two colleagues, Dominic Whitehouse and Steven Bow, and I argue that those espousing a pro-choice worldview should actually support abortion pill reversal and that the current evidence indicates that they should actually be doing it. -/- While some pro-choice activists might be happy simply to expand women’s reproductive choices, some might also want to ensure that these choices are safe and effective at achieving the desired outcome, which in principle includes maintaining a pregnancy. -/- We then review the scientific evidence with respect to the ability of APR to halt an abortion, look at the potential impact of APR on mental health, as well as its procedural safety. While highlighting that gold-standard evidence is lacking, we note that APR is associated with about two times higher rate of embryo survival compared to not completing the full early medical abortion course, that there is large agreement in the literature that women who are ambiguous about abortion are at risk of poorer mental health outcomes after abortion (and argue that women who request APR fall into this category), and highlight that there is no evidence that APR is more dangerous than abandoning an initiated early medical abortion. -/- The latter fact is important, as the results of the only randomised-controlled trial of APR have been at times misrepresented in the media [5.6], creating the impression that APR is not safe while most of the adverse effects occurred in the study group that did not receive APR. As our paper argues, with respect to APR the two UK doctors were “champions of women’s choice and should be congratulated, not condemned, by pro-choice advocates”. -/- While the cases against the two doctors have now been dropped (and there have even been accusations against a member of one of these pro-choice organisations that they pressurised a patient into complaining about one of the doctors and twisted the patient’s experience of the treatment [7]), we argue that it is important to set-up systems to facilitate the future provision of APR to protect both patients and healthcare staff. -/- Our conclusion is that, while being open to any change in evidence, those espousing a pro-choice outlook should “support calls for an APR framework that will protect women and the healthcare professionals caring for them” “and certainly not oppose” APR. -/- The debate over abortion pill reversal will be heading to the United States soon. It is quite possible that it will be denounced as dangerous misinformation. It’s not. But pro-life defenders should be prepared to defend their ground. -/- This article was first published by Mercatornet. (shrink)

My dissertation philosophically analyzes experiments in evolutionary biology, an area of science where experimental approaches have tended to supplement, rather than supercede more traditional approaches, such as field observations. I conduct the analysis on the basis of three case studies of famous episodes in the history of selection experiments: H. B. D. Kettlewell's investigations of industrial melanism in the Peppered Moth, Biston betularia; two of Th. Dobzhansky's studies of adaptive radiation in the fruit fly, Drosophila pseudoobscura; and M. Wade's studies (...) of group selection in the flour beetle, Tribolium castaneum. The case studies analyze the arguments and evidence these investigators used to identify the respective roles of experiments and other forms of inquiry in their investigations. I discuss three philosophical issues. ;First, the analysis considers whether these selection experiments fit models of experimentation developed in the context of micro-and high energy physics by Allan Franklin and Peter Galison . My analysis documents that the methods used in the case studies can be accommodated on both Franklin and Galison's views. I conclude the case studies do not support claims regarding the relative autonomy of biology. ;Second, the analysis documents a number of important roles for life history data acquired by strictly observational means in the process of experimentation, from identification of research problems and development of experimental designs to interpretation of results. Divorced from this context experiments in biology make no sense. Thus, in principle, experimental approaches cannot replace more traditional methods. ;Third, the analysis examines a superficial tension between the use of experiments, which I characterize by the presence of artificial intervention, and the stated goal of most investigations in evolutionary biology, that of understanding how systems behave in the absence of intervention. Experiments involve trade-offs between the control one has over the circumstances of the study and how informative the study is with regard to questions of interest to biologists regarding specific, actual systems in nature. Experimental simulations of natural phenomena in other historical sciences involve similar trade-offs, but there are reasons for believing this tension is more prominent in biology. (shrink)

The relationship of consciousness to brain, which Schopenhauer grandly referred to as the "world knot," remains an unsolved problem within both philosophy and science. The central focus in what follows is the relevance of science---from psychoanalysis to neurophysiology and quantum physics-to the mind-brain puzzle. Many would argue that we have advanced little since the age of the Greek philosophers, and that the extraordinary accumulation of neuroscientific knowledge in this century has helped not at all. Increas- ingly, philosophers and scientists have (...) tended to go their separate ways in considering the issues, since they tend to differ in the questions that they ask, the data and ideas which are provided for consideration, their methods for answering these questions, and criteria for judging the acceptability of an answer. But it is our conviction that philosophers and scientists can usefully interchange, at least to the extent that they provide co~straints upon each other’s preferred strategies, and it may prove possible for more substantive progress to be made. Philosophers have said some rather naive things by ignoring the extraordinary advances in the neurosciences in the twentieth century. The skull is not filled with green cheese! On the other hand, the arrogance of many scientists toward philosophy and their faith in the scientific method is equally naive. Scientists clearly have much to learn from philosophy as an intellectual discipline. Manifestations of Mind: Some Conceptual and Empirical Issues Walter B. Weimer Pages 5-31 The Mysterious “Split‘: A Clinical Inquiry into Problems of Consciousness and Brain Peter H. Knapp Pages 37-69 Mind, Brain, and the Symbolic Consciousness Irwin Savodnik Pages 73-98 Brain and Free Will John C. Eccles Pages 101-121 An Old Ghost in a New Body C. Wade Savage Pages 125-153 How Dogmatic Can Materialism Be? John C. Eccles Pages 155-160 Mental Phenomena as Causal Determinants in Brain Function R. W. Sperry Pages 163-177 Consciousness as an Emergent Causal Agent in the Context of Control System Theory E. M. Dewan Pages 181-198 Reductionism, Levels of Organization, and the Mind-Body Problem William C. Wimsatt Pages 205-267 Mind, Structure, and Contradiction Gordon G. Globus Pages 271-293 Problems Concerning the Structure of Consciousness Karl H. Pribram Pages 297-313 The Role of Scientific Results in Theories of Mind and Brain: A Conversation among Philosophers and Scientists E. M. Dewan, John C. Eccles, Gordon G. Globus, Keith Gunderson, Peter H. Knapp, Grover Maxwell et al. Pages 317-328 Scientific Results and the Mind-Brain Issue: Some Afterthoughts Grover Maxwell Pages 329-358. (shrink)

