An overview of the philosophical and bioethics literature on conscientious refusals by health care professionals to provide abortion and contraceptive services.

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Despite the widespread use of the notion of moral intuition, its psychological features remain a matter of debate and it is unclear why the capacity to experience moral intuitions evolved in humans. We first survey standard accounts of moral intuition, pointing out their interesting and problematic aspects. Drawing lessons from this analysis, we propose a novel account of moral intuitions which captures their phenomenological, mechanistic, and evolutionary features. Moral intuitions are composed of two elements: an evaluative mental state and a (...) feeling of rightness (FOR). We illustrate the phenomenology of the FOR with examples of non-moral and moral cases, and provide a biological and mechanistic account: the emergence of human reasoning capacities created a need for the co-evolution of a psychological system producing the feeling of rightness (the FORs). This system is triggered when we experience conflicting evaluations. The FORs renders evaluations resulting from rational deliberation less compelling than the evaluations produced by simple evolved systems. It thus facilitates optimal decision-making, preventing excessive interference by rational deliberation. Our account sheds light on why moral intuitions are so frequently experienced and why they are so compelling and resistant to argument. In addition, the account fuels interesting speculations about common metaethical intuitions. (shrink)

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. -/- Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. (...) -/- Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. -/- Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified. (shrink)

The conception of conscience that dominates discussions in bioethics focuses narrowly on private regulation of behaviour resulting from explicit attitudes. It neglects to mention implicit attitudes and the role of social feedback in becoming aware of one's implicit attitudes. But if conscience is a way of ensuring that a person's behaviour is in line with her moral values, it must be responsive to all aspects of the mind that influence behaviour. There is a wealth of recent psychological work demonstrating the (...) influence of implicit attitudes on behaviour. A necessary part of having a well-functioning conscience must thus be awareness and regulation of one's implicit attitudes in addition to one's explicit attitudes; this cannot be done by an individual in isolation. On my revised conception of conscience, heeding social feedback, being emotionally self-aware and engaging in self-monitoring are important for the possession of a well-functioning conscience. Health professionals may need specific training to help them develop and maintain a well-functioning conscience, which should involve cultivation of awareness of implicit attitudes, emphasis on social feedback and techniques to enable better control over them. (shrink)

BackgroundImplicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations (...) with explicit prejudice. MethodsIn stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen’s d. Two-tailed p < 0.05 was selected as the significance threshold.ResultsCompared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese.ConclusionsSpecialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection. (shrink)

In response to two trenchant objections, radical subjective Bayesianism has been widely rejected. In this paper, I seek, if not to rehabilitate subjectivism, at least to show its critic what is attractive about the position. I argue that what is at stake in the subjectivism/anti-subjectivism debate is not, as is commonly thought, which norms of rationality are true, but rather, the conception of rationality that we adopt: there is an alternative approach to the widespread telic approach to rationality, which I (...) call the poric approach, on which subjectivism is an attractive position. I then argue that the poric approach—and therefore subjectivism—cannot be easily dismissed. (shrink)

This article is an account of the dynamics of interaction across the social sciences and neurosciences. Against an arid rhetoric of ‘interdisciplinarity’, it calls for a more expansive imaginary of what experiment – as practice and ethos – might offer in this space. Arguing that opportunities for collaboration between social scientists and neuroscientists need to be taken seriously, the article situates itself against existing conceptualizations of these dynamics, grouping them under three rubrics: ‘critique’, ‘ebullience’ and ‘interaction’. Despite their differences, each (...) insists on a distinction between sociocultural and neurobiological knowledge, or does not show how a more entangled field might be realized. The article links this absence to the ‘regime of the inter-’, an ethic of interdisciplinarity that guides interaction between disciplines on the understanding of their pre-existing separateness. The argument of the paper is thus twofold: (1) that, contra the ‘regime of the inter-’, it is no longer practicable to maintain a hygienic separation between sociocultural webs and neurobiological architecture; (2) that the cognitive neuroscientific experiment, as a space of epistemological and ontological excess, offers an opportunity to researchers, from all disciplines, to explore and register this realization. (shrink)

This commentary argues the case for developmental psychopathology in understanding social learning. Informed by work on “epistemic disruption,” we have described difficulties with social learning associated with many forms of psychopathology. Epistemic disruption manifests in an inability to move between innovation and conformity, and arises from poor mentalizing, which generates difficulties in identifying social cues that trigger the correct stance.

