This chapter focuses on the question of who has duties regarding poverty and what those duties demand, from within the perspective of contemporary analytic normative philosophy. The chapter is structured in three sections. Section 1 considers the duties of those living in poverty, which might be either self-regarding or other-regarding duties, and which must be tempered by concerns of overdemandingness. Section 2 considers the duties of affluent individuals. These are imperfect duties grounded in affluent individuals’ relations to the structures that (...) produce poverty: relations of contribution, benefit, and ability to change. Section 3 considers duties of collective agents – including states, for-profits, charities, and civil society groups. The poverty-related duties of these collective agents are sometimes perfect and sometimes imperfect, and include both primary and secondary duties, and both positive and negative duties. (shrink)

Moral duties are regularly attributed to groups. Does this make conceptual sense or is this merely political rhetoric? And what are the implications for these individuals within groups? Collins outlines a Tripartite Model of group duties that can target political demands at the right entities, in the right way and for the right reasons.

Plausibly, only moral agents can bear action-demanding duties. This places constraints on which groups can bear action-demanding duties: only groups with sufficient structure—call them ‘collectives’—have the necessary agency. Moreover, if duties imply ability then moral agents (of both the individual and collectives varieties) can bear duties only over actions they are able to perform. It is thus doubtful that individual agents can bear duties to perform actions that only a collective could perform. This appears to leave us at a loss (...) when assigning duties in circumstances where only a collective could perform some morally desirable action and no collective exists. But, I argue, we are not at a loss. This article outlines a new way of assigning duties over collective acts when there is no collective. Specifically, we should assign collectivisation duties to individuals. These are individual duties to take steps towards forming a collective, which then incurs a duty over the action. I give criteria for when individuals have collectivisation duties and discuss the demands these duties place on their bearers. (shrink)

The ethics of care has flourished in recent decades yet we remain without a succinct statement of its core theoretical commitment. This book uses the methods of analytic philosophy to argue for a simple care ethical slogan: dependency relationships generate responsibilities. It uses this slogan to unify, specify and justify the wide range of views found within the care ethical literature.

Which kinds of responsibility can we attribute to which kinds of collective, and why? In contrast, which kinds of collective responsibility can we not attribute—which kinds are ‘gappy’? This study provides a framework for answering these questions. It begins by distinguishing between three kinds of collective and three kinds of responsibility. It then explains how gaps—i.e. cases where we cannot attribute the responsibility we might want to—appear to arise within each type of collective responsibility. It argues some of these gaps (...) do not exist on closer inspection, at least for some collectives and some of the time. (shrink)

When a liberal-democratic state signs a treaty or wages a war, does its whole polity do those things? In this article, we approach this question via the recent social ontological literature on collective agency. We provide arguments that it does and that it does not. The arguments are presented via three considerations: the polity's control over what the state does; the polity's unity; and the influence of individual polity members. We suggest that the answer to our question differs for different (...) liberal-democratic states and depends on two underlying considerations: the amount of discretion held by the state's officeholders; the extent to which the democratic procedure is deliberative rather than aggregative. (shrink)

Plausibly, only moral agents can bear action-demanding duties. Not all groups are moral agents. This places constraints on which groups can bear action-demanding duties. Moreover, if such duties imply ability then moral agents – of both the individual and group varieties – can only bear duties over actions they are able to perform. I tease out the implications of this for duties over group actions, and argue that groups in many instances cannot bear these duties. This is because only groups (...) with the right kind of structure – groups I call ‘collectives’ – have the agency to bear action-demanding duties. Yet neither can individuals bear these duties, assuming that individuals cannot perform group actions and that duty implies ability. This appears to leave us at a loss when assigning duties to perform some group actions. I argue we can solve this problem by assigning collectivization duties to individuals – duties to form a collective that then incurs a duty over the action. I give criteria for when individuals have collectivization duties and discuss the demands these duties place on their bearers. (shrink)

This paper investigates agents’ blameworthiness when they are part of a group that does harm. We analyse three factors that affect the scope of an agent’s blameworthiness in these cases: shared intentionality, interpersonal influence, and common knowledge. Each factor involves circumstantial luck. The more each factor is present, the greater is the scope of each agent’s vicarious blameworthiness for the other agents’ contributions to the harm. We then consider an agent’s degree of blameworthiness, as distinct from her scope of blameworthiness. (...) We suggest that an agent mostly controls her degree of blameworthiness—but even here, luck constrains what possible degrees of blameworthiness are open to her. (shrink)

