On the traditional view, moral distress arises only in cases where an individual believes she knows the morally right thing to do but fails to perform that action due to various constraints. We seek to motivate a broader understanding of moral distress. We begin by presenting six types of distress that fall outside the bounds of the traditional definition and explaining why they should be recognized as forms of moral distress. We then propose and defend a new and more expansive (...) definition of moral distress and examine how it can enable the development of a taxonomy of moral distress. (shrink)

It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...) make simple generalizations about disability's relationship to well-being in other important senses. After defending this view, we discuss its practical implications for selective abortion for disability, nondisabled people's interactions with disabled people, and the use of QALYs in health policy. (shrink)

It is widely recognized that lives and activities can be meaningful or meaningless, but few have appreciated that they can also be anti-meaningful. Anti-meaning is the polar opposite of meaning. Our purpose in this essay is to examine the nature and importance of this new and unfamiliar topic. In the first part, we sketch four theories of anti-meaning that correspond to leading theories of meaning. In the second part, we argue that anti-meaning has significance not only for our attempts to (...) theorize about meaning in life, but also for our ability to lead meaningful lives in the modern world. (shrink)

The so-called Disability Paradox arises from the apparent tension between the popular view that disability leads to low well-being and the relatively high life-satisfaction reports of disabled people. Our aim in this essay is to make some progress toward dissolving this alleged paradox by exploring the relationship between disability and various “goods of life”—that is, components of a life that typically make a person’s life go better for her. We focus on four widely recognized goods of life (happiness, rewarding relationships, (...) knowledge, achievement) and four common types of disability (sensory, mobility, intellectual, and social) and systematically examine the extent to which the four disability types are in principle compatible with obtaining the four goods of life. Our findings suggest that that there is a high degree of compatibility. This undermines the widespread view that disabilities, by their very nature, substantially limit a person’s ability to access the goods of life, and it provides some guidance on how to dissolve the Disability Paradox. (shrink)

Disability and enhancement are often treated as opposing concepts. To become disabled in some respect is to move away from those who are enhanced in that same respect; to become enhanced is to move away from the corresponding state of disability. This chapter examines how best to understand the concepts of disability and enhancement in this symmetrical way. After considering various candidates, two types of accounts are identified as the most promising: welfarist accounts and typical-functioning accounts. The authors ultimately defend (...) a complex typical-functioning account as the best way to achieve a symmetrical understanding of disability and enhancement. (shrink)

It seems better to have a life that begins poorly and ends well than a life that begins well and ends poorly. One possible explanation is that the very shape of a life can be good or bad for us. If so, this raises a tough question: when can the shape of our lives be good or bad for us? In this essay, I present and critique an argument that the shape of a life is a non-synchronic prudential value—that is, (...) something that can be good or bad for us in a way that is not good or bad for us at any particular time. After distinguishing two interpretations of ‘the shape of a life’, I argue that the first type of shape can be good or bad for us at particular moments while the other cannot be good or bad for us at all. This suggests that the shape of a life gives us no reason to posit non-synchronic prudential values. (shrink)

It is commonly thought that disability is a harm or “bad difference” because having a disability restricts valuable options in life. In his recent essay “Disability, Options and Well-Being,” Thomas Crawley offers a novel defense of this style of reasoning and argues that we and like-minded critics of this brand of argument are guilty of an inconsistency. Our aim in this article is to explain why our view avoids inconsistency, to challenge Crawley's positive defense of the Options Argument, and to (...) suggest that this general line of reasoning employs a double standard. (shrink)

This essay introduces and defends a new analysis of prudential value. According to this analysis, what it is for something to be good for you is for that thing to contribute to the appeal or desirability of being in your position. I argue that this proposal fits well with our ways of talking about prudential value and well-being; enables promising analyses of the related concepts of luck, selfishness, self-sacrifice, and paternalism; preserves the relationship between prudential value and the attitudes of (...) concern, love, pity, and envy; and satisfies various other desiderata. I also highlight two ways in which the analysis is informative and can lead to progress in our substantive theorizing about the good life. (shrink)