Awareness growth—coming to entertain propositions of which one was previously unaware—is a crucial aspect of epistemic thriving. And yet, it is widely believed that orthodox Bayesianism cannot accommodate this phenomenon, since that would require employing supposedly defective catch-all propositions. Orthodox Bayesianism, it is concluded, must be amended. In this paper, I show that this argument fails, and that, on the contrary, the orthodox version of Bayesianism is particularly well-suited to accommodate awareness growth. For it entails what I call the refinement (...) view, which allows us to capture that awareness growth consists in the increase of one’s capacity of discernment. (shrink)

Ethical issues arise in the world’s first population-level treatment of severe lead poisoning caused by small-scale mining for gold in rural Nigeria. Emergency medical intervention and environmental cleanup have reduced the mortality in children younger than 5 years from lead poisoning from over 40 to 2.5 per cent leaving little evidence of the harms caused by lead poisoning. In the absence of obvious sequelae, family adherence to long-term intensive therapy to remove accumulated lead reservoirs in children wanes and some community (...) miners challenge safer mining interventions to prevent recontamination of the environment with lead. This letter raises questions regarding community versus individual rights in public health interventions and patient autonomy. (shrink)

Albert of Saxony was one of the great logicians of the Middle Ages, on a par with William Ockham and John Buridan. The Twenty-Five Disputed Questions on Logic treat of central issues in logic, both then and now, such as the nature of meaning, of universals, of truth, and of tense and modality; and the quality and quantity of propositions, the role of negation, and the relations of contradiction and equivalence between them. Dr. Fitzgerald has studied Albert's work extensively, (...) and previously edited the Twenty-Five Disputed Questions from the original manuscripts. This translation makes available for the first time in English this careful and exemplary examination of logical notions by an outstanding medieval thinker.-Stephen Read, University of St. Andrews. (shrink)

Although the philosophical systems of G. W. Leibniz and David Lewis both feature possible worlds, the ways in which their systems are similar and dissimilar are ultimately surprising. At first glance, Leibniz’s modal metaphysics might strike us as one of the most contemporarily relevant aspects of his system. But I clarify in this paper major interpretive problems that result from understanding Leibniz’s system in terms of contemporary views (like Lewis’s, for instance). Specifically, I argue that Leibniz rejects the inference that (...) if something is possible, it therefore occurs in some possible world. This discussion highlights how Leibniz’s account of individual substance (with his strict notion of identity) constrains his modal theorizing and produces fatalistic threats. I then make an unexpected connection between Leibniz’s and Lewis’s systems by showing that Leibniz’s treatment of fatalism bears similarities to the response Lewis gives to the fatalist when considering the paradoxes of time travel. (shrink)