Individuals have various kinds of obligations: keep promises, don’t cause harm, return benefits received from injustices, be partial to loved ones, help the needy and so on. How does this work for group agents? There are two questions here. The first is whether groups can bear the same kinds of obligations as individuals. The second is whether groups’ pro tanto obligations plug into what they all-things-considered ought to do to the same degree that individuals’ pro tanto obligations plug into what (...) they all-things-considered ought to do. We argue for parity on both counts. (shrink)

Philosophers increasingly argue that collective agents can be blameworthy for wrongdoing. Advocates tend to endorse functionalism, on which collectives are analogous to complicated robots. This is puzzling: we don’t hold robots blameworthy. I argue we don’t hold robots blameworthy because blameworthiness presupposes the capacity for a mental state I call ‘moral self-awareness’. This raises a new problem for collective blameworthiness: collectives seem to lack the capacity for moral self-awareness. I solve the problem by giving an account of how collectives have (...) this capacity. The trick is to take seriously individuals’ status as flesh-and-blood material constituents of collectives. The idea will be: under certain conditions that I specify, an individual can be the locus of a collective's moral self-awareness. The account provides general insights concerning collectives’ dependence on members, the boundaries of membership, and the locus of collectives’ phenomenology. (shrink)

Organizations do moral wrong. States pursue unjust wars, businesses avoid tax, charities misdirect funds. Our social, political, and legal responses require guidance. We need to know what we’re responding to and how we should respond to it. We need a metaphysical and moral theory of wrongful organizations. This book provides a new such theory, paying particular attention to questions that have been underexplored in existing debates. These questions include: where are organizations located as material objects in the natural world? What’s (...) the metaphysical relation between organizations and their members? Can organizations be blameworthy for attitudes and character traits, as well as for actions? What about feelings of guilt, remorse, and shame—can organizations feel these emotions and why does this matter? How and why are members implicated in organizations’ wrongs? How should organizations’ reparative costs be apportioned among members? The book answers these questions. It argues that organizations are material objects with humans as material parts—much like how a pizza is a material object with slices as material parts. This picture helps us make sense of organizations’ blameworthiness, including blame for organization-level actions, attitudes, and character traits. The book argues that organizations can experience moral self-awareness—a crucial component of guilt, remorse, and shame. Members can be implicated in organizations’ actions in numerous ways—and, it is argued, members’ level of implication should determine their share of organizations’ reparative burdens. (shrink)

A collective duty gap arises when a group has caused harm that requires remedying but no member did harm that can justify the imposition of individual remedial duties. Examples range from airplane crashes to climate change. How might collective duty gaps be filled? This paper starts by examining two promising proposals for filling them. Both proposals are found inadequate. Thus, while gap-filling duties can be defended against objections from unfairness and demandingness, we need a substantive justification for their existence. I (...) argue that substantive justification can be found in the normative force of commitments individuals make to others with regard to ends. Along the way, I argue that gap-filling duties must be conceptualized differently in group agents, as compared to non-agent groups: in the former, gap-filling duties can be understood as duties to “take up the slack”; in the latter, this would be a category error. (shrink)

A standard objection to socioeconomic human rights is that they are not claimable as human rights: their correlative duties are not owed to each human, independently of specific institutional arrangements, in an enforceable manner. I consider recent responses to this ‘claimability objection,’ and argue that none succeeds. There are no human rights to socioeconomic goods. But all is not lost: there are, I suggest, human rights to ‘socioeconomic consideration’. I propose a detailed structure for these rights and their correlative duties, (...) while remaining neutral on substantive moral debates. I argue that socioeconomic-consideration human rights are satisfactorily claimable and sufficiently practical. (shrink)

In this paper, we focus on the moral responsibility of organized groups in light of historicism. Historicism is the view that any morally responsible agent must satisfy certain historical conditions, such as not having been manipulated. We set out four examples involving morally responsible organized groups that pose problems for existing accounts of historicism. We then pose a trilemma: one can reject group responsibility, reject historicism, or revise historicism. We pursue the third option. We formulate a Manipulation Condition and a (...) Guarding Condition as addendums to historicism that are necessary to accommodate our cases of group responsibility. (shrink)