What is it for something to be good for you? It is for that thing to contribute to the appeal of being in your position or, more informally, “in your shoes.” To be in one’s position or shoes in the broadest possible sense is to have that person’s life. Accordingly, something is good or bad for a person in the broadest possible sense if and only if it contributes to or detracts from the appeal of having her life. What, then, (...) is a prudentially good life, or a life that goes well for the one living it? It is an appealing life. More precisely, it is a life such that having it is worthy of appeal, in and of itself. This dissertation is a defense and exploration of this way of understanding prudential value. I call it the "appealing life analysis." In Chapter I, I argue that this analysis fits well with our ways of talking about prudential value; preserves the relationship between prudential value and the attitudes of concern, love, pity, and envy; yields promising analyses of the concepts of well-being, luck, selfishness, self-sacrifice, and paternalism; and succeeds where three rival analyses fail. I also examine how this analysis bears on the relationship between prudence and morality and the debate between subjectivists and objectivists about prudential value. Chapter II draws upon the appealing life analysis to interpret a long-standing puzzle about prudential value and time. I highlight various ways in which this interpretation is informative and moves us closer to a solution to the puzzle. Chapter III provides a preliminary investigation and defense of an ethical theory that I call "prudentialism," which prescribes maximizing the appeal of having one’s own life. On certain conceptions of the appealing life, this theory has the virtue of avoiding the charge of being either too morally demanding or not morally demanding enough. I examine the structure of this theory, sketch a partial, substantive account of the appealing life, and discuss how the prudentialist can respond to various objections. (shrink)

abstract R. M. Hare claims that we have duties to take the preferences of possible people into consideration in moral thinking and that it can harm a merely possible person to have been denied existence. This essay has three parts. First, I attempt to show how Hare's universalizability argument for our obligations to possible people may fail to challenge the consistent proponent of the actuality restriction on moral consideration, regardless of whether this proponent is construed as an amoralist or a (...) fanatic. Second, I raise some objections to Hare's claim that a merely possible person can be harmed. Even if Hare could successfully overcome the objection that a possible person cannot be the recipient of harm, he would still need to show that this harm is morally significant. Third, whether or not Hare is able to answer these objections, I indicate how his moral theory still supports his general position on possible people — namely, that we are ceteris paribus morally bound to bring happy people (and avoid bringing miserable people) into existence. (shrink)

The philosophical literature on well-being and the good life contains very little explicit discussion of what makes for a better or worse death. The purpose of this essay is to highlight some commonly held views about the good death and investigate whether these views are recognized by the leading theories of well-being. While the most widely discussed theories do have implications about what constitutes a good death, they seem unable to fully accommodate these popular good death views. I offer two (...) partial explanations for why these views have been neglected in discussions of well-being and make two corresponding recommendations for future work in the philosophy of well-being. (shrink)

It may seem obvious that causing disability in another person is morally problematic in a way that removing or preventing a disability is not. This suggests that there is a moral asymmetry between causing disability and causing non-disability. This chapter investigates whether there are any differences between these two types of actions that might explain the existence of a general moral asymmetry. After setting aside the possibility that having a disability is almost always bad or harmful for a person (a (...) view that we have critiqued at length elsewhere), seven putative differences are considered. Ultimately, it is concluded that none of these seven factors can ground a general moral asymmetry between causing disability and causing non-disability, though each factor can provide some moral reason to avoid causing disability in certain particular cases. (shrink)

With increased frequency, reproductive technologies are placing prospective parents in the position of choosing whether to bring a disabled child into the world. The most well-known objection to the act of “selecting against disability” is known as the Expressivist Argument. The argument claims that such acts express a negative or disrespectful message about disabled people and that one has a moral reason to avoid sending such messages. We have two primary aims in this essay. The first is to critically examine (...) the standard Expressivist Argument, which we analyze in terms of the expression of ableist attitudes. We distinguish three interpretations of the argument and argue that each version faces serious objections. Our second aim is to articulate two closely related arguments that also pertain to expressed ableist attitudes. The Expressive Harms Argument maintains that there is a moral reason to avoid actions that give rise to the perception of ableist attitudes in cases where this is likely to have negative consequences for disabled people. The Ableist Motivation Argument speaks against selecting against disability in cases where one would be motivated by ableist attitudes. While these two arguments face various objections, we seek to establish that they are more promising than the most natural interpretations of the Expressivist Argument. (shrink)

A Treatise of Human Nature opens with ambitious hopes for the science of man, but Hume eventually launches into a series of skeptical arguments that culminates in a report of radical skeptical despair. This essay is a preliminary exploration of how to interpret this surprising development. I first distinguish two kinds of surprise twist: those that are incompatible with some preceding portion of the work, and those that are not. This suggests two corresponding pictures of Hume. On one picture, he (...) believed the skeptical development to be at odds with something in early Treatise; on the other, he took these two portions of Book 1 to be perfectly compatible. After defending the claim that Hume endorsed both of these portions, I sketch two promising interpretations—a “perspectivist,” incompatibilist interpretation and a “post-skeptical,” compatibilist interpretation—and offer some reasons to favor the latter view. (shrink)