A study of Picasso's status in the art community and his influence on the avant-garde market follows his early year search for a gallery and his monumental rise to fame, noting his popularity among dealers and his commercial strategies.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy's Role in Psychopathology Back to Jaspers and an Appeal to Grow PracticalThe author reports no conflicts of interest.In "Philosophy's role in theorizing psychopathology," Gibson presents a defense of the continued relevance of philosophy to psychopathology, and a non-exhaustive framework for the role of philosophy in this domain (Gibson, 2024). I find it hard to disagree that psychopathology is soaked in philosophy from its origins, and that to try (...) and dry it out would be both unwise and impossible.In this commentary, I go back to Karl Jaspers' account of the role of philosophy in his General Psychopathology. In doing so, I do not find that Gibson adds anything new, but instead gives us a well-illustrated reminder that philosophy "is operative within every living science" (Jaspers, 1997, p. 770).Situated Psychopathological TheorizingGibson addresses a broad 'we' who might be engaged with psychopathological theorizing. This seems to encompass three main settings, from which examples are drawn.1. Everyday and regulative social practices (ordinary and legal setting).2. Empirically driven disciplines which work with psychopathological constructs (academic setting).3. Psychiatry and psychotherapy (clinical setting).In my view, it is a mistake not to map the terrain where psychopathological theorizing is situated. In each setting psychopathological theorizing has its own set of aims and constraints. In the ordinary setting, the aim might be to know whether to blame a loved one for their action. In the legal setting it might be to decide whether treatment or punishment is appropriate. In the clinical setting, the aim is usually a therapeutic assessment, and moral stance taking is often best kept at bay. In the academic setting, we might want to ensure our concepts are reliable and valid, opening them up to investigation using objective scientific methods. [End Page 13]Beyond what can be said in the most general terms, the role of philosophy will look different in these different situations.Understanding Is Not (Just) a Philosophical ToolUnderstanding is a mode of knowing that is concerned with the particular, rather than the general, and accessed inter-relationally, relying on tacit knowledge and empathetic imagination. Gibson introduces the concept as an elementary form of social intuition, used in ordinary life to make sense of social relations and other people's behaviors and reactions. I agree with Gibson, drawing on Strawson, that Understanding is a mode of knowledge that involves the subject of enquiry as a participant (Strawson, 1982). There is a moral imperative to take this stance, which drives us to value the expansion of what we are able to understand of other people's mental states. This at least partly motivates the agenda when we theorize about psychopathology.At times throughout his argument, Gibson seems to be arguing for the role of Understanding in psychopathological theorizing, in place of his explicit aim of arguing for the role of philosophy. However it is not at all clear that this replacement can be made. Accepting the picture drawn, Understanding is not any more the expertise or domain of the philosopher than the author, police officer, or sociologist. We are surely not meant to take Understanding as a uniquely philosophical tool, but rather a mode of knowing available to all social agents, integral to social reasoning in ordinary life and in the human studies.What philosophy can distinctively do is point to and defend the existence of forms of intersubjective and tacit knowledge within human studies such as psychopathology. For Jaspers, Understanding can be a scientific tool, albeit one that reminds us that knowledge in psychopathology is not all of one kind. One role for philosophy therefore is to help us to "distinguish the different modes of knowing," so that we might "order knowledge into a comprehensive whole" (Jaspers, 1997, p. 769). This is akin to the 'synthetic' role that Gibson proposes.Philosophy and ScienceJaspers defines scientific knowledge broadly as knowledge with "general validity, convincing insights (which can be proved), clarity of method, and the possibility for a meaningful discussion" (Jaspers, 1997, p. 768).We do not get such a definition from Gibson, but in the sections of... (shrink)

In this essay I argue that Albert would reject the need for a separate fourth mode of common personal supposition, and that his view of merely confused supposition has not been fully explicated by modern scholars. I first examine the various examples of conjunct descent given by modern scholars from his Perutilis logica , and show that Albert clearly adopts it in resolving the sophistic examples involved. Second, I explicate the view of merely confused supposition that Albert defends in his (...) Sophismata , and then attempt to answer the question: which view of merely confused supposition was his final view, the view articulated in the Perutilis logica or the view in the Sophismata ? I conclude that based upon his Sophismata view of merely confused supposition, Albert came to realize the logical strength his revised theory of personal supposition afforded, and consequently, that he is one of the earliest 14th-century logicians to adopt conjunct terminal descent to resolve various sophisms, a move which gave his theory of personal supposition a logical symmetry having two sorts of propositional descents to singulars, and two sorts of terminal descents to singulars. (shrink)