Individuals sometimes pass their duties on to collectives, which is one way in which collectives can come to have duties. The collective discharges its duties by acting through its members, which involves distributing duties back out to individuals. Individuals put duties in and get (transformed) duties out. In this paper we consider whether (and if so, to what extent) this general account can make sense of states' duties. Do some of the duties we typically take states to have come from (...) individuals having passed on certain individual duties? There are complications: states can discharge their duties by contracting fulfilment out to non-members; states seem able to dissolve the duties of non-members; and some of states' duties are not derived in this way. We demonstrate that these complicate, but do not undermine, the general account and its application to states. And the application has an interesting upshot: by asking which individuals robustly participate in this process of duty transfer-and-transformation with a given state, we can begin to get a grip on who counts as a member of that state. (shrink)

Philosophers often talk as though each ability is held by exactly one agent. This paper begins by arguing that abilities can be held by groups of agents, where the group is not an agent. I provide a new argument for—and a new analysis of—non-agentive groups’ abilities. I then provide a new argument that, surprisingly, obligations are different: non-agentive groups cannot bear obligations, at least not if those groups are large-scale such as ‘humanity’ or ‘carbon emitters.’ This pair of conclusions is (...) important, since philosophers who endorse large-scale non-agentive groups’ abilities almost universally endorse their obligations. More importantly, the twin arguments (one for abilities, one against obligations) make the following novel contribution: abilities imply agency-involving explanations, while obligations imply action-guidance. This general conclusion should be of interest beyond social ontology. (shrink)

In order for states to fulfil (many of) their moral obligations, costs must be passed to individuals. This paper asks how these costs should be distributed. I advocate the common-sense answer: the distribution of costs should, insofar as possible, track the reasons behind the state’s duty. This answer faces a number of problems, which I attempt to solve.

Many governments are failing to act sufficiently strongly on climate change. Given this, what should motivated affluent individuals in high-consumption societies do? This paper argues that social norms are a particularly valuable target for individual climate action. Within norm-promotion, the paper makes the case for a focus on anti-fossil fuel norms specifically. Section 1 outlines gaps in the existing literature on individuals’ climate change obligations. Section 2 characterises social norms. Section 3 provides seven reasons why social norms are a particularly (...) worthy target for individual climate actors. Section 4 asks which social norms individuals should emphasise, arguing that anti-fossil fuel norms have advantages over emissions reduction and offsetting norms. Section 5 outlines the pathways and mechanisms individuals might exploit to promote anti-fossil fuel norms. (shrink)

Why, morally speaking, ought we do more for our family and friends than for strangers? In other words, what is the justification of special duties? According to partialists, the answer to this question cannot be reduced to impartial moral principles. According to impartialists, it can. This paper briefly argues in favour of impartialism, before drawing out an implication of the impartialist view: in addition to justifying some currently recognised special duties, impartialism also generates new special duties that are not yet (...) widely recognised. Specifically, in certain situations, impartial principles generate duties to take actions and adopt attitudes in our personal lives that increase the chance of new or different special relationships being formed—new or different friendships, family-like relationships, relationships akin to co-nationality, and so on. In fact, even if one thinks partialism is the best justification of the duties we have once in special relationships, impartialist justifications for taking steps to form such relationships should have some sway. Moreover, a little reflection shows that these duties are not as demanding or counterintuitive as one might expect. (shrink)

Philosophers often talk as though each ability is held by exactly one agent. This paper begins by arguing that abilities can be held by groups of agents, where the group is not an agent. I provide a new argument for—and a new analysis of—non-agentive groups’ abilities. I then provide a new argument that, surprisingly, obligations are different: non-agentive groups cannot bear obligations, at least not if those groups are large-scale such as ‘humanity’ or ‘carbon emitters.’ This pair of conclusions is (...) important, since philosophers who endorse large-scale non-agentive groups’ abilities almost universally endorse their obligations. More importantly, the twin arguments (one for abilities, one against obligations) make the following novel contribution: abilities imply agency-involving explanations, while obligations imply action-guidance. This general conclusion should be of interest beyond social ontology. (shrink)

Is the state a collective agent? Are citizens responsible for what their states do? If not citizens, then who, if anyone, is responsible for what the state does? Many different sub-disciplines of philosophy are relevant for answering these questions. We need to know what “the state” is, who or what it's composed of, and what relation the parts stand in to the whole. Once we know what it is, we need to know whether that thing is an agent, in particular (...) a moral agent capable of taking moral responsibility for its actions. We have to know what it takes for it to be capable of moral responsibility, e.g., what the functional equivalents in groups are of knowledge, intention, foreseeability, recklessness, and so on. And once we've established that it is an agent, and is responsible for what it does, we have to explain whether and in what way this implicates members, i.e., whether state responsibility distributes to the members of states, whoever they may be. Answers to these questions come from metaphysics, social ontology, action theory, epistemology, political theory, and ethics. In what follows, we'll give an outline of some different ways of answering these questions. (shrink)

In order for states to fulfil their moral duties, costs must be passed to individual citizens. This paper asks how these costs should be distributed. I advocate the common-sense answer: the distribution of costs should, insofar as possible, track the reasons behind the state’s duty. This answer faces a number of problems, which I attempt to solve.