Hübner and White argue that we should not administer DBS to psychopathic prisoners. While we are sympathetic to their conclusion, we argue that the authors’ two central arguments for this conclusion are problematic. Their first argument appeals to an overly restrictive conception of individual medical benefit: namely, that an individual medical benefit must alleviate subjective suffering. We highlight cases that clearly constitute individual medical benefits although there is no relief of subjective suffering. The second argument depends on an overly restrictive (...) conception of the sort of motivation needed to ground consent to a medical procedure. It is also too quick to treat it as unproblematic to consider psychopaths as fully competent. We argue that this view overlooks certain kinds of internal motivation. It also overlooks the possibility that after successful activation of underactive brain-regions, a former psychopath might become a better representative of his or her “true self.” -/- . (shrink)

"I say that the strongest principle of growth lies in human choice."Reduced to its most basic task, bioethics is about choices. What is the ethical or unethical decision at a particular biomedical moment? What is most just or unjust for a disabled or infirmed loved one? What feels like the morally right or wrong decision in a healthcare moment? "Should we or shouldn't we" at a medical impasse?Understandably, the question of choice has found an especially prominent and ethically contentious place (...) in disability discourses. Are disabled lives, disabled identities, and disabled bodies themselves best understood as "chosen"? As terminological variations on this theme, disability scholar Simi Linton has asked in the past... (shrink)

Iddo Landau understands a meaningful life as a life containing a sufficient number of sufficiently valuable aspects. Do the world's and the human condition's imperfections threaten meaning, thus understood? Landau argues that we can have a sufficient number of sufficiently valuable parts of our lives, even if the world is imperfect and the human condition involves various different imperfections. In this review, we offer some constructive criticisms of Landau's discussion, and we also highlight some of the virtues of his book.

The Ethics of Human Enhancement: Understanding the Debate has two chief aims. These aims are to help readers understand the existing debate and to move the debate forward. The book consists of an introductory chapter by Alberto Giubilini and Sagar Sanyal (which lays out some prominent bioconservative objections to enhancement), eight essays grouped under the theme of "Understanding the Debate" (Section I), and eight devoted to "Advancing the Debate" (Section II). In this review, we offer brief summaries of each essay (...) and ask whether the book successfully advances the debate. (shrink)

Multiteam systems are complex organizational forms comprising interdependent teams that work towards their own proximal goals within and across teams to also accomplish a shared superordinate goal. MTSs operate within high-stakes, dangerous contexts with high consequences for suboptimal performance. We answer calls for nuanced exploration and cross-context comparison of MTSs “in the wild” by leveraging the MTS action sub-phase behavioral taxonomy to determine where and how MTS failures occur. To our knowledge, this is the first study to also examine how (...) key MTS attributes influence MTS processes and performance. We conducted historiometric analysis on 40 cases of failed MTS performance across various contexts to uncover patterns of within- and between-team behaviors of failing MTSs, resulting in four themes. First, component teams of failing MTSs over-engaged in within-team alignment behaviors by enacting acting, monitoring, and recalibrating behaviors more often within than between teams. Second, failing MTSs over-focused on acting behaviors and tended to not fully enact the action sub-phase cycle. Third and fourth, boundary status and goal type exacerbated these behavioral patterns, as external and physical MTSs were less likely to enact sufficient between-team behaviors or fully enact the action sub-phase cycle compared to internal and intellectual MTSs. We propose entrainment as a mechanism for facilitating MTS performance wherein specific, cyclical behavioral patterns enacted by teams align to facilitate goal achievement via three multilevel behavioral cycles. We argue that the degree to which these cycles are aligned both between teams and with the overarching MTS goal determines whether and how an MTS fails. Our findings add nuance beyond single-context MTS studies by showing that the identified behavioral patterns hold both across contexts and almost all types of MTS action-phase behaviors. We show that these patterns vary by MTS boundary status and goal type. Our findings inform MTS training best practices, which should be structured to integrate all component teams and tailored to both MTS attributes and situation type. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

While rooted in careful study of Mead’s original writings and transcribed lectures and the historical context in which that work was carried out, the papers in this volume have brought Mead’s work to bear on contemporary issues in metaphysics, epistemology, cognitive science, and social and political philosophy.