On September 1, 2023, Texas made important revisions to it its decades‐old statute granting legal safe harbor immunity to physicians who withhold or withdraw life‐sustaining treatment over the objection of critically ill patients’ surrogate decision‐makers. However, lawmakers left untouched glaring flaws in a key safeguard for patients—the transfer option. The transfer option is ethically important because, when no hospital is willing to accept the patient in transfer, that fact is taken as strong evidence that the surrogates’ treatment requests fall outside (...) accepted medical practice. But there are serious shortcomings in how the transfer option is carried out in Texas and many other states, which undermines the ethical usefulness of the process. We identify these shortcomings and recommend revisions to state statutes and professional guidelines to overcome them. (shrink)

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

Background At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This ‘resetting’ of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the ‘NHS Reset Ethics’ project, (...) which explored the everyday ethical challenges of resetting England’s NHS maternity and paediatrics services during the pandemic. Methods Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith’s symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related. Results The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery. Conclusions Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges. (shrink)

Even though the digital church has been in existence for some time, it was mainly a transmission of onsite church services and programmes in the online space. The coronavirus disease 2019 (COVID-19) pandemic and its demands for a global shutdown to mitigate and contain the disease moved almost all social activities including church services to the online space. It is evident that persons with disability experience extreme exclusion from the church’s theology, praxes, and ethos. Unfortunately, this phenomenon is replicated in (...) the virtual space. Research proves that persons with disability were not considered in the migration of churches to the virtual space; hence, digital accessibility is minimal or non-existent during and after the COVID-19 era.Contribution: This article explores the various transformational stages of both the church and media while further exploring possible ways by which the virtual church may grant accessibility to persons with disability. (shrink)

_The purpose_ of the article is to comprehend the Husserlian model of constituting temporal modes through the ability of intentional "retentional-protentional" consciousness, as well as to clarify the possibility of interpreting its positions in the reconstruction of the concept of anthropic time. _Theoretical basis._ The theoretical framework of the research includes: 1) the interpretation of the phenomenological reflection of "time-consciousness" by E. Husserl in the context of solving the problem of phased-differentiation of this form of temporality; 2) the concept of (...) anthropic time (V. Khanzhy). _Originality._ For the first time in research literature, the possibilities of applying the ideas of Husserl to the reconstruction of the concept of anthropic time are considered through the interpretation of the phenomenological solution to the problem of temporality, proposed and specified in Husserl’s "time-consciousness" concept. _Conclusions._ The comprehension of the Husserlian model of intentionality of consciousness through the "grasping-from-now" and the constitution of phases of phenomenological time through the component of "exiting-from-now" showed that solving the problem of phased-differentiation of phenomenological time leads to the observation of the impossibility of isolating the modes of past, present, and future as self-sufficient and unconditional. More accurate indications, based on the constitutive intentionality of consciousness on the "grasping-from-now" phases of time (as conventional), are as follows: a) the abilities of retention and recollection are the foundation for the constitution of the past and its connections to the present; b) the perception establishes the basis for the phase of the present itself; c) the possibilities of protention and anticipation (as forms of imagination) constitute the future and its connections to the present. By the concept of retention, Husserl fixes a certain primary memory (the present "now" of a past interval), which enables retaining the past in the present. The category of recollection or secondary memory is used by the philosopher to refer to the self-sufficient reproduction of past experiences (without being joined to present perception). The fundamental difference between recollection and retention is that the former _re-_presents a temporal interval, grasping its content and reproducing it as it was in the past, while in the latter, the perceived duration is presented as a fragment of time that has just passed. According to the German philosopher, the "grasping" of the present phase is performed by perception. Through the constitutive intentionality of consciousness, perception synthesizes the results of primary-actual activity and retentional holding of duration. The second part of the article will present solutions to the following research tasks: 1) analysis of the possibilities of protention and anticipation in constituting the future and its connections with the present; 2) understanding the possibility of using interpreted forms of Husser’s ideas in reconstructing the concept of anthropic time. (shrink)

The acquisition of a new skill usually proceeds through five stages, from novice to expert, with a sixth stage of mastery available for highly motivated performers. In this chapter, we re-state the six stages of the Dreyfus Skill Model, paying new attention to the transitions and interrelations between them. While discussing the fifth stage, expertise, we unpack the claim that, “when things are proceeding normally, experts don’t solve problems and don’t make decisions; they do what normally works” (Dreyfus & Dreyfus, (...) 1988, pp. 30 – 31). This leads us to offer an account of the “perspectival deliberation” that arises for experts and masters and that is distinct from the calculative deliberation characteristic of the lower stages of skillfulness. (shrink)