Are obligations of collective agents—such as states, businesses, and non-profits—ever overdemanding? I argue they are not. I consider two seemingly attractive routes to collective overdemandingness: that an obligation is overdemanding on a collective just if the performance would be overdemanding for members; and that an obligation is overdemanding on a collective just if the performance would frustrate the collective’s permissible deep preferences. I reject these. Instead, collective overdemandingness complaints should be reinterpreted as complaints about inability or third-party costs. These are (...) not the same as overdemandingness. Accordingly, we can ask an awful lot of collective agents. (shrink)

This short article provides an overview of "care ethics" for students who are new to moral theory.

ABSTRACTThe Assistance Principle is common currency to a wide range of moral theories. Roughly, this principle states: if you can fulfil important interests, at not too high a cost, then you have a moral duty to do so. I argue that, in determining whether the ‘not too high a cost’ clause of this principle is met, we must consider three distinct costs: ‘agent-relative costs’, ‘recipient-relative costs’ and ‘ideal-relative costs’.

In this chapter, Stephanie Collins examines the idea that individuals can acquire ‘membership duties’ as a result of being members of a group that itself bears duties. In particular, powerful and wealthy states are duty-bearing groups, and their citizens have derivative membership duties (for example, to contribute to putting right wrongs that have been done in the past by the group in question, and to increase the extent to which the group fulfils its duties). In addition, she argues, (...) individuals have duties to signal their willingness to coordinate with others so as to do more good than the sum of what each could do on their own. Putting these two things together, Collins suggests, individuals’ duties in (for instance) matters of global poverty might be largely driven by such group-based considerations, leaving little room for the duties that would follow from more individualistic reasoning. (shrink)

This paper provides an overview of Group Duties: Their Existence and Their Implications for Individuals.

This is a response to the critial comments by Anne Schwenkenbecher, Olle Blomberg, Bill Wringe and Gunnar Björnsson.

Most of the literature on teaching within nursing education presents teaching and learning strategies as unproblematic and widely generalized across contexts, content, learners, and educators. We argue that to be truly effective, teaching strategies must be harmonious with instructor’s beliefs, intentions, and actions. In this paper, we introduce the notion of a plurality of effective teaching based on five different ‘perspectives on teaching’– each composed of different beliefs, intentions, actions, and strategies and illustrated by cases from nursing education. We propose (...) that this foundational conceptualization provides a base from which nurse educators can (1) communicate across differences of philosophical perspective and intent; and (2) critically reflect on their educational practices. (shrink)

When we say that ‘the government should be ashamed’, can we be taken literally? I argue that we can: organisations have duties over their emotions. Emotions have both functional and felt components. Often, emotions’ moral value derives from their functional components: from what they cause and what causes them. In these cases, organisations can have emotional duties in the same way that they can have duties to act. However, emotions’ value partly derives from their felt components. Organisations lack feelings, but (...) can have duties to increase the likelihood that their members have relevant emotions (with the right felt components), in virtue of and in accordance with their role in the organisation. To systematise these conclusions, I provide a taxonomy of organisations’ – and individuals’ organisationally situated – emotional duties. This taxonomy will enable scholars of electoral politics, international politics and public policy to systematically integrate emotions into the study of organisations. (shrink)

In this reply to an article of Toni Erskine's, I argue that coalitions of the willing are moral agents. They can therefore bear responsibility in their own right.