Background 300 million operations and procedures are performed annually across the world, all of which require a patient’s informed consent. No standardised measure of the consent process exists in current clinical practice. We aimed to define a core outcome set for informed consent for therapy. Methods The core outcome set was developed in accordance with a predefined research protocol and the Core OutcoMes in Effectiveness Trials methodology comprising systematic review, qualitative semi structured interviews, a modified Delphi process and consensus webinars (...) to ratify outcomes for inclusion in the final core outcome set.. Participants from all key stakeholder groups took part in the process, including patients and the public, healthcare practitioners and consent researchers. Results 36 outcome domains were synthesised through systematic review and organised into a consent taxonomy. 41 semi-structured interviews were performed with all consent stakeholders groups. 164 participants from all stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed Round 2. 11 outcomes met the ‘consensus in’ criteria. 6 met ‘consensus in’ all stakeholder groups and were included directly in the final core outcome set. 5 remaining outcomes meeting ‘consensus in’ were ratified over two consensus webinars. 9 core outcomes were included in the final core outcome set: Satisfaction with the quality and amount of information, Patient feeling that there was a choice, Patient feeling that the decision to consent was their own, Confidence in the decision made, Satisfaction with communication, Trust in the clinician, Patient satisfaction with the consent process, Patient rated adequacy of time and opportunity to ask questions. Conclusion This international mixed-methods qualitative study is the first of its kind to define a core outcome set for informed consent for intervention. It defines what outcomes are of importance to key stakeholders in the consent process and is a forward step towards standardising future consent research. (shrink)

The Unfinished Revolution compares the post-Second World War histories of the American and British gay and lesbian movements with an eye toward understanding how distinct political institutional environments affect the development, strategies, goals, and outcomes of a social movement. Stephen M. Engel utilizes an electic mix of source materials ranging from the theories of Mancur Olson and Michel Foucault to Supreme Court rulings and film and television dialogue. The two case study chapters function as brief historical sketches to elucidate (...) further the conclusions on theory and whilst being politically-oriented, they also examine gay influence and expansion into mainstream popular culture. The book also includes an appendix that surveys and assesses the analytical potential of five critical understandings of social movements: the classical approach, rational choice, resource mobilization, new social movement theories, and political opportunity structures. It will be of value to academics and students of sociology, political science, and history. (shrink)

This long-awaited work by prominent Harvard psychologist Stephen Kosslyn integrates a twenty-year research program on the nature of high-level vision and mental ...

Climate change is a global problem that is predominantly an intergenerational conflict, and which takes place in a setting where our ethical impulses are weak. This "perfect moral storm" poses a profound challenge to humanity. This book explains how the "perfect storm" metaphor makes sense of our current malaise, and why a better ethics can help see our way out.

What might a theory of mental imagery look like, and how might one begin formulating such a theory? These are the central questions addressed in the present paper. The first section outlines the general research direction taken here and provides an overview of the empirical foundations of our theory of image representation and processing. Four issues are considered in succession, and the relevant results of experiments are presented and discussed. The second section begins with a discussion of the proper form (...) for a cognitive theory, and the distinction between a theory and a model is developed. Following this, the present theory and computer simulation model are introduced. This theory specifies the nature of the internal representations (data structures) and the processes that operate on them when one generates, inspects, or transforms mental images. In the third, concluding, section we consider three very different kinds of objections to the present research program, one hinging on the possibility of experimental artifacts in the data, and the others turning on metatheoretical commitments about the form of a cognitive theory. Finally, we discuss how one ought best to evaluate theories and models of the sort developed here. (shrink)

I critically examine the semantic view of theories to reveal the following results. First, models in science are not the same as models in mathematics, as holders of the semantic view claim. Second, when several examples of the semantic approach are examined in detail no common thread is found between them, except their close attention to the details of model building in each particular science. These results lead me to propose a deflationary semantic view, which is simply that model construction (...) is an important component of theorizing in science. This deflationary view is consistent with a naturalized approach to the philosophy of science. (shrink)

Very few moral philosophers have written on climate change.1 This is puzzling, for several reasons. First, many politicians and policy makers claim that climate change is not only the most serious environmental problem currently facing the world, but also one of the most important international problems per se.2 Second, many of those working in other disciplines describe climate change as fundamentally an ethical issue.3.

This paper describes an operational computer simulation of visual mental imagery in humans. The structure of the simulation was motivated by results of experiments on how people represent information in, and access information from, visual images. The simulation includes a “surface representation,” which is spatial and quasi‐pictorial, and an underlying “deep representation,” which contains “perceptual” information encoding appearance plus “propositional” information describing facts about an object. The simulation embodies a theory of how surface images are generated from deep representations, and (...) how surface images are processed when one accesses information embedded in them. The simulation also offers an account of various sorts of imagery transformations. (shrink)

This collection gathers a set of central papers from the emerging area of ethics and climate change.

The peculiar features of the climate change problem pose substantial obstacles to our ability to make the hard choices necessary to address it. Climate change involves the convergence of a set of global, intergenerational and theoretical problems. This convergence justifies calling it a 'perfect moral storm'. One consequence of this storm is that, even if the other difficult ethical questions surrounding climate change could be answered, we might still find it difficult to act. For the storm makes us extremely vulnerable (...) to moral corruption. (shrink)