Bioethics scholarship considering the possibility of gestating an embryo to full term in an artificial womb (ectogenesis) often overstates the capacities of current technologies and underestimates the barriers to the development of full ectogenesis. Moreover, this debate causes harm by (1) neglecting more immediate problems in the development of artificial wombs, (2) treating abortion as a “problem with a technological solution,” bolstering anti-abortion rhetoric, and (3) presuming the stability of women’s reproductive rights. The ectogenesis conversation must consider anticipated uses of (...) the technology (neonatal intensive care) and acknowledge the immediate context (recognizing abortion as essential healthcare and existing reproductive inequities). (shrink)

Focusing on imagination and the social context in the generation of conviction narratives, we propose that these elements are dynamically related to one another, and crucially that it is the nature of this relationship that determines individuals' level of epistemic openness and capacity to respond adaptively to update their narratives in a way that increases the possibility of more successful decision-making.

Psychiatric diagnoses are increasingly seen as viable categories around which self and social identities might be drawn. This introduces a new pressure on the “boundary problem” for psychiatry: when members of the public request diagnoses to affirm their self-identities how should we draw the line between mental disorder and normality? If psychiatrists have the authority to recognize and diagnose mental disorder, how can roles as diagnosers and gate-keepers be balanced in a post-stigma era of mental health care? Focusing on the (...) disorder identified would-be patient who would not attract the diagnosis they seek were they not to seek it, this essay explores what it means to have an identity bound to a psychiatric diagnosis and considers a framework for psychiatrists to negotiate clinical encounters that involve the seeking of identity affirming diagnoses. (shrink)

There has long been interest in why languages are shaped the way they are, and in the relationship between sign language and gesture. In sign languages, entity classifiers are handshapes that encode how objects move, how they are located relative to one another, and how multiple objects of the same type are distributed in space. Previous studies have shown that hearing adults who are asked to use only manual gestures to describe how objects move in space will use gestures that (...) bear some similarities to classifiers. We investigated how accurately hearing adults, who had been learning British Sign Language for 1–3 years, produce and comprehend classifiers in locative and distributive constructions. In a production task, learners of BSL knew that they could use their hands to represent objects, but they had difficulty choosing the same, conventionalized, handshapes as native signers. They were, however, highly accurate at encoding location and orientation information. Learners therefore show the same pattern found in sign-naïve gesturers. In contrast, handshape, orientation, and location were comprehended with equal accuracy, and testing a group of sign-naïve adults showed that they too were able to understand classifiers with higher than chance accuracy. We conclude that adult learners of BSL bring their visuo-spatial knowledge and gestural abilities to the tasks of understanding and producing constructions that contain entity classifiers. We speculate that investigating the time course of adult sign language acquisition might shed light on how gesture became conventionalized during the genesis of sign languages. (shrink)

Qu'elle soit entendue comme état de désordre social ou qu'elle soit pensée comme ordre social sans Etat, l'anarchie reste difficilement appréhendée par les juristes autrement que par l'exclusion. Droit et anarchie seraient incompatibles, car le droit impliquerait nécessairement l'autorité (dont l'Etat moderne constitue la forme ultime, par la monopolisation du pouvoir de contrainte) que l'anarchie supprime. Aussi, l'étude de l'anarchie n'aurait plus grand chose à révéler au juriste, et sa marginalisation intellectuelle ne devrait pas surprendre. Pourtant, est-il vraiment satisfaisant de (...) cantonner la question de l'anarchie à l'histoire des idées politiques, alors que l'enjeu du débat touche les fondements mêmes de l'ordre juridique? C'est cette question complexe des rapports entre le droit et l'anarchie que cet ouvrage - qui regroupe les actes d'une journée d'étude organisée par l'Institut d'études de droit public de la faculté jean Monnet de l'Université Paris Sud - se propose d'investir à nouveau. (shrink)

Les deux dernières décennies ont été marquées dans les pays occidentaux par d’importants changements culturels dans les domaines de la sexualité et de la parenté. En France, les évolutions législatives telles que le vote du pacte civil de solidarité (pacs) en 1999 et l’ouverture du mariage aux individus de même sexe en 2013, ainsi que les polémiques et les mouvements d’opposition qu’elles ont suscités, témoignent des profondes mutations à l’œuvre dans nos systèmes de parenté et nos modes de c...