We vindicate the widespread intuition that there is something morally problematic with for-profit corporations providing care to young children and elders. But instead of putting forward an empirical argument showing that for-profit corporations score worse than not-for-profits when it comes to meeting the basic needs of these vulnerable groups, we develop a philosophical argument about the nature of the relationship between a care organisation, its role-occupants, and care recipients. We argue that the correlation between profit and lower-quality care is a (...) result of intrinsic features of a for-profit model, combined with conceptual features of meaningful caring relationships, such that non-profits are the most reliable institutional providers of adequate care. Our claim is that care requires a kind of commitment that for-profit institutions are constituted to avoid, and that non-profit institutions are constituted to embrace. (shrink)

The following pair of claims is standardly endorsed by philosophers working on group agency: (1) groups are capable of irreducible moral agency and, therefore, can be blameworthy; (2) groups are not capable of irreducible moral patiency, and, therefore, lack moral rights. This paper argues that the best case for (1) brings (2) into question. Section 2 paints the standard picture, on which groups’ blameworthiness derives from their functionalist or interpretivist moral agency, while their lack of moral rights derives from their (...) lack of sentience. In Section 3, I add support to a recent argument that this standard picture needs alteration: groups’ blameworthiness requires something akin to sentience, which groups acquire from members. Section 4 discusses rights: if groups acquire sentience from members, as Section 3 argues, then can groups have moral rights? I argue that they can, but that groups have only a limited range of moral rights, whose existence depends on (without being ontologically or justificatorily reducible to) the attitudes and actions of humans. (shrink)

This chapter asks whether there is a human right to close personal relationships. It begins by providing a prima facie argument in favour of such a right: humans’ interests in close personal relationships are important, universal, and fundamental. It then explains that there are problems with the distribution, demandingness, and motivation of the correlative duties. The result is that each individual bears a human right only to ‘intimacy consideration’, not to close personal relationships themselves. The chapter then argues that things (...) are different if we conceptualize the right as belonging to groups, rather than to individuals. It is argued that groups of co-intimates have rights that others respect, protect, and promote the group’s intimacy. The duties correlative to such group-held rights do not face the problems of distribution, demandingness, and motivation that plague the individually-held right. Group-held rights in this arena are an important moral and political tool. (shrink)

Theorists of democratic multiculturalism have long-defended individuals’ religious exemptions from generally-applicable laws. Examples include Sikhs being exempt from motorcycle helmet laws, or Jews and Muslims being exempt from humane animal slaughter laws. This paper investigates religious exemptions for organisations. Should organisations ever be granted exemptions from generally-applicable laws in democratic societies, where those exemptions are justified by the organisation’s religion? The paper considers four arguments for this, which respectively rely on: the ‘transferring up’ to organisations of individuals’ claims to autonomy (...) or recognition; organisations’ own claims to autonomy or recognition; organisations’ status in the accountability-community; and organisations’ procedural constraints. The paper concludes that only the last argument works—and then, only with caveats. (shrink)

The urgency of the problem of climate change calls upon us to investigate the climate duties of agents beyond the state. Individuals are the most salient candidate in this respect. In section I, I argue that the idea that individuals might have duties to reduce their emissions raises difficult issues about individual difference-making. The rest of the chapter, then, focuses on what I take to be the third most-salient duty-bearer: large for-profit corporations. These entities have largely been overlooked in philosophical (...) discussions of climate-related duties. In Section II, I consider two possible reasons for this neglect, and argue that neither are good reasons. In Section III, I give a positive case for weighty and demanding duties for corporations, to cut back their present and planned emissions and to offset their past emissions. In Section IV, I bring the discussion full circle: corporations’ duties always imply duties for corporations’ members, that is, for the individuals who constitute the corporation. Drawing on earlier work, I give an account of who corporations’ members are and how their duties are structured. In heavily-emitting corporations, members prominently include managers, shareholders, and rank-and-file employees. So a range of individuals are on the hook after all, because the corporations that they constitute bear duties. Additionally, even non-members may have duties to act upon corporations, from the outside, with a view to inducing corporate duty-fulfillment. (shrink)

Mainstream political philosophy traditionally follows Jean-Jacque’s Rousseau’s lead, ‘taking men as they are and laws as they can be made’ (Rousseau, 1998, p. 3). The non-enforceable responsibiliti...

When an organisation does wrong, each of the members is part of the entity that authored that wrong—or so I shall assume. But it does not follow that each of the members has herself done wrong. Doing wrong, I will assume, results from the combination of two conditions: first, authoring (or being part of the entity that authored) a harm; and second, lacking an excuse for that (part-) authorship. To answer my title question, then, we have to know which members (...) of an organisation have excuses for their part-authorship of an organisation’s wrong. I will argue that members gain excuses for their part-authorship only by using their role in the organisation to signal their disavowal of the organisation’s wrongdoing. The answer to the title question, then, is “all those members who don’t use their role to signal their disavowal of the organisation’s wrongdoing.” In the final section, I apply my proposal to citizens of liberal democratic states. This supports the common-sense intuition that, when such states do wrong, wrong is done by those citizens who support or acquiesce in the wrongful policy. (shrink)

Being Sure of Each Other: An Essay on Social Rights and Freedoms, by KimberleyBrownlee. Oxford: Oxford University Press, 2020. Pp. 256.

Mainstream political philosophy traditionally follows Jean-Jacque’s Rousseau’s lead, ‘taking men as they are and laws as they can be made’ (Rousseau, 1998, p. 3). The non-enforceable responsibiliti...

Le rempart établi par les Romains à Délos en 69 av. J.‑C., dit « Mur de Triarius », a fait l’objet d’une campagne de fouilles en 2014 sous la direction de St. Maillot. La fouille de 2014 a été suivie d’une campagne d’étude en 2015 menée par M. Fincker et S. Maillot. Les objectifs de la mission étaient d’étudier la portion du rempart subsistante sur la ligne de crête de la colline du théâtre (relevé topographique et architectural) ; de préciser (...) son mode de fondation et sa technique de construc... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 571 Moving through Cancer: An Interview with Carol Collins Artist Carol Collins spoke with Feminist Studies editorial collective member Stephanie Gilmore about her experience of cancer, treatment, and recovery and how it gave rise to an art series that examines what nature means in the midst of unnatural treatments. SG: Carol, thank you for the (...) opportunity to speak with you about your artwork. Having just lost my sister to cancer, your work reminds me of much pain and loss, but also of love and the desire to survive. Before we discuss the work itself, I would like to hear about your journey through cancer, treatment, and recovery. CC: The breast cancer patient’s journey is complex and perilous. When I was healthy, I was ignorant about the magnitude of suffering many cancer patients undergo. And, although I am a private person, I’m now publicly sharing my cancer experience in order to be a voice for those who have suffered through similar treatments—and worse—and those who sadly are no longer with us to tell their story. Being bald and nauseated are not the most awful possible side effects of the treatments, although they are the most well known. Some women survive the cancer but can die from the treatments, or others suffer through the treatments and die anyway. Often, it seems many believe patients can overcome their 572 Carol Collins adversity solely with positive thinking and persistence. However, not discussing the array of physical and psychological damage that even those with good prognoses incur propagates ignorance about this malady. I hope that my artwork and story will promote a deeper understanding of a breast cancer patient’s plight and will encourage more support for research for individualized therapies and prevention. My cancer journey began when I received a breast cancer diagnosis in January 2014. Life just before that point was good; the future was bright. Tendon pain, caused by my flat feet and a lot of exercising, was my only known ailment. But one day a routine mammogram revealed three tumors in my right breast. The radiology oncologist said the masses were highly likely to be cancerous, so he immediately did painful core biopsies at the sites of my three tumors. The next day, it became clear that we needed to act quickly. The biopsy results revealed I had a very aggressive invasive breast cancer with estrogen, progesterone, and HER2 receptors. Breast cancer in premenopausal women grows quickly due to the high level of hormones present. The oncologists and surgeons said I would, at a minimum, need a mastectomy and possibly lymph node resection, and they warned that I would likely need chemotherapy, which would destroy my eggs and ovaries. After learning of my limited options, I approved the removal of one breast and my sterilization. I knew I needed to think rationally and face the giant raven before me head on. However, I did not realize the magnitude and multitude of physical and psychological pains, illnesses, and losses that were soon to come. The first year of cancer treatments inflicted much physical pain. I received three extremely painful injections into my right breast with a radiolabeled colloid just prior to the mastectomy. The pain came from the injected dye, not from the needle. The modified radical mastectomy was more excruciatingly painful than I anticipated, even with painkillers and overnight hospitalization. Breast reconstruction was an option that added more pain and discomfort from weekly fillings of the installed “expander” and additional surgeries. Extreme pain after the mastectomy prevented me from lying down for months. Foolishly, I did not get an injection port installed in my chest. Instead, I endured numerous deep (and often unsuccessful) needle pricks into the seemingly few veins of my left arm (which still had its lymph nodes) that were appropriate for infusions over the period of a year. Shooting pains across my chest and arm were the norm. Carol Collins 573 In addition to the surgically induced physical pain, the chemotherapy quickly caused a myriad of undesirable physical side effects. It is scary to realize that the medical community does not often fully understand... (shrink)