This paper begins with a recognition that questions of climate change, environmental degradation, and our relations to the natural world are increasingly significant and requiring of a response not only as philosophers of education but also as citizens of the planet. As such the paper explores five of the key journals in philosophy of education in order to identify the extent, range, and content of current discussions related to the environment. It then organizes and summaries the articles that were located (...) while seeking to identify the extent, possibilities, and limitations of current discussions relating to the environment in the philosophy of education community. The hope is that ultimately this work is an invitation to anyone, regardless of tradition, orientation, and expertise, to contribute to the expansion and deepening of both theory and practice in the face of this most serious of challenges. (shrink)

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of (...) enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.All human agents, whether they have a... (shrink)

Religious-secular distinctions have been crucial to the way in which modern governments have rationalised their governance and marked out their sovereignty – as crucial as the territorial boundaries that they have drawn around nations. The authors of this volume provide a multi-dimensional picture of how the category of religion has served the ends of modern government. They draw on perspectives from history, anthropology, moral philosophy, theology and religious studies, as well as empirical analysis of India, Japan, Mexico, the United States, (...) Israel-Palestine, France and the United Kingdom. (shrink)

In this short note we prove that a definable set X over is superstable only if.

The system of free expression John Milton defends in Areopagitica, a pamphlet against prior restraint in publishing, is often characterized as merely a proto-liberal, truth-based marketplace of ideas theory. But this represents a misunderstanding of Milton’s views on the freedoms of conscience, speech, and the press. The tendency in political theory, philosophy, and law to reduce the “free speech Milton” to Areopagitica, and the reduction of that essay to several soundbites, has meant sidelining both the significant exceptions to expressive liberties (...) that Milton calls for and also the role of the social in his theory. This incomplete characterization has enabled Milton’s misuse in First Amendment discourse and jurisprudence, where he is made to support hierarchical approaches to free speech that privilege public political speech and are therefore ill-equipped to address the full range of communicative experiences. More comprehensive readings of Milton, however, reveal both certain limits to free expression, and also deep consideration for a wide range of speech acts. By reading Milton’s theory of expressive liberties in light of the justifications he provides for those freedoms—i.e., virtue-building and Truth-seeking—this essay provides a fuller account of his views. What emerges is a distinctly Miltonian, virtue-driven “political theory of everyday talk” that locates value in even the most ordinary communicative acts. This theory—embracing both verbal and nonverbal expression—not only complements existing political theories of the everyday but can also help illuminate contemporary free speech concerns, many of which stem from the libertarian approach to expressive liberties that Milton helped inspire. (shrink)

Arts and Humanities in Higher Education, Ahead of Print. Despite the growing interest of academia in public outreach, little is known about what university students, among who are future researchers, take away from their academic education in terms of research dissemination opportunities. In this study, we analyzed social science students’ discourses on creative dissemination practices in relation to standardized dissemination practices. Our findings reveal that student’s conceptions of creative research dissemination are diverse and influenced by varying perceptions of knowledge, the (...) public, and creativity. Discourses on CRD are also strongly linked with values such as innovation and impact on society, but the concrete meaning of these values often remains undefined. We propose rethinking the academic context at the educational level so it offers a platform for multimodal formats of research dissemination. This would require encouraging students to take a stance toward how they envision a progressive academic future. (shrink)

Many disabled individuals adamantly oppose medical assistance in dying, quite rightly referencing pervasive ableism and, euthanasia’s dark history in the Aktion T4 program of Nazi Germany